Person: AKICI, AHMET
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AKICI
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AHMET
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Publication Metadata only Prescription audit adjunct to rational pharmacotherapy education improves prescribing skills of medical students(SPRINGER HEIDELBERG, 2005) AKICI, AHMET; Akici, A; Goren, MZ; Aypak, C; Terzioglu, B; Oktay, SObjective: To assess the impact of a rational pharmacotherapy (RP) teaching program during clinical pharmacology clerkship by analyzing the results of prescription audits (PAs) of the medical students. Collectively, we intended to observe the possible improvement of the students in their prescribing, problem solving and self-directed learning skills. Design: At the beginning and end of the clerkship, the students were presented with cases of uncomplicated osteoarthritis to assess their prescribing skills; format and rationality were scored. Setting: A medical school in Turkey that teaches RP to the fourth-year students in clinical pharmacology clerkship. Participants: There were 94 students of the 2002-2003 academic year in three groups and a single group of students belonging to the previous academic year tested. Of those students from the previous academic year, 26 were also analyzed a year later to demonstrate the long-term impact of the training. Main outcome measures: Prescribing skills of medical students and their opinions about PA. Results: Direct assessment via PA demonstrated that the scores for post-clerkship prescriptions were far better than those for pre-clerkship prescriptions in terms of format and rationality. Long-term assessment showed that the scores declined within a year following clerkship, but they were still higher than those of their pre-clerkship scripts. Analysis of the questionnaires revealed that the students were satisfied with PA. The majority of the students stated they had learned the general principles of RP and gained better prescribing skills, and they intended to apply most of the principles learned to their future professional lives. The script format scores of a retrospectively created PA-exempted group were significantly lower than those of the students to whom an established PA education was given. Conclusion: PA sessions were shown to be an easy and a useful method of both evaluating and reinforcing prescribing skills gained though problem-based RP education.Publication Metadata only Antihypertensive drug utilization at health centres in a district of Istanbul(SPRINGER, 2007) AKICI, AHMET; Akici, Ahmet; Kalaca, Sibel; Ugurlu, Uemit; Toklu, Hale Z.; Oktay, SuleObjective: Since irrational use of antihypertensives has considerable clinical and economical consequences, this study was conducted to evaluate antihypertensive drug utilization in hypertension at seven State Health Centres in Istanbul. Method: A total of 297 hypertensive patients who accepted to participate in the study were evaluated by a face-to-face questionnaire and a copy of their prescriptions were collected for prescription analysis. Results: Angiotensin-converting enzyme (ACE) inhibitors (31.7%), calcium channel blockers (28.8%), diuretics (16.2%), beta blockers (7.5%) and others (15.8%) have been prescribed. There were no statistically significant relation between prescribed antihypertensive drug groups and gender, age, and NSAIDs co-prescribing. The most frequent comorbidity in hypertensive patients was diabetes mellitus (10.4%) and calcium channel blockers (35.5%) have been prescribed to them as a first antihypertensive medication. Average cost per prescription was $42.7 +/- 38.1. According to the patients' self-reporting, the majority of them (85%) were prescribed without a physical examination. The physicians failed to write the prescriptions appropriately; only 5% of the scripts contained all information about the drug(s) and use instructions in full format. Conclusion: The present study indicates that GPs working at primary healthcare centres were rational in terms of antihypertensive drug choice. However, they poorly applied rational pharmacotherapy principles such as (a) writing a good prescription which is easily readable by the pharmacist and the patient and that contains full essential information; (b) a medical examination of the patient to assess her/his current clinical condition; and (c) taking care of not prescribing drugs with potential interaction like antihypertensives and NSAIDs together.Publication Open Access Assessment of antibiotic prescribing at different hospitals and primary health care facilities(ELSEVIER, 2013-07) AKICI, AHMET; Mollahaliloglu, Salih; Alkan, Ali; Donertas, Basak; Ozgulcu, Senay; Akici, AhmetIn this study, it was aimed to investigate the utilization of antibiotics at various health care facilities. Photocopies of 1250 prescriptions which were containing antibiotics and written out in primary health care facilities (PHCFs), public hospitals (PHs), private hospitals and university hospitals in 10 provinces across Turkey, were evaluated by some drug use indicators. The number of drugs per prescription was 3.23 +/- 0.92 and it was highest in PHCFs (3.34 +/- 0.84), (p < 0.05). The cost per prescription was 33.3 $, being highest in PHs while being lowest in PHCFs (38.6 $ and 28.2 $ respectively). Antibiotic