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20% of individuals aged 65 years and older are prescribed 10 or more repeat medicines.
True
One medication error occurs per hospital patient every week in Irish hospitals.
False
Drug related morbidity accounts for 10% of preventable hospital admissions in older patients.
True
Rational prescribing involves using the wrong medication for a patient.
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Adherence assessment is part of the drug history that should be taken before prescribing.
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The Irish Medicines Board is a source of information on medications.
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There are seven sections listed in the Summary of Product Characteristics.
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Medical history is essential to avoid drug-drug interactions.
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The percentage of the population taking medication at any one time is 66%.
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Medicines account for nearly 20% of total healthcare spending.
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Writing a prescription is one of the learning outcomes in the Introduction to Prescribing course.
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There is no need to understand the principles of rational prescribing.
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The content mentions the difference between generic and branded medications.
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All consultations end with a diagnosis, never with a prescription.
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The process of reporting Adverse Drug Reactions is part of the learning outcomes.
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Understanding the ethics around prescribing is not relevant to the course.
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Brand medications are usually more expensive than generic medications.
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The International Nonproprietary Name (INN) is a generic name assigned to all medications by WHO.
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Patients taking their medication exactly as prescribed is a common scenario.
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All beta-adrenoreceptor antagonists end with the suffix –olol.
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Brand names for medications are typically longer and more complex than generic names.
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Poor adherence to medication can affect treatment effectiveness.
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Generic medications are always more expensive than branded medications.
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Individuals of older age are less likely to forget to take their medication.
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Polypharmacy refers to the use of multiple medications by a patient.
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Good communication has no impact on medication adherence.
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It is important for patients to know what to expect in terms of benefits and side effects of their medication.
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A shorter antibiotic course, such as 3 days, is always better than a longer course.
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The doctor-patient relationship is irrelevant to treatment adherence.
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Patients should be actively involved in decisions about their treatment.
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Patients do not need to know their medication's name.
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Understanding a patient's medical history is important for prescribing effective treatment.
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Rational prescribing involves selecting the most efficacious medication based on a patient’s individual needs.
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The percentage of healthcare spending attributed to medicines is nearly 20%.
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All consultations in healthcare contexts conclude with a prescription being written.
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Understanding the ethics around prescribing is an essential component of the prescribing course.
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Generic medications are typically less expensive than branded medications.
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Drug-drug interactions are not a factor to consider in a patient's medical history.
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A significant percentage of the population, 66%, is currently taking medication at any given time.
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It is common for patients to precisely adhere to their prescribed medication regimen without assistance.
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Only 2% of individuals aged ≥ 65 years are prescribed ≥ 10 repeat medicines.
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Optimising prescribing involves selecting the right medicine, dose, and patient, but not the right route.
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The Summary of Product Characteristics contains 8 distinct sections.
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An essential part of the drug history is identifying the patient's current prescription medications, including OTC and herbal remedies.
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Clinical skills are irrelevant when considering factors for prescribing medication.
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Drug-drug interactions only pose a risk with prescription medications and not with OTC products.
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The British National Formulary is a source of objective information on medications.
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The improper selection of medications can lead to drug-related morbidity, impacting patient safety.
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Branded medications are typically marketed under longer and more complex names compared to generic medications.
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The International Nonproprietary Name (INN) designated by WHO is only applicable to branded medications.
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One-third of patients do not take their medication at all.
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The use of a generic name for medications can complicate the exchange of information internationally.
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Patients' belief systems have no effect on their medication adherence.
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Generic medications are generally more expensive than branded medications.
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The WHO states that good adherence to long-term therapies enhances treatment effectiveness.
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Age has no correlation with patients forgetting to take their medications.
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Involving family members in the treatment process can improve medication adherence.
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The duration of treatment does not impact patient adherence to medication.
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Patients do not need to be aware of potential adverse effects of their medications.
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A thorough explanation of the treatment regime can reduce patient fears regarding medication.
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The patient's ideas and expectations about treatment are irrelevant in the prescribing process.
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Time spent by a doctor explaining treatment benefits increases the likelihood of adherence.
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Patients should only be informed about the cost and not about how to take their medication.
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Trust between the doctor and patient has no influence on medication adherence.
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Study Notes
Introduction To Prescribing
- Prescription medications are frequently used, with 66% of the population taking medications at any given time.
- Prescription drugs account for 13.5% of total healthcare spending.
- 63% of medical consultations result in a prescription being written.
Rational Prescribing
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Key Concepts:
- Right medicine: Accurate selection of the most appropriate medication.
- Right dose: Ensuring the correct dosage for the patient's needs.
- Right route: Choosing the appropriate administration method (oral, intravenous, etc.).
- Right time: Administering the medication at the optimal intervals.
- Right patient: Verifying the medication is prescribed to the correct individual.
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Importance of Medical history:
- Drug history is crucial to identify potential drug-drug interactions.
- This includes current and past prescription medications, over-the-counter medications, herbal remedies, illicit drug use, and allergy history.
- Medical history is also important for identifying potential drug-disease interactions.
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Prerequisites for Rational Prescribing:
- Clinical Skills: Expertise in medical diagnosis and treatment.
- Knowledge of Therapeutics: Accessing reliable information on medications and their uses.
- Communication Skills: Effectively conveying information to patients about their medication.
Information Resources
- British National Formulary (BNF): A comprehensive resource for prescribing information in the UK.
- Irish Medicines Formulary (IMF): The main prescribing resource for healthcare professionals in Ireland.
- Summary of Product Characteristics (SPC): Detailed information provided by the licensed manufacturers of medicines.
