Assessment of hydrocodone prescribing within a family medicine residency program.

BACKGROUND AND OBJECTIVES: Hydrocodone is one of the most frequently prescribed medications in the United States. Chronic users of hydrocodone are high-risk patients who consume valuable time and resources within a Family Medicine Residency Program. A narcotic agreement is a tool to help providers define patient expectations regarding chronic medication use. Objectives of this project were to classify hydrocodone utilizers by frequency of use, determine use of narcotic agreements in chronic users, and evaluate patients' ad- herence to agreement parameters. METHODS: A report was created for all hydrocodone prescriptions generated between January and June 2013. Patients were classified as acute, episodic or chronic users. Clinic records were reviewed to determine if chronic users had an existing narcotic agreement with the Family Medical Clinic (FMC). Adherence to agreement criteria was assessed by reviewing the Arkansas Prescription Monitoring Program. RESULTS: A total of 371 patients received hydrocodone prescriptions; forty-eight percent (N = 177) were chronic users. Chronic users accounted for 85% (N = 44,693) of the 52,478 hydrocodone units prescribed. Forty-four percent (N = 78) of chronic users had a narcotic agreement; 37% (N = 29) were completely compliant with the terms. CONCLUSIONS: The majority of hydrocodone prescribed within our FMC during the study period was for chronic users, most of whom did not have narcotic agreements. A minority of patients with agreements were adherent to all parameters. Identifying chronic utilizers in a timely manner, standardizing implementation of narcotic agreements, and integrating prescription database monitoring into routine care would permit pro- viders to more appropriately manage these high risk patients.

Practical considerations of new drugs: new choices for old problems.

As drug therapy experts, pharmacists are often called upon for facts and opinions about recently introduced drugs. New drugs are introduced at a rate that exceeds the reading time of many busy practitioners. This article is intended to provide an objective information and broad-based discussion about new drug options that have particular relevance for the elderly. Drugs that will be reviewed include: acamprosate, darifenacin, eszopiclone, exenatide, ibandronate, nitazoxanide, pramlintide, pregabalin, ramelteon, tigecycline, tinidazole, trospium, and solifenacin.

Speech production in noise with and without hearing protection.

People working in noisy environments often complain of difficulty communicating when they wear hearing protection. It was hypothesized that part of the workers' communication difficulties stem from changes in speech production that occur when hearing protectors are worn. To address this possibility, overall and one-third-octave-band SPL measurements were obtained for 16 men and 16 women as they produced connected speech while wearing foam, flange, or no earplugs (open ears) in quiet and in pink noise at 60, 70, 80, 90, and 100 dB SPL. The attenuation and the occlusion effect produced by the earplugs were measured. The Speech Intelligibility Index (SII) was also calculated for each condition. The talkers produced lower overall speech levels, speech-to-noise ratios, and SII values, and less high-frequency speech energy, when they wore earplugs compared with the open-ear condition. Small differences in the speech measures between the talkers wearing foam and flange earplugs were observed. Overall, the results of the study indicate that talkers wearing earplugs (and consequently their listeners) are at a disadvantage when communicating in noise.