Abstract
Despite our knowledge regarding the efficacy, tolerability and optimal use of drugs, suboptimal prescribing still occurs. In view of all the factors that influence prescribing, this is not surprising. The focus of drug tolerability has changed from ‘choosing the best alternative’ when a drug is prescribed, to a balanced decision incorporating various different treatments from separate healthcare providers. This article reviews strategies that may influence prescribing behaviour and discusses practical considerations for achieving optimal prescribing in view of tolerability concerns.
The patient has a major influence on prescribing and, with the current diversification of healthcare, the patient now controls prescribing behaviour more than ever before. Communication between healthcare providers consequently assumes a vital role. If messages are to be coherent and transferable, it is increasingly important that healthcare workers communicate effectively with one another rgarding patients, prescribing patterns, and drug tolerability issues.
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Jick H, Derby LE, Myers MW, et al. Risk of hospital admission for idiopathic venous thromboembolism among users of postmenopausal oestrogens. Lancet 1996; 348(9033): 981–3
Spitzer WO, Lewis MA, Heinemann LA, et al. Third generation oral contraceptives and risk of venous thromboembolic disorders: an international case-control study. BMJ 1996; 7023: 83–8
Co-trimoxazole use restricted. Drug Ther Bull 1995; 33: 92–3
Ad hoc subcommittee of the Liaison Committee of the World Health Organisation and the International Society of Hypertension. Effects of calcium antagonists on the risks of coronary heart disease, cancer and bleeding. Hypertension Res 1997; 20(2): 61–73
Crane J, Pearce N, Flatt A, et al. Prescribed fenoterol and death from asthma in New Zealand, 1981–83: case-control study. Lancet 1989; I: 917–22
Spitzer WO, Suissa S, Ernst P, et al. The use of β-agonists and the risk of death and near death from asthma. N Engl J Med 1992; 326(8): 501–6
Nelson HS. New Developments in bronchodilator therapy. Curr Opin Pulm Med 1996; 2(1): 35–9
Freemantle N, Harvey EL, Wolf F, et al. Printed educational materials: effects on professional practice and health care outcomes (Cochrane Review). In: The Cochrane Library: issue 2. Oxford; Update Software, 1999
de Vries CS, van den Berg PB, de Jong-van den Berg LTW. Oral contraceptive prescribing before and after the pill scare: changes in OC use and how users change. Contraception 1998; 57: 247–9
Britten N, Ukoumunne O. The influence of patients’ hopes of receiving a prescription on doctors’ perceptions and the decision to prescribe: a questionnaire survey. BMJ 1997; 315(7121): 1506–10
Freemantle N, Bloor K. Lessons from international experience in controlling pharmaceutical expenditure: I: influencing patients. BMJ 1996; 312(7044): 1469–71
Sackett DL, Haines RB, editors. Compliance with therapeutic regimens. Baltimore (MD): The Johns Hopkins University Press, 1976
Cramer JA. Compliance with oral contraceptives and other treatments. Obstet Gynecol 1996; 88 (3 Suppl.): 4S–12S
Mustard CA, Mayer T. Case-control study to medication and the risk of injurious falls requiring hospitalisation among nursing home residents. Am J Epidemiol 1997; 145(8): 738–45
Morgan K, Clarke D. Longitudinal trends in late-life insomnia: implications for prescribing. Age Ageing 1997; 26(3): 179–84
Hamm RM, Hicks RJ, Bemben DA. Antibiotics and respiratory infections: do antibiotic prescriptions improve outcomes? J Okla State Med Assoc 1996; 89(8): 267–74
Kumar PJ, Clark ML. Clinical medicine. 2nd ed. London: Balliere Tindall, 1990
Monane M, Monane S, Semla T. Optimal medication use in elders: key to successful aging. West J Med 1997; 167(4): 233–7
Beers MH. Explicit criteria for determining potentially inappropriate medication use by the elderly: an update. Arch Intern Med 1997; 157: 1531–6
Yamreudeewong W, Johnson JV, Cassidy TG, et al. Comparison of two methods for INR determination in a pharmacist-based oral anticoagulation clinic. Pharmacotherapy 1996; 16(6): 1159–65
Hawley CJ, Quick SJ, Harding MJ, et al. A preliminary study to examine the adequacy of long-term treatment of depression and the extent of recovery in general practice. Br J Gen Pract 1997; 47: 233–4
Carlson JE. Perils of polypharmacy: 10 steps to prudent prescribing. Geriatrics 1996; 51(7): 26–30, 35
Soumerai SB, McLaughlin TJ, Avorn J. Improving drug prescribing in primary care: a critical analysis of the experimental literature. Milbank Q 1989; 67: 268–317
Mugford M, Banfield P, O’Hanlon M. Effects of feedback of information on clinical practice: a review. BMJ 1991; 303(6799): 398–402
Cunningham G, Dodd TR, Grant DJ, et al. Drug-related problems in elderly patients admitted to Tayside hospitals, methods for prevention and subsequent reassessment. Age Ageing 1997; 26(5): 375–82
Sturkenboom MCJM, de Jong-van den Berg LTW, Cornel MC, et al. Communicating a drug alert: a case study on acitretin in the Netherlands. Eur J Clin Pharmacol 1994; 47: 125–32
Denig P, Haaijer-Ruskamp FM, Zijsling DH. Impact of a drug bulletin on knowledge, perception of drug utility, and prescribing behaviour of physicians. DICP 1990; 24: 87–93
Omnibus Budget Reconciliation Act, 1990. Section 1927 GH of the Social Security Act (public law 101508)