cost per prescription was 16.7 $ and it was also highest and lowest in PHs and PHCFs respectively (p < 0.05). The most commonly prescribed group of antibiotics was beta-lactam antibacterials, penicillins (29.2%) while amoxicillin/clavulanic acid was the most commonly prescribed antibiotic (18.1%). Sixty-one percent of the antibiotics prescribed for acute infections was generics; among facilities being highest in PHCFs (66.5%) and among diagnosis being highest in acute pharyngitis. In general, the duration of antibiotic therapy was approximately 7 days for acute infections. Although much more drugs were prescribed in PHCFs than others, it was found to be in an inverse proportion with both the total cost of prescriptions and the cost of antibiotics. Broad-spectrum antibiotics, beta-lactamase combinations in particular, were considered to be more preferable in all health care facilities is also notable. These results do serve as a guide to achieve the rational use of antibiotics on the basis of health care facilities and indications. (C) 2012 King Saud University. Production and hosting by Elsevier B. V. All rights reserved.Publication Metadata only Aspects of physicians' attitudes towards the rational use of drugs at a training and research hospital: a survey study(SPRINGER HEIDELBERG, 2013) AKICI, AHMET; Basaran, Nesrin Filiz; Akici, AhmetThe rational use of drugs (RUD) is primarily the responsibility of physicians. The aim of this study was to investigate whether physicians are aware of RUD principles and how they apply them in daily medical practice. A total 136 physicians working at the Kartal Training and Research Hospital in Istanbul were enrolled in the study between February and March 2012. A face-to-face interview was conducted with physicians to assess their knowledge and attitude regarding RUD. A large majority of the physicians declared that consultation time was insufficient (84 %). The data obtained from the survey indicate that 54 % of the enrolled physicians monitored the therapeutic outcome and that 27 % found the information given to the patient to be sufficient. Participating physicians stated that the less known characteristics of the drugs they prescribed were drug interactions, traceability in market, and price. The most preferred reference source was Vademecum (a drug guideline prepared by the private sector). Two major factors contributing to prescribing patterns were self study and observation of teachers at clinical training. There was a significant difference between internists-surgeons and residents-specialists in the number of prescribed drugs per prescription (p < 0.001) and in the information provided to the patient on the prescribed drugs (name, effect, dose, instructions, possible side effect) (p < 0.05), respectively. Our findings overall show that the principles of RUD were not fully applied in daily medical practice by the participating physicians. One important reason for this is a heavy patient load, which requires a change in managerial practices within the healthcare system. The other, more essential explanation is education; consequently, serious consideration should be given to including effective clinical pharmacotherapy training and RUD courses in the medical education curriculum.Publication Open Access Comparison of pediatric antibiotic prescribing practice between low and high prescribers for children in primary care(2022-07-01) AKICI, AHMET; Kirmizi N. I. , Aydin V., Akici N., Atac O., AKICI A.Background. Antibiotic prescribing is more prevalent in children. Many factors influence this practice, including the burden of outpatient visits. We aimed to compare antibiotic prescribing for children by low prescribers (LP) and high prescribers (HP) in primary care.Methods. We analyzed pediatric prescriptions in primary care in Istanbul. Among the physicians randomly selected by systematic sampling, those generating >= 1 pediatric prescription/day (n=1218) were defined as LP or HP when they belonged to the lowest (n=305) or highest (n=304) quartile of prescribing, respectively. The antibiotic prescribing characteristics of these groups were compared.Results. We identified that 38.5% of the prescriptions written by physicians included antibiotics, significantly higher in HPs (38.8%) than in LPs (37.2%), (p=0.04). Among antibiotic-containing prescriptions, the mean number of drugs and boxes and the percentage of prescriptions containing injectable drugs/antibiotics were significantly higher in HPs compared to that in LPs. We detected that co-amoxiclav was the most frequently prescribed antibiotic in the LP and HP groups (61.1% and 48.3%, respectively). Stratification of antibiotics by their spectra showed that 11.2% were narrow, 79.8% were broad and 0.5% were ultra-broad-spectrum drugs. LPs were significantly more likely to prescribe broad-spectrum antibiotics (82.5%) than do HPs (78.9%,p<0.001). Conclusions. Antibiotic prescribing remains excessive in pediatric primary care, slightly more marked in HPs. While HPs also tend to prescribe a higher number of overall and injectable drugs/antibiotics, broad-spectrum anti-biotherapy seems to be more practiced by LPs surprisingly. Both physician groups appeared to prefer either narrow-or broad-spectrum drugs without paying enough attention to their pharmacodynamic properties.