Dispensing Dates And Quantity

It is well recognised that a proportion of prescriptions given to patients is not submitted for dispensing. Records of dispensing are therefore a more reliable indicator of drug use than prescriptions, although uncertainty remains as to the compliance of patients in using the medicines dispensed. With the continuous records of dispensings in the IMMP, patients who have ceased therapy can be identified when prescription records stop being received. The prescriber is then sent a questionnaire asking the reason for cessation. This provides important information, which is discussed below.

The monitoring of omeprazole demonstrated another use of continuous recording of prescriptions. Some patients had relatively short courses and others remained on treatment long term. In understanding the use of the drug it was useful to be able to identify how many courses of treatment patients were having and how long these were. Patients who had been on continuous therapy for a year or longer were followed up annually for evidence of the development of reactions of long latency. This questionnaire included questions about endoscopic examinations of the upper gastrointestinal tract and any evidence of the development of malignancy or carcinoid tumours.

These have been considered as a potential risk of prolonged reduction of gastric acid. This long-term follow-up is as yet incomplete, but benign, multiple, gastric polyps have been identified in two patients. This problem has been attributed by others as a reaction to prolonged achlorhydria with omeprazole (Graham, 1992; Schenk et al., 1997).

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