Prescription medication use aboard US submarines during periods underway

Since January 1997, automated medical records from U.S. submarines have been stored in a centralized database as part of a descriptive epidemiology study. 200 medical encounter notes were randomly selected from 1,017 initial health visits during submarine underway periods between April 1996 and January 1998. Medication prescription appropriateness was assessed using a modified Medication Appropriateness Index (MAI) described in the literature. Seven diagnostic categories accounted for 51.4% of all diagnoses: acute upper respiratory infections (17.6%), superficial wounds (9.7%), elevated blood pressure without the diagnosis of hypertension (7.9%), sprain/strains (4.7%), skin infections (4.3%), eye disorders (3.6%), and ear disorders (3.6%). Prescribed medications were consistent with the care of minor health problems. Mean number of medications prescribed per encounter was 1.4 +/- 1.1 (S.D.). 84% of prescribed medications were assigned a modified MAI summary score of 0, indicating the prescription was appropriate in all aspects. However, anti-infective medication prescriptions demonstrated a significant proportion of non-zero summary scores suggesting some room for improvement in the prescribing practices for this specific medication category.