3797 : COUGH MEDICINES INCLUDING OPIATES ARE PRESCRIBED FOR MANY PATIENTS BY COMMUNITY DOCTORS IN HONG KONG

Author(s): 
Dickinson, James; Wong, William; Chan, Cynthia
Text: 
Oral Presentation
Research Based
Cough medicines are widely prescribed, and there is concern about toxicity, but they are little studied or taught about. Therefore we describe the pattern of cough medicine prescribing in Hong Kong. Doctors participating in a postgraduate Diploma of Family Medicine submitted a logbook of diagnoses and prescribing as part of their course. 208 doctors completed logbooks between 1999 and 2002, describing 10, 499 patient encounters. 4631 cases (33.9%) had conditions related to cough, of which 75.6% were URTI. At least one cough medicine was prescribed for nearly half (mean 1.3 per patient). 77 patients were given three or more in one consultation. 27.6% of infants under one year, 40% of children and 55.2% adults over 65 were prescribed cough medicines. Over half of these contained opiates. Patients were less likely to receive cough syrups if antibiotics were given (RR 0.77) Over half of all cough syrups contained multiple components, and private doctors were more likely than those in the public sector to give medicines containing opiates (RR 3), or combinations of three or more components (RR 2) Cough-related illnesses is common in the primary care setting, and most of them are self-limiting. Cough medicines are potentially toxic, so it is important to prescribe systematically and safely. Some doctors demonstrated errors and poor practice. It appears that much prescribing was part of the "gift relationship", more than medical need. Medical schools and continuing education must emphasise good care for common and self-limiting conditions as well as serious and progressive ones.
Topic: Clinical Practice