|Year : 2018 | Volume
| Issue : 3 | Page : 67-69
Good prescribing to maximize patient benefit
Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur, Malaysia
|Date of Web Publication||20-Jun-2018|
Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Haque M. Good prescribing to maximize patient benefit. Int J Nutr Pharmacol Neurol Dis 2018;8:67-9
| Contextual Issues|| |
The prescribing of medicines is the most common and complex intervention process of healthcare. It is the very first step of the medicine utilization process., The use of effective, safe medications has an essential part of modern healthcare system. The Royal Pharmaceutical Society of Great Britain recognized that prescribing is “a technically difficult, and morally complex, problem” and honestly it is doubtful objective whether will patient adheres to the prescribed medicine.,,,, The writing of flawless, explicit prescriptions by a medical doctor is considered as an art erudite though prolong years of practice and indoctrination. Thereafter, prudent use of medicine ensures the success of the pharmacologic intervention. The prescribing practices of a medical doctor are controlled by multiple issues which include the physician his/herself, the practice backdrop, and the health-care system.,,,,
| Good Prescribing|| |
The quality prescribing medicine is an imperative element to ensure and improve patient care in any community, and balancing demands for increased effective prescribing with the risk of adverse drug reactions (ADRs) is a demanding issue for any healthcare system. Many prescribing quality indicators based on register data have been proposed, and several are used regularly. Prescription data are often used for indicators; however, they do not make available any straightforward evidence about disease and patient aspects significant for assessing the excellence of prescribing. Multiple governmental bodies and concern group increasingly giving more attention regarding the irrational use of medicine. Nevertheless, standards defining the prudent or instinctual use of medicine are not readily accessible and are not systematic and reliable. Plummeting imprudent use of medicine is well-thought-out as the best and most cost-effective approach to improve the quality of healthcare and limit waste of limited resources. Rational prescribing necessitates the medical doctor to make a precise diagnosis, comprehend the pathophysiology of the disease, knowledge of pharmacology regarding medicine to be prescribed, and need to consider multiple aspects of the patients and medicine., A good prescription must consequently contemplate (1) pertinent patient aspects and “comorbidities, (2) evidence-based knowledge on medically sound prescribing practices, and (3) the setting in which a prescription is issued.” The King's Fund in commissioned for improving quality care described good prescribing as “the NHS might define it as the lowest-cost prescribing that meets public health needs. The Department of Health and commissioners are keen to monitor prescribing and may measure good prescribing according to the available information and as this largely relates to drug costs, their definitions of good prescribing tend to use cost as the focus. The pharmaceutical industry may look on good prescribing as prescribing the latest drug to all patients who have need of treatment on the basis that new equals better. Evidence-based practitioners tend to define it as the use of therapies proven to be most effective in randomized controlled trials, or according to evidence-based guidelines.” Dr. Jeffrey Kenneth Aronson, a British clinical pharmacologist describes that a good prescribing is one that “recommends a medicine appropriate to the patient's condition and minimizes the risk of undue harm from it.” Aronson's definition was in covenant with Nick Barber, Professor of the Practice of Pharmacy who clarified that a good prescribing is one that accomplishes the four objectives, explicitly: (1) to maximize effectiveness; (2) minimize risks; (3) minimize costs; and (4) respect the patient's choices., Dr. Barber additionally specifies that this conceptualization of good prescribing “brings together the traditional balancing of risks and benefits with the need to reduce costs and the right of the patient to make choices in treatment.”
| Hazards of Irrational Prescribing|| |
Even though medicine cure or alleviate, irrational prescribing increases adverse drug reaction and healthcare cost. These obnoxious aspects of utilization of medicine have been testified to be substantial causes of morbidity, mortality, institutionalization, and individual cost of treatment. Multiple research studies estimated that on average, $76.6–85 billion was spent annually in the United States to resolve drug-related problems., The amount was much higher than the findings of the Institute of Medicine. Another study reported that the cost implications of ADRs could also be enormous. In Germany, for illustration, ADRs are assessed to cost more than €430 million per annum, however, in the UK, the cost of emergency admissions succeeding to an ADRs had valued at £2 billion per year. An American molecular biologist and Nobel Laureate Joshua Lederberg describe regarding irrational antimicrobial use that in “the future of humanity and microbes will evolve as episodes of a suspense thriller that could be titled of our wits versus their genes.” Dr. Lederberg further mentioned that irresponsible human practice such as the indiscriminate use of antimicrobials is one of the substantial aspects underlying the global uprising of antimicrobial resistance. Irrational prescribing of painkillers and tranquilizers can lead to developing drug dependence; the overuse of injections can increase possibility abscesses, hepatitis B, and HIV/AIDS and increased the workload for health professionals.,
| Strategies to Ensure Good Prescribing|| |
Irrational use of medicines is a most important health challenge for our planet with noteworthy consequences for patients, healthcare systems, and communities. The WHO considers irrational prescribing is a disease which is tough to cure – though deterrence possible. The educational and managerial intervention was widely considered as a principal-targeted approach to ensure good prescribing.,, Educational interventions will improve doctors' knowledge and awareness, but their efficiency in changing deeds remains modest unless used in combination with regulatory and economic interventions., It will be much better if educational intervention started as early as possible especially during undergraduate medical studies to develop good prescribing skill. As when medical students will be graduated, they obtain license and freedom to prescribe of their own and many occasions prescribing without supervision. Again, once the bad habit of irrational prescribing develops it will be very difficult to cure.
| Conclusion|| |
The WHO-6-step method for pharmacotherapy education needs to be executed in each-every medical school curriculum “as part of an integrated learning program which has positive effects on medical students' knowledge of basic and applied pharmacology, pharmacotherapy skills, and satisfaction and confidence in prescribing.” Furthermore, those medical doctors already graduated, and practicing should constantly update the new biomedical knowledge regarding medicine and clinical pharmacology to strengthen their prescribing skill. Moreover, medical doctors must utilize every opportunity to counsel their patient for healthy living, balanced diet, and physical activity. In addition, in improving the prudent use of medicine and maximize patients' benefit, there is an urgent need for collaboration among all stakeholders of healthcare especially doctors, nurses, and pharmacist. Online national database, regarding patient information, medical records, drug interaction, and repeat prescriptions, etc., can minimize preventable harm from the medication-related issue.,
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