تجویز دارو

One of the most important change role in the nursing profession is the development of nurse prescribing. In the implementation of nurse prescribing, it seems necessary to recognize the existing challenges.

In this review, Persian and English articles were researched in the years of 1998-2023 using the keywords include "nursing prescription", "drug prescription", "independent prescribing" and "supplemental prescribing". The research was done in online databases including Science direct,PubMed, Web of Science, Google scholar and Persian databases including Mag Iran and Jahad Daneshgahi. The inclusion criteria were articles that only focus on the drug prescription in nursing and were related to the objectives of the study. Exclusion criteria included articles whose full text was not available or were presented in the form of a poster, speech and letter to the editor. Also, the validity of the selected articles has been qualitatively evaluated by the authors in terms of originality,credibility and the publishing journal.

58 selected studies showed the advantages, disadvantages, obstacles and facilitating factors of nursing prescription from the point of view of nurses and doctors in Iran and other countries. One of the major challenges is the lack of appropriate policies in this field, the lack of necessary infrastructure, the critical view of the health care team, the lack of issuing legal licenses, and the unwillingness of some nursing.

Considering the benefits and advantages of nurse prescribing, it is suggested that policy makers and nursing managers provide the conditions for the implementation of nurse prescribing in Iran with planning for existing challenges, including legal licenses, holding specialized pharmacology courses for nurses and encourage nurses to accept this responsibility.

Nurse prescription is a relatively new and developing subject, with many critics and advocates worldwide. However, it is expanding rapidly and is being implemented in many countries. In Iran, nurses are not allowed to prescribe. No significant action has been taken in this regard. In Iran, nurse prescribing requires preparing the ground and providing the necessary conditions. The current study aimed to examine nurse prescribing worldwide and its possible challenges in Iran.This study is a narrative review of the English and Persian articles published in 2022 on nurse prescription in Iran and worldwide. We collected data by searching the international databases of PubMed, Science Direct, and Scopus, and the local databases of SID, Magiran, and Iran Medex for the keywords “nurse prescribing”, “nurse prescription”, “prescribing factors”, “prescribing effect”, “prescribing facilitation”, “prescribing barriers”, “prescribing benefits”, “prescriptions”, “medication and nursing”, “independent nurse prescribing”, “supplementary nurse prescribing”, “independent prescribing”, “nurse prescriber”, “prescribing”, and the possible combinations. We retrieved all related articles published between 2010 and the end of 2022.A total of 32 case studies were reviewed in this study. The results showed that nurse prescribing occurs globally in one of three forms: independent, supplementary, and patient group protocols. In Iran, nurse prescribing is prohibited, necessitating social support and assistance in policy-making, planning, and nursing education.Due to the unprepared environment in Iran, it is vital to provide assistance for prescribing. Numerous factors play a role in implementing nurse prescribing in Iran, so it is necessary to use the successful experience of countries that have been pioneers in this domain. It is suggested that health officials and those engaged take steps to teach prescribing nurses at the postgraduate and doctoral levels, or create a new discipline of nurse prescription.

Expenditure in the health sector requires appropriate resources management. This study was conducted to determine the amount of moral hazards associated with the service providers in the medication prescriptions paid by an insurance organization.

Study population included paid pharmaceutical documents in Tehran province in 2019. 2000 prescriptions for 500 insured people were randomly selected from the database of the organization. Two indicators (the number of suspicious prescriptions based on the incompatibility of a drug with the history of the disease or the drug spectrum of an insured and the number of prescriptions with a financial burden higher than the average usual burden of a normal patient) were matched with transcript data and analyzed with SPSS version 24. An experienced pharmacist was consulted to examine the drug spectrum of all prescriptions.

