Extemporaneous Prescribing: Whatever Happened to It? A Survey of Australian General Practitioners

Abstract

Objectives: Recent Australian and New Zealand studies have shown that dispensing of extemporaneous products by pharmacists has declined over recent years to only 1 to 2% of total prescriptions. The purpose of this study was to survey general practitioners (GPs) to identify the scope of extemporaneous prescribing, reasons for any limitations to such prescribing and their interest in further education. Method: A mail survey comprising eighteen questions was distributed by eleven Divisions of General Practice from five Australian States to 1138 GPs. Results: 318 replies were received which equated to aresponse rate of 28%. 52% of respondents were male with 87% from inner city/suburban practices. The primary source of instruction in extemporaneous prescribing was either experience (48%) or medical school (25%), and the majority (68%) either never or rarely prescribed extemporaneous preparations. The main reasons given were lack of product knowledge (78%) and items not being listed on the Pharmaceutical Benefits Scheme (29% ). When extemporaneous products were prescribed, the most common were topical (31% often or very often) and eye/ear/nose (16% often or very often). Despite the overall low level of extemporaneous prescribing, there was considerable interest (94% overall) in accessing information on these products with at least two-thirds of respondents considering that the Internet would be a useful or very useful medium for accessing appropriate information. Conclusion: Although extemporaneous products are no longer commonly prescribed, the majority of GPs surveyed do not see these products as 'a thing of the past', and expressed a desire to learn more. There may be an opportunity for the medical and pharmaceutical professions to collaborate in maintaining this traditional area of practice.

Extemporaneous Compounding Practice by Pharmacists: A Systematic Review

“…Five studies used a questionnaire to identify the current practice of compounding [7,[11][12][13][14], with various way of delivering questionnaire include self-administered, face to face interviews [13], or mailed questionnaire. Richey used a combination of questionnaire and direct observation and compared the results of data [11].…”

“…Richey et al [11], Pappas et al [12] and Lindbald et al [16] invited physicians served as a respondent for the source of information [11,12]. In regards with types of patient, four studies focusing compounding practice for paediatric patients in the clinics, hospital, and pharmacies [5,15,18] and rest studies used non-classified patients (both adults and children) [7,[12][13][14][16][17][18].…”

“…Zaid et al found that 1.55% of pharmacists provided compounding services based on prescriptions requested by doctor [13]. A study by Pappas found that only one-third of physician prescribed extemporaneous product [12]. According to McPherson's data, a prescription that required compounding represented less than 1% of total prescription [14].…”

“…The majority of studies found that dermatological product is the most frequent compounded products by pharmacists [12,16,18]. Burma et al observed that a huge share of dermatological dosage forms among compounded medicines (62.1%) was found [18].…”

“…Aspirin in the chloroform paint was compounded at five hospitals, the only lotion compounded was menthol 0.5% in DP lotion [15]. Compounding products in second rank frequency were an oral solution and oral suspension [12,18]and followed by ear-nose-throat (ENT) products [18] and tablet modification [11]. Richey et al study provided the details of tablet modification, that of the 40 tablet modification, 25 (62.5%) of the tablet were cut, 12 (30%) dispersed, one (2.5%) crushed, one (2.5%) was broken by hand [11].…”