Introduction to Prescribing FFP1 PDF 2023-2024

2023-2024 FFP1 Introduction to Prescribing Dr. Hani Malik Lecturer in Family Medicine RCSI Dublin: Dr Emer O’Brien, Dr Máirtín Ó Maoláin, Dr Aimee O’Farrell, Dr Caroline McCarthy (Department of General Practice) FFP1 LEARNING OUTCOMES 1. Describe global trends in morbidity and mortality using Gl...

2023-2024 FFP1 Introduction to Prescribing Dr. Hani Malik Lecturer in Family Medicine RCSI Dublin: Dr Emer O’Brien, Dr Máirtín Ó Maoláin, Dr Aimee O’Farrell, Dr Caroline McCarthy (Department of General Practice) FFP1 LEARNING OUTCOMES 1. Describe global trends in morbidity and mortality using Global Burden of Disease study data 2. Describe the biomolecular, cellular and biochemical fundamental to life, and the principles of pharmacology 3. Explain the pathological and immunological processes underlying disease 4. Identify and explain the characteristics of medically important microbiological organisms, pathogenesis of bacterial infections the principles of microbiological diagnostic investigation 5. Use effective strategies (e.g., communication, collaboration, interventions) as part of a team as well as displaying knowledge of the basic framework of the Calgary Cambridge Model in communication 6. Discuss the application of professionalism, leadership and resilience (i.e. the constructs of Personal and Professional Identity) to manage self and engage with patients, colleagues and communities 7. Explain psychological principles of maintaining health 8. Describe the social determinants of health and the breadth and INTRODUCTION TO PRESCRIBING Department of General Practice RCSI Medical School Dublin  LEARNING OUTCOMES 1. To understand the principles of rational prescribing 2. To be aware of generic versus branded medications 3. To understand the causes and results of reduced adherence to medication 4. To be able to write a prescription 5. To be aware of the process of reporting of Adverse Drug Reactions 6. To understand the ethics around prescribing 7. To appreciate the potential influence of the Department of General Practice RCSI Medical School Dublin  SO WHY IS THIS AN IMPORTANT TOPIC... 66% of population taking medication at any one time 63% of consultations conclude with a prescription being written Medicines account for nearly 13.5% of total healthcare spending Department of General Practice RCSI Medical School Dublin SO WHY IS THIS AN IMPORTANT TOPIC... People living longer, with more chronic conditions, 20% of those aged ≥ 65 years are prescribed ≥ 10 repeat medicines and 5% are prescribed ≥ 15 repeat medicines One medication error occurs per hospital patient per day in Irish hospitals (HIQA 2018) 4% of preventable hospital admissions are as a result of drug related morbidity, rising to 10% in older patients RATIONAL PRESCRIBING What is it? Prescribing conforms to consensus opinion of the current best practice Optimising the choice of most appropriate medication Right medicine Right dose Right route Right time Right patient Department of General Practice RCSI Medical School Dublin RATIONAL PRESCRIBING Drug History Essential – potential for drug-drug interactions Current prescription medications All forms, inhalers and patches included Contraception if appropriate OTC medication Herbal Remedies Illicit drug use Adherence assessment Current and past allergy history Medical History Essential – potential for drug- disease interaction Department of General Practice RCSI Medical School Dublin RATIONAL PRESCRIBING So before prescribing.. NeedClinical Skills Knowledge of therapeutics (sources of information) Communication Skills Department of General Practice RCSI Medical School Dublin RATIONAL PRESCRIBING Sources of objective information on Medications British National Formulary (BNF) http://www.bnf.org/products/bnf-online/ or https://www-medicinescomplete-com.proxy.library.rcsi.ie/mc/index.htm Irish Medicines Formulary (IMF) www.formulary.ie Practice Formulary Other formularies MIMS Summary of Product Characteristics (SPC) www.medicines.ie Peer-Reviewed Journals Drugs and Therapeutics Bulletins National Medicines Information Centre (NMIC) Irish Medicines Board www.imb.ie Department of General Practice RCSI Medical School Dublin SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE MEDICINAL PRODUCT 2. QUALITATIVE AND QUANTITATIVE COMPOSITION 3. PHARMACEUTICAL FORM 4. CLINICAL PARTICULARS 1. Therapeutic indications 2. Posology and method of administration 3. Contraindications 4. Special warnings and precautions for use 5. Interaction with other medicinal products and other forms of interaction 6. Fertility, pregnancy and lactation 7. Effects on ability to drive and use machines 8. Undesirable effects 9. Overdose 5. PHARMACOLOGICAL PROPERTIES 6. PHARMACEUTICAL PARTICULARS GENERIC VERSUS BRANDED MEDICATIONS Medicines have at least two different names – The band name which is created by the pharmaceutical company that created that medicine – The generic name- which describes the active ingredient of the medicine Drug companies take out exclusive rights on new medicines