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Other Valuable Resources:
- Practice Formularies
- MIMS (Monthly Index of Medical Specialities)
- Peer-Reviewed Journals
- Drugs and Therapeutics Bulletins
- National Medicines Information Centre (NMIC)
- Irish Medicines Board (IMB)
Generic Vs Branded Medications
- Generic Name: Describes the active ingredient of a medication.
- Brand Name: The name created by the pharmaceutical company that developed the drug.
- Patent Protection: Pharmaceutical companies hold exclusive rights to produce their brand name product until the patent expires.
- Generic Equivalents: Once the patent expires, other companies can produce generic versions, typically at a lower cost.
- International Nonproprietary Name (INN): A unique, globally recognized name assigned by the World Health Organization for all pharmaceuticals.
Adherence (Compliance)
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Adherence Rates: Estimates suggest only 1/3 of patients take their medication exactly as prescribed, 1/3 take it inconsistently, and 1/3 don't take it at all.
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Consequences of Poor Adherence: Suboptimal treatment outcomes, increased healthcare costs, and reduced quality of life.
-
Patient Factors Contributing to Poor Adherence:
- Beliefs about the medication's effectiveness.
- Age (older patients may be more prone to forgetting).
- Educational level.
- Family support and understanding.
- Concerns about side effects (real or anticipated).
- Fear that medication will worsen their condition.
-
Medication Factors Contributing to Poor Adherence:
- Polypharmacy (taking multiple medications).
- Treatment burden (complex medication regimens).
- Length of treatment (shorter courses tend to have better adherence).
- Prevention versus treatment (preventative medications have lower adherence).
- Adverse effects.
- Cost.
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Doctor Factors Contributing to Poor Adherence:
- Doctor-Patient Relationship: Trust and rapport between doctor and patient.
- Communication: Effective communication about the medication and treatment plan.
- Time Investment: Adequate time spent explaining the medication, potential side effects, and what to do if they occur.
Improving Adherence
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Good Communication:
- Providing thorough explanations to the patient.
- Involving the patient and family members as appropriate.
- Developing simple medication regimens.
- Regular medication reviews and adjustments.
- Utilizing available resources like pharmacists, pillboxes, and support groups.
Writing a prescription
- As far as possible, all treatment, medication, and therapy prescribed for a patient should be safe, evidence-based, and in the patient's best interests.
Principles of Rational Prescribing
- Prescribing should be evidence-based and consistent with best practices.
- Aim for the optimal medication choice, considering the right medicine, dose, route, time, and patient.
Importance of Drug History
- Essential to assess potential drug-drug interactions.
- Includes current prescriptions (all forms, including inhalers and patches), over-the-counter medication, herbal remedies, illicit drug use, and adherence assessment.
- Review current and past allergy history.
Importance of Medical History
- Essential to assess potential drug-disease interactions.
Sources of Objective Information on Medications
- British National Formulary (BNF)
- Irish Medicines Formulary (IMF)
- Practice Formulary
- MIMS
- Summary of Product Characteristics (SPC)
- Peer-Reviewed Journals
- Drugs and Therapeutics Bulletins
- National Medicines Information Centre (NMIC)
- Irish Medicines Board
Generic Versus Branded Medications
- A medicine has two names: the brand name (created by the pharmaceutical company) and the generic name (describing the active ingredient).
- Patent protection allows only the original company to produce the drug until the patent expires. After expiration, other companies can make generic versions.
Generic Medications
- Use the International nonproprietary name (INN) generated by WHO.
- INN is a unique, globally recognized name.
- Generic name often reflects the drug's chemical or therapeutic class.
- Generics are typically cheaper.
- Promote international information sharing.
Branded Medications
- Marketed by a specific pharmaceutical company.
- Brand names are often shorter, simpler, and easier to remember.
- Brands are usually more expensive than generics.
Medication Adherence (Compliance)
- Only 1/3 of patients take their medication exactly as prescribed.
- Medication adherence challenges significantly compromise treatment effectiveness.
- Poor adherence to blood pressure medication is prevalent (almost 1 in 3 people forget to take it frequently or occasionally).
Patient Issues Affecting Adherence
- Belief system: Lack of patient conviction about medication benefits.
- Age: Older patients may be more forgetful.
- Education level
- Family support
- Side effects: Both actual and perceived.
- Fear of medication worsening their condition.
Medication Issues Affecting Adherence
- Polypharmacy
- Treatment burden
- Complexity of medication regimes
- Treatment duration
- Prevention vs. treatment
- Adverse effects
- Cost
Doctor Issues Affecting Adherence
- Doctor-patient relationship
- Trust
- Communication
- Time spent explaining the treatment regime, potential side effects, and what to do if they occur.
- Clarifying the risk-benefit ratio and reasons for medication choice.
- Listening and understanding patient priorities.
Strategies to Improve Adherence
- Good communication: Involves thorough explanation, patient involvement, and family member inclusion.
- Simple treatment regime: Clearly written down.
- Regular review and adjustments.
- Utilize resources: Pharmacist, pill boxes, etc.
Information Patients Need to Know
- Medication name
- Purpose of the medication
- How it works
- Dosage information
- Expected benefits and adverse effects
- Action plan for side effects
- Review date
Information Doctors Need to Know
- All information listed for patients.
- Patient's medical and drug history.
- Patient's thoughts, concerns, and expectations about treatment.
- Understanding the patient's priorities.
Prescription Writing
- Follow the "Guide to Professional Conduct and Ethics for Registered Medical Practitioners", which states that prescriptions should be safe, evidence-based, and in the patient's best interests.
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Description
Test your knowledge on the principles of rational prescribing. This quiz covers essential concepts such as the right medicine, dose, route, time, and patient. Additionally, understand the significance of medical history in preventing drug interactions.
