Prescribing solutions

By Dr Samantha Gan

A recent inquiry by the health think tank The King’s Fund has found that doctors rely more on advice from pharmaceutical representatives and colleagues, and the internet than they do on actual medical evidence when making prescribing decisions.

One of the studies cited in the report interviewed 107 general practitioners to determine what influenced their decision to prescribe a new drug.  Disturbingly, pharmaceutical representatives were the most commonly cited influence.

“The researchers concluded that the decision to initiate a new drug is heavily influenced by ‘who says what’, in particular the pharmaceutical industry, hospital consultants and patients…Evaluation of the scientific merit or evidence base for the treatment did not appear to be a strong influence.”

There is one pharmaceutical representative for every four general practitioners in the UK, and most GP’s report seeing pharmaceutical representatives between once a week and once every three months, with 21% reporting that they see a pharmaceutical representative weekly.  Furthermore, frequent contact between general practitioners and pharmaceutical representatives has been associated with higher prescribing costs.

Another heavily utilised information resource for prescribing decisions is the internet.  A North American study cited in the report observed that 24 out of 25 participants in the study used the internet as their primary information resource.  Databases such as the Cochrane Database of Systematic Reviews and Clinical Evidence were used most frequently, followed by MEDLINE.

However, a separate study showed that Google and the Cochrane Database of Systematic Reviews were only associated with the correct answer about 50% of the time, and MEDLINE was more often associated with an incorrect answer than a correct answer.

The problem, Kingsfund say, is that while there are many available resources to support prescribing decisions, few are reliable, relevant, readable, and quickly accessible.

“It is likely that this causes or encourages primary health care professionals to either not look for answers to their clinical questions or to take shortcuts to the information they require (for example by asking colleagues, or reading summary information in magazines, or asking pharmaceutical representatives). These shortcuts may or may not provide reliable information.”

Fortunately, this is one area in which new technologies and personal computing devices can make a dramatic difference.  Smartphone apps, such as the one recently developed by doctors and pharmacists at Southampton University NHS Hospitals Trust to provide guidance related to the prescription of antimicrobials, are readily accessible and can provide clinical staff with the high-quality information they need to make informed prescribing decisions.  However, as the old adage goes, data is only as good as the person who generated it.  In order for the app to be truly useful, it must follow “the three R’s” as described above, and be reliable, relevant, and readable as well as being accessible.

References:

http://www.kingsfund.org.uk/

http://www.pjonline.com/news/smartphone_app_aims_to_improve_antimicrobial_prescribing