Objective-To determine the rate of patients not redeeming their prescriptions (primary noncompliance) and assess the factors influencing this.Design Main outcome measures-The rate of nonredemption ofprescriptions.Results-Seven hundred and two patients (14X5%) did not redeem 1072 (5X20/) prescriptions during the study period, amounting to 11X5% of men and 16X3% of women. Non-redemption was highest in women aged [16][17][18][19][20][21][22][23][24][25][26][27][28][29] (27.6% of women) and men aged [40][41][42][43][44][45][46][47][48][49] (18.3% of men). Of prescriptions issued to women for oral contraceptives 24-8% were not redeemed during the study period. In those who redeemed prescriptions 17% were not exempt from prescription charges compared with 33% of patients who failed to redeem them. The non-redemption rate was highest for prescriptions issued at the weekends, although this was a small proportion of all prescribing. Prescriptions issued by trainee general practitioners were also less likely to be redeemed.Conclusions-Non-redemption varies with age, sex, general practitioner, exemption status, and with day ofthe week the prescription was written. Observational studies of drug exposure can be more accurately estimated from dispensing rather than prescribing data.

This study assesses the treatment attitudes and practices of general practitioners in the management of pain caused by cancer. The study consisted of two parts: (1) a questionnaire survey of 328 GPs (including trainees) in Tayside, Scotland and (2) an analysis using duplicate prescriptions of all opioid analgesic prescribing over a five-year period among the doctors in a primary health care centre (population 11500). In the questionnaire survey, 63% (206) of the GPs replied. Of these respondents, 80% were prepared to manage malignant pain on their own and 17% would refer 'frequently' to the local hospice. Only 19% of respondents work in collaboration with the pain clinic and, if so, the pain clinic undertakes most of the decisions made on pain management. Co-proxamol (paracetamol plus dextropropoxyphene hydrochloride preparation) was the preferred analgesic for mild to moderate pain due to cancer and controlled-release morphine sulphate was preferred for severe pain. Duplicate prescription monitoring showed that 24% (2722) of patients received one or more prescriptions for opioid analgesics over the study period. Forty-five per cent of the patients were prescribed co-proxamol. When morphine sulphate or diamorphine was prescribed (3% and 1 % of patients respectively), laxatives were frequently coprescribed (64% and 58% respectively), as were anti-emetics (57% and 32% respectively). This study therefore shows that most GPs manage pain caused by cancer without help from hospital specialists. This study also shows a degree of awareness concerning good prescribing practice in cancer pain. Cette étude évalue les conceptions et pratiques des médecins généralistes en ce qui concerne le traitement dans la gestion de la douleur d'origine cancereuse. L'étude se divise en deux parties: (1) un questionnaire envoyé & a g r a v e ; 328 généralistes (y compris stagiaires) dans le Tayside en Ecosse et (2) une analyse & a g r a v e ; I'aide des duplicata des ordonnances de toutes les prescriptions d'analgésiques opioïdes, sur une période de cinq ans, des médecins appartenant à un centre de soins généraux (population 11 500). 63% (soit 206) des généralistes ont répondu. Parmi ceux-ci, 80% étaient disposés & a g r a v e ; gérer la douleur d'origine cancereuse par leurs propres moyens et 17% préféreraient se référer "fréquemment" à I'hospice local. Seuls 19% travaillent en collaboration avec le service clinique de la douleur et, dans ce cas, la clinique se charge de la plupart des décisions en ce qui concerne la gestion de la douleur. Le Co-proxamol (une préparation de paracétamol additionné de chlorhydrate de dextropropoxyphène) était I'analgésique p r & e a c u t e ; f & e a c u t e ; r & e a c u t e ; pour le traitement d'une douleur d'origine cancéreuse faible & a g r a v e ; moyenn...

The objectives of this study were to assess the prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) by general practitioners and to determine their attitudes to problems caused by this class of drugs. The study consisted of two parts. The first was a questionnaire survey among general practitioners in Fife and Tayside, and the second was an analysis of NSAID prescribing over 12 months among the doctors in the Carnoustie Health Centre, using duplicate prescriptions. In the questionnaire survey 61% of the general practitioners responded. The three most preferred drugs were buprofen (56%), naproxen (20%) and mefenamic acid (7%); choice of drug was determined by efficacy and personal experience. Gastrointestinal side effects were most frequently encountered, although there was little consensus amongst respondents as to their management. The duplicate prescription study showed that 14% of patients (1607 individuals) received at least one NSAID prescription in the year of study Ibuprofen (31%), naproxen (20%) and piroxicam (15%) were most frequently prescribed and up to 16% of the patients were co-prescribed a gastroprotective agent; ranitidine (75%) was the most commonly prescribed. Despite the introduction of newere NSAIDs, ibuprofen and naproxen are still the most commonly prescribed drugs. Furthermore, although gastrointestinal side effects are commonly encountered, there is some uncertainty about their management.

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