Soumerai SB, Lipton HL. Computer-based drug utilisation review —risk, benefit, or boondoggle? N Engl J Med 1995; 332(24): 1641–5
Donald JB. On line prescribing by computer. BMJ 1986; 292: 937–9
Wyatt J, Walton R. Computer based prescribing. BMJ 1995; 311: 1181–2
Stockley IH. Computerised automatic warnings about drug interactions are now available. BMJ 1997; 314: 303
Walton RT, Gierl C, Yudkin P, et al. Evaluation of computer support for prescribing (CAPSULE) using simulated cases. BMJ 1997; 315: 791–5
Stoner NS, Tanfield CJ, Talbot DC. Computerised prescribing of chemotherapy reduces errors. BMJ 1996; 312: 707
McDonald CJ, Hui SL, Smith DM, et al. Reminders to physicians from an introspective medical record: a two-year randomized trial. Ann Intern Med 1984; 100: 130–8
Roland MO, Zander LI, Evans M, et al. Evaluation of a computer assisted repeat prescribing programme in a general practice. BMJ 1985; 291: 456–8
Hekster Y, Buurma H, Leufkens HGM, et al. Drug consumption in the Netherlands: vol. II. Groningen; Styx Publications 1997
de Vries CS. Collaboration in healthcare — the tango to drug safety [dissertation]. Groningen; University of Groningen, 1998
Purves IN. Guidelines for GPs are being tested. BMJ 1996; 312: 1112–3
Purves IN. Prodigy research team: prodigy interim report. Prodigy Publn 1996; 24: 19
Avorn J, Soumerai SB. Improving drug-therapy decisions through educational outreach. N Engl J Med 1983; 308: 1457–63
Schaffner W, Ray WA, Federspiel CF, et al. Improving antibiotic prescribing in office practice: a controlled trial of three educational methods. JAMA 1983; 250: 1728–32
May F, Gilbert A, Hurley E, et al. A drug and therapeutics information service for community medical practitioners. Aust Prescriber 1993; 16: 49–51
Braybrook S, Walker R. Influencing prescribing in primary care: a comparison of two different prescribing feedback methods. J Clin Pharm Ther 1996; 21: 247–54
Harris CM. Better feedback on prescribing for general practitioners. BMJ 1994; 309: 356
Thomson MA, Oxman AD, Davis DA, et al. Audit and feedback: effects on professional practice and health care outcomes (Cochrane Review). In: The Cochrane Library: issue 2. Update Software, 1999
Braybrook S. Rationalising prescribing in primary care: impact of different outreach strategies [dissertation]. Cardiff University, 1996
Mason M, Wood J, Freemantle N. Designing evaluations of interventions to change professional practice. J Health Serv Res Policy 1999: 4; 106–11
Soumerai SB, Avorn J. Economic and policy analysis of university-based drug detailing. Med Care 1986; 24: 313–31
Avorn J, Soumerai SB, Everitt DE, et al. Arandomised trial of a program to reduce the use of psychoactive drugs in nursing homes. N Engl J Med 1992; 327: 168–73
Jennett PA, Laxdal OE, Hayton RC, et al. The effects of continuing medical education on family doctor performance in office practice: a randomized control study. Med Educ 1988; 22: 139–45
Davis DA, Thomson MA, Oxman AD, et al. Evidence for the effectiveness of CME: a review of 50 randomized controlled trials. JAMA 1992; 268: 1111–7
Anderson Jr FA, Wheeler HB, Goldberg RJ, et al. Changing clinical practice. Prospective study of the impact of continuing medical education and quality assurance programs on use of prophylaxis for venous thromboembolism. Arch Intern Med 1994; 154: 669–77
Santoso B. Small group intervention vs formal seminar for improving appropriate drug use. Soc Sci Med 1996; 42(8): 1163–8
Baert AE, Baig SS, Bardoux C. Effects of group auditing on improving drug therapy in primary care: a randomized controlled trial. Amsterdam: IOS Press, 1995: 22–3
Virji A, Britten N. A study of the relationship between patients’ attitudes and doctors’ prescribing. Fam Pract 1991; 8: 314–9
Webb S, Lloyd M. Prescribing and referral in general practice: a study of patients’ expectations and doctors actions. Br J Gen Pract 1994; 44: 165–9
Schwartz RK, Soumerai SB, Avorn J. Physician motivation for non-scientific drug prescribing. Soc Sci Med 1989; 28: 577–8
Sleath B, Svarstadt B, Roter D. Physician vs patient initiation of psychotropic prescribing in primary care settings: a content analysis of audiotapes. Soc Sci Med 1997; 44(4): 541–8
de Vries CS, van Diepen NM, Tromp TFJ, et al. Auditing GPs’ prescribing habits: cardiovascular medication frequently continues prescribing initiated by specialists. Eur J Clin Pharmacol 1996; 50: 349–52
Carretero MD, Chiswick A, Cataln J. Whose health is it?: the views of injecting drug users with HIV infection and their professional carers. AIDS Care 1998; 10(3): 323–8
McCormick J. Flourishing process-foundering care. Br J Gen Pract 1992; 42: 493
Marsh GN. Efficient care in general practice. Oxford: Oxford University Press, 1991
Balint M. The collusion of anonymity. In: Balint M, editor. The doctor, his patient, and the illness. Tunbridge Wells: Pitman Medical, 1964: 60–80
Bradley CP, Taylor RJ, Blenkinsopp A. Developing prescribing in primary care. BMJ 1997; 314: 744–7
Bradley M. The role of the practice pharmacist — the new member of the team. VFM Update 1996; 2: 27–8
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de Vries, C.S., Duggan, C.A., Tromp, T.F.J. et al. Changing Prescribing in the Light of Tolerability Concerns. Drug-Safety 21, 153–160 (1999). https://doi.org/10.2165/00002018-199921030-00001
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DOI: https://doi.org/10.2165/00002018-199921030-00001