Boston—Should prescriptions include their purpose so that medication choices are narrowed to those indicated for a specific problem?
A Perspective article in a recent issue of the New England Journal of Medicine suggests they should.
“Currently, even though there is a widespread commitment to sharing drug information with patients, the reason for a medication prescription is generally not recorded or shared when it is being written and is therefore missing a key piece of information,” said lead author Gordon D. Schiff, MD, a general internist at Brigham and Women’s Hospital.
Schiff and his co-authors argue that the practice would improve prescribing by:
• Reducing errors including mismatches, prescribing or dispensing errors, and errors related to drugs of similar names;
• Enabling patients to better understand and adhere to their medication regimens and question the necessity of a medication;
• Providing clinicians with a system to identify therapeutic alternatives to choose the best drugs for their patients’ problems;
• Informing prescribers, pharmacists, caregivers, and patients regarding what is being treated and what outcomes are desired;
• Reconciling lists of medications by indication, rather than randomly, alphabetically, or chronologically and make duplicates and discontinued medications much easier to spot;
• Permitting clearer assessments and comparisons to track and evaluate prescriptions and measure a drug’s long-term effectiveness.
The article notes that patients historically were purposefully kept from understanding the ingredients and indications for their drugs. It cites an 1833 article in the Boston Medical and Surgical Journal that explained why prescriptions should be written in Latin so patients wouldn’t know the names or indications of the prescribed drugs and would have to rely solely on the skill of the physicians.
“Beyond the five “rights” for safe medication ordering and use—the right patient, right drug, right dose, right time, and right route—a sixth element must be correct: the indication. Indications based prescribing can improve medication use in multiple ways,” write the Perspective authors.
Brigham and Women’s Hospital now has funding from the U.S. Agency for Healthcare Research and Quality (AHRQ) to bring together information technology design specialists and policy leaders for a 3-year project to build a prototype that will allow prescribers to start from the patient's problem and guide users toward best choices, according to the article.
“We will be testing our hypothesis that electronic prescribing needs to incorporate this missing link and that this system will result in a safer, more efficient way of ordering medications to benefit patients, families, prescribers, pharmacists, and other members of the health care team,” Schiff said.
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