Prescribing in General Practice

Adherence
• Factors Affecting Adherence (Patient / Doctor Factors)
– Understanding of the instructions
• Age of patient
• Educational level of patient
• Complexity of regimen etc. (e.g. COCP, bisphosphonates)
– Quality of doctor-patient interaction
– Family and social isolation
– Beliefs, attitude and personality
• Health belief model
• Locus of control
• Ego strength
• Drug aversion
Adherence
• Factors Affecting Adherence (Illness / Medication
Factors)
– Number of medications prescribed concurrently
– Nature of illness
• Asymptomatic
• Psychiatric
• Chronic
– Use of medicine for prevention rather than treatment
– Number of troublesome side fx with the medicine
– Duration of therapy
Adherence
• Ways to Improve Adherence
– Involve the patients and carers in the management
– Choose the simplest regime possible
• E.g. once weekly dosing for bisphosphonates
– Discuss the rationale fully
– Simple written instructions
– Review risk : benefit balance
– Consider alternatives
– Use expertise of local pharmacist
– Monitor treatment
• Review regularly re side fx etc. and adjust regime accordingly
Adherence
• What should patients be told about their medication
– The name of the medicine
– What it is for
– How it works (or is thought to work)
– Whether it is essential, important, or optional
– How much to take, how to take, how often to take it and how
long to take it for
– What benefits to expect
– What adverse effects might occur
• Legal obligation to tell patients about common side fx and those that are
potentially serious (even if rare) – informed consent
– What to do if no benefit, or less than expected benefit
– What to do if adverse effects occur
Special Circumstances
• Special considerations are needed when prescribing for
the following patient groups:
– The elderly
– Children
– Pregnant (or potentially pregnant) women
– Breast-feeding women
– Terminal care
– Co-existing medical conditions e.g. renal / liver failure
– Particular drug categories e.g. warfarin
The Pharmaceutical Industry
• Relationship between the Pharmaceutical Industry
and doctors has come under increasing scrutiny
– Irish Medical Council issued guidelines in 2004
• “Non-promotional educational grants represent the only
acceptable mechanism of financial support by the
pharmaceutical and medical manufacturing industries to
individual doctors”
– Pros:
• The industry conducts almost all the research and
development into new drugs, that goes on in the world
• Provide information and education to healthcare workers
• Support the economy
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