called a patent. Only that company can produce their brand of the drug until the patent expires. After that different companies can make other branded generics GENERIC MEDICATIONS International nonproprietary name (INN) generated by WHO for all pharmaceuticals worldwide Each INN is a unique name that is globally recognised Generic name usually indicates the drugs chemical or therapeutic class eg all beta-adrenoreceptor antagonists contain the suffix –olol, metoprolol/atenolol Generic usually cheaper Use of generic name promotes easy exchange of information internationally Department of General Practice RCSI Medical School Dublin BRANDED MEDICATIONS Marketed by a particular pharmaceutical company Brand names usually shorter, simpler and easier to remember e.g. paracetamol (generic) v panadol or calpol (brand) Ibuprofen versus nurofen Brand usually more expensive than generic Department of General Practice RCSI Medical School Dublin ADHERENCE (COMPLIANCE) 1/3 of patients take their medication exactly as prescribed 1/3 take their medications but not exactly as prescribed 1/3 do not take their medication Department of General Practice RCSI Medical School Dublin ADHERENCE The WHO states that: poor adherence to long-term therapies severely compromises treatment effectiveness, making it a critical issue in population health from both the quality of life and health economic perspectives From an Irish perspective it has been shown that almost 1 in 3 people on for example BP medication frequently or occasionally forget to take them. So why is there a problem with poor adherence? Department of General Practice RCSI Medical School Dublin ADHERENCE Patient Issues Belief system, lack of conviction on patients part of benefit of medication Age of patient, older age more forgetful? Education level Family support and understanding Side effects, both actual and anticipated Fear that medication will make them more unwell Department of General Practice RCSI Medical School Dublin ADHERENCE Medication Issues Polypharmacy Treatment burden Complexity of the medication regime Duration or treatment (eg 3 day Vs 5 day antibiotic course) Prevention versus treatment Adverse effects Cost ADHERENCE Doctor Issues Doctor patient relationship Trust Communication Time spent explaining the treatment regime, possible side-effects and what to do if they occur Explanation of risk versus benefit, why is the doctor deciding to put this particular patient on this particular medication Listening and understanding patient priorities Department of General Practice RCSI Medical School Dublin ADHERENCE So how can adherence be improved? Good Communication Time invested initially to provide thorough explanation. Involve and empower patient and family members as appropriate Simplest possible regime, written down for patient Regular review and adjustments, making a decision about medication need and side-effects at each review visit Use of other resources available, Pharmacist, Pill Box, Department of General Practice RCSI Medical School Dublin ADHERENCE So what does the patient need to know? Name of medication What the medication is for How it works How much to take, How to take it, How often to take it and for How long What to expect, benefits and adverse effects that may occur, common side-effects and potentially serious side-effects (informed consent) What to do should side-effects occur Review date arranged and patient aware of it Department of General Practice RCSI Medical School Dublin ADHERENCE So what does the doctor need to know? Everything listed on previous slide AND (especially in the case of long term medicines) Patient’s medical and drug history Patients ideas, concerns and expectations about treatment Understand what is important to the patient Department of General Practice RCSI Medical School Dublin WRITING A PRESCRIPTION Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 ‘As far as possible, you should make sure that any treatment, medication or therapy prescribed for a patient is safe, evidence-based and in the patient’s best interests. A doctor’s opinion that a treatment, medication or therapy is not in the patient’s best interests must not be based on the doctor’s own conscientious objection (see paragraph 49 – Conscientious objection). Where possible, when prescribing drugs, avoid the use of brand names – unless there is a good reason for using them. You should be particularly careful when prescribing multiple medications in case the combination might cause adverse reactions, and you should liaise with the pharmacy to clarify any issues or concerns you may have. You should take special care when prescribing for patients who may have an impaired ability to metabolise the medication prescribed. You should weigh up the potential benefits with the risks of adverse effects and interactions when deciding what to prescribe. You should review patients’ treatment regimes periodically’ WRITING A PRESCRIPTION A prescription must comply with legal requirements Must contain Date Doctors details/ Institution details Patient Name Address Date of Birth if