News Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 Rand Study Answers Some Questions about the Effects of drug therapy are much affected hy receiving a PPI. Most PPis respondents elected to take the drug once they had pur­ chased it; only a few seem to have chrmged their decision as Patient package inserts (PPIs) fared well in an FDA-spon a result of the information they received. sored study of alternative designs by the Rand Corporation. The 5. The costs of returned prescriptions are likely to be quite low. Previous estimates of the annual cost of returned pre­ study showed that patients read and understand PPIs, do not scriptions that will result from FDA's proposed labeling report more side effects as a result of reading PPIs, and can ' program have been as high as $87.75 million—a figure based handle fairly lengthy and complex PPIs. on the assumption that for every 60 new prescriptions, PPIs will cause one additional prescription to he returned. These The Rand study was conducted from autumn 1979 through results indicate that this estimate is several orders of mag­ spring 1980 at 69 pharmacies in Los Angeles County, CA. Al­ nitude too high. During the course of the study, only three ternative PPIs were studied for three drugs: erythromycin, prescriptions were returned to pharmacies for cash refunds, conjugated estrogens, and flurazepam. Six variables of PPIs out of more than 2000 prescriptions dispensed with PPIs. Even if pharmacies were to pass on the full costsof returned were included: specificity of instructions, amount of explanation, pr^riptions to the consiuner, the resulting increases in drug writing style, risk emphasis, format, and reduced content prices would he extremely small. (length). Patients having prescriptions for one of the study drugs 6. PPIs do not, in general, lead patients to report more side effects. PPI critics have contended that warning patients at the 69 pharmacies were informed of the study by the phar­ about side effects will cause them to experience those effects macist, and 1821 patients participated. Each subject was as­ through suggestion. However, the researchers found no signed randomly to receive one of several versions of a PPI or difference in the number of side effects reported hy re­ spondents who received leaflets and those who did not, in­ to a control group (no PPI for erythromycin and flurazepam, dicating that the provision of side effect information does the manufacturer's PPI for estrogens). Outcomes were assessed not, by itself, cause patients to "imagine every symptom in by means of a telephone survey conducted an average of two to the leaflet." Some evidence indicated increased side effect reporting for certain kinds of leaflets, however. three weeks after the prescription was filled, and by means of 7. PPIs are unlikely to change the frequency with which pa­ a subsequent mail questionnaire. tients contact their physicians. Some critics have claimed Principal findings of the study, as summarized by the inves­ that.PPIs will substantially increase the number of times tigators, were: patients call physicians to seek further information or re­ assurance, thereby increasing the costsof health care. Others have .claimed that PPIs will encourage patients to bypass 1. PPIs are likely to be widely read. In this study, about 70% their physicians in favor of self-diagnosis, self-monitoring, of those who received PPIs reported having read them. and self-care. The researchers found no evidence that PPIs Among those using the drug for the first time, readership had any effect whatsoever on the number of times patients was still higher. For two of the three drugs, older people were contacted their physicians. For one of the threestudy drugs more likely than younger people to report having read the (ei^hromycin) PPIs may have altered the content of phy­ PPI. No evidence was found that PPIs are read only hy an sician-patient interactions. Patients who received PPIs were information-seeking elite; the less educated were just as more likely to report having discussed drug safety and side likely to read them as anyone else. effects with their physicians. 