5.4% of total prescriptions were incompatible drugs and 6.4% had created extra financial burden. The highest incidence of risks by speciality was related to general practitioners (16 % with a surplus financial burden of 87/500/000 Rials). The highest number and amount of risks in Rials per insured group was related to supervisors (63 % with a surplus financial burden of 26/000/000 Rials). The risk in the military centres’ prescriptions were more than private and governmental centres and it was relatively equal in contracted (48%) and non-contracted (52%) centres.

The abuse in the health service provision is a high risk for  health care managers  in countries that have health insurance programs which their intelligent tracking reduces many of the insurers’ costs and prevent the shortage of vital medicines.

The rational prescription of the drug and consideration of its principles affect the treatment outcome. Regarding this, the purpose of this study was to evaluate prescriptions to check if they follow the given principles and investigate the prescribed medications by dentists.

This descriptive-analytical, cross-sectional, and retrospective study was conducted on 238 prescriptions administered by general dentists in Qom, Iran, during the second semester of 2018-2019 academic year in the form of social security and medical services insurance in the RUD Committee of Qom University of Medical Sciences, Qom. The data evaluated in this study included patient age and gender, prescribed medications and their forms, medication category, route of administration, and prescription errors.

Oral, injectable, and topical drugs were prescribed at the frequencies of 97.5%, 34.5%, and 5%, respectively. Furthermore, antibiotics, painkillers, corticosteroids, mouthwash, and other medications were prescribed in 97.6%, 85.7%, 8.4%, 3.8%, and 2% of the prescriptions, respectively. With regard to the prescription problems, 40.3%, 4.2%, 39.5%, 14.3%, 16.4%, and 57.1% of the prescriptions had no drug dose, wrong drug dose, no drug consumption order, wrong drug consumption order, wrong form of medication, and incomplete drug name, respectively. Furthermore, 3.4% of the prescriptions had misspellings, 5.5% of them were eligible. However, none of the prescriptions had problems related to drug interaction or the lack of seal, signature, and date.

In the present study, the error rate of writing prescriptions and administration of antibiotics and analgesics was higher than the figure recommended by the World Health Organization.

The main part of drug industry marketing activities focuses on physicians as drug prescribers, which is usually conducted by Pharmaceutical Sales Representatives (PSR) who visit the physicians. The aim of this study was development and validation of a tool for Direct-to-Physician (DTP) pharmaceutical marketing survey.

In the first phase of this study, the first version of a questionnaire was developed by reviewing the related literature. Then, face and content validities of the designed questionnaire were confirmed by a panel of experts. In the next step, Convenience Sampling method was applied and the questionnaire was distributed between 297 General Practitioners and Specialists. The Cronbach’s Alpha was conducted to confirm the validity of the questionnaire and the exploratory factor analysis for derive components of physicians' attitude toward pharmaceutical sales representatives. Data analysis was performed using SPSS 22.

The questionnaire had 2 parts; the demographic information and Direct-to-Physician pharmaceutical marketing survey, which included 11 dimensions. The first dimension studied the frequency of PSRs' visits with physicians. The second dimension dealt with the prevalence of each recommended gifts and benefits offered by PSRs. The third dimension reviewed the strategies used by PSRs. The fourth and fifth dimensions investigated the acceptance of gifts by physicians and their colleagues. The sixth and seventh dimensions surveyed the physicians’ viewpoints about the effect of PSRs' visits and their gifts on prescribing behavior. The eighth dimension was about the effective factors on the efficiency of PSRs' visits. The last three dimensions considered the ethical viewpoints of physicians about gifts and benefits recommended by PSRs. The physicians' attitudes toward PSRs were also studied in this section. Moreover, the physicians' awareness about the domestic guidelines with regard to DTP pharmaceutical marketing was surveyed. As a result of the content validation process, 7 items were removed from the attitude section. The Cronbach’s Alpha score for the attitude and awareness sections were 0.72 and 0.83, respectively. In the attitude dimension, 5 components were determined using the exploratory factor analysis.

The developed questionnaire is a valid tool to investigate DTP pharmaceutical marketing and can be used by other researchers.