Good prescribing practice should be a top priority
One of the key skills a clinician should possess is prescribing. Of course, this involves more than just writing a prescription, which in itself requires specific knowledge and skills. Prescribing and therapeutics are critically important areas for the modern clinician and require us to regularly update our knowledge. Safe, sensible and rational prescribing is essential, yet this is an area where mistakes and imperfect practice do occur. This has an obvious clinical cost in terms of morbidity and even mortality, but poor prescribing can also be a costly financial exercise.
Research recently published in the British Medical Journal (BMJ) highlighted the challenges of prescribing safely. As reported in the univadis GP News (click here), the study showed evidence of high-risk prescribing in primary care. The article explains: "Although the authors say that at least some of this prescribing would have been appropriate, with GPs balancing the risks and benefits in their decision, they also found evidence that some practices had above- or below-average high-risk prescribing rates".
Noting the significant variation in high risk prescribing between practices in primary care, the authors of the BMJ paper state politely that there is room for improvement. Without doubt, we could all improve on the quality of our prescribing and reduce unnecessary high-risk prescribing. This requires time, knowledge and access to a good support network, which could include pharmacists and knowledge bases, nowadays often electronic.
I have seen plenty of prescribing support services in action over the years, some of which have been more successful than others. One reason why some have failed is simply a lack of time. GPs are an expensive commodity and therefore we have to be seen to be productive and efficient, leaving little room for reflection and spending time solely reviewing medication and discussing this with the patient. However, this may be a false economy, as savings from evidenced based rational and cost-effective prescribing can be significant. The clinical gain from, say, reducing polypharmacy is also important.
Unfortunately, in the current economic and political climate, there may not be much room to introduce high-quality prescribing initiatives that will allow GPs protected time to analyse, reflect and to make changes to their prescribing. Such a project would demand some initial funding and that is not going to happen at the moment.
Nevertheless, trying to reduce high-risk prescribing and promoting rational and evidence based prescribing should be a priority.
Dr Harry Brown, editor-in-chief univadis