2. Many patients use PPIs as reference documents. Between 8. Patients find written drug information helpful. For all three ^ and 56% of those who received a PPI reported having kept study drugs, most respondents who received PPIs reported it, and between 22 and 32% reported having read it more that they found PPIs helpful in understanding the drug and than once. The fact that PPIs receive such use suggests a its effects. In addition, most respondents who were t^ing potential advantage over other methods of providing drug flura^pam or erythromycin also said that the PPI contained information that do not place the information in the hands new information, helped them to follow their doctor's orders, of the patient. and helped them to know when to take thedrug. For all three 3. PPIs lead to reliable gains in drug knowledge. Piyiiaomycin drugs, evaluations tended to be most favorable among the • patients who received PPIs were better able to answer groups that are ordinarily least responsive to consumer- questions about how the drug works and how to use it, and oriented information (e.g., less educated respondents and more likely to know that the drug is contraindicated for minorities). These results indicate that the appeal of PPIs patients with a history of liver problems. Flurazepam pa­ is not limited to the more sophisticated patients who make tients who received PPIs were more aware of possible drug up the "carriage trade." interactions and of the potential dangers of taking the drug 9. The amount of explanation provided in a PPI makes very durmg pregnancy or lactation. PPIs appear to he an effective little difference in how much information patients under- vehicle for getting more information to more people. 4. PPIs seem to haoe little effect on how patients use a drug. The researchers found no evidence that patients who re­ ceived a PPI were any more or less likely to comply with the prescribed regimen or (if the amount to he taken was left up to them) to alter their patterns of drug use. The results also provide no evidence that patients' initial decisions regarding Continued on page 1642 Vol 38 Nov 1981 American Journal of Hospital Pharmacy 1835 AccudorAdministration Sets Recision Gontrol with s; Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 Accudot is an extraordinary I.V. administration set." You can establish a precise drop rate by simply adjusting the flow metering knob. Once set, you will be amazed how. seldom you have to readjust flow. In fact, control provided by the Accudot administration set is so precise that you can often use it in place of an electronic controller.. We have eliminated roller clamps from the Accudot control mechanism. Gone are your problems associated with roller clamp/I.V. tubing creep and cold flow. - When enhanced precision of an electronic controller is needed, you can easily insert the Accudot set into IMED's 350 Controller. The result is precision electronic monitor­ ing and maintenance of an established drop rate. Accudot I.V. administration sets are available in a. variety of configurations and are key components of the IMED Infusion Management™ System. Ask your Infusion Management Specialist for tech­ nical information and a demonstration. IMP/ACC-lOSl Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 IMED 350 Controller MicroprDcessor technoloi^^ Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 Recision Gontiol of drop rate, safety andease-of-use. For ultimate precision in gravity flow fluid delivery, simply insert the Accudot set' into IMED's 350 Controller. The IMED 350 Controller continuously monitors your prescribed drop rate. Simply set desired rate and the 350 Controller will automatically adjust the Accudot set to reliably maintain flow. IMED's 350 Controller also senses most infiltrations, low flows, empty solution containers, and t ' 1 other factors that can affect flow conditions. , . When your patient needs to be moved without the 350 Controller, simply remove the Accudot set from the controller. The amazing Accudot administration set allows a pre-established drop rate to continue. n' • Piggybacking is simple. That's because the sanie microprocessor technology which ensures drop rate accu­ racy also allows two IMED 350 Controllers to work to­ gether. This gives you electronic Precision Control of both primary and secondary solutions. In addition to monitoring drop rates, the micro­ processor in IMED's 350 Controller monitors itself and diagnoses its own intemal problems should they occur. The IMED 350 Controller is a key component of th IMED Infusion Management"' System. Ask your Infusion Management Specialist for.teclw^/^ nical information and a demonstration. ^ ' IMP/350-1081 Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 IMED" \blumetric Runps Accusefcassette piuvidesVblun Downloaded from https://academic.oup.com/ajhp/article/38/11/1635/5200642 by guest on 28 September 2021 Delivery and safety. IMED's entire line of pumps gives you volumetric delivery using a piston and valve mechanism in the Accuset cassette. Only this unique IMED valvirtg system is designed to prevent uncontrolled flow frorp container to patient, thus providing an extra margin of safety — even if Accuset cassettes are removed from IMED pumips. IMED volumetric pumps are easy, very easy, to use. Just purge cassette, set rate, set volume to be infused and start! Once the volume has been delivered, IMED vol- ' umetric pumps automatically switch to a keep open rate.