HIGH-RISK PRESCRIBING IN THE VETERAN POPULATION

Concerns about the frequency and consequences of adverse drug reaction s have prompted the Department of Veterans' Affairs to establish a 'qu ality use of medicines' program. This involves several approaches, inc luding patient and pharmacist education and prescriber pharmaceutical feedback, The traditional approach, regulatory change, is also used to influence prescribing The process of prescribing feedback involves th e identification of high risk prescribing situations, such as the pres cribing of drug combinations known to interact significantly. Analysis of prescribing information for veterans indicates the extent to which these 'high risk' situations occur. Increased regulation for tire pre scribing of certain of the benzodiazepines on the Repatriation Pharmac eutical Benefits Scheme was introduced in April 1993. Analysis of drug utilisation, using the Department of Veterans' Affairs pharmaceutical database reveals, not surprisingly, that this has had a dramatic effe ct on the prescribing of the newly restricted drugs, Tire prescribing of all benzodiazepines including restricted and unrestricted drugs how ever, has dropped by a net of 11% when comparing twelve month periods before and after the introduction of restrictions, Equally importantly , the prescribing of tricyclic antidepressants (TCA) has not significa ntly changed implying that prescribers are not routinely changing from benzodiazepines to TCAs.