Prescribing - What's all the fuss?

Table 2: World Health Organisation Guide to Good Prescribing Steps: (modified from ⁴)
 

1. Make diagnosis

2. Set therapeutic goal for the individual patient

3. Decide on the therapeutic approach

4. Choose a drug class

5. Choose a generic drug within a class

6. Individualise dose, formulation, frequency, and duration

7. Verify suitability of chosen drug

8. Write prescription

9. Inform patient

10. Monitor for effects and adverse effects

11. Alter prescription, if necessary

with choices being made on rational and evidence based grounds. By prescribing according to a well founded P-drug list, GPs can develop greater familiarity and confidence in their prescribing with improved outcomes for patients.

References
1. Britt H, Miller G C, Charles J, et al. General practice activity in Australia 1999-2000. University of Sydney and Australian Institute of Health and Welfare, 2000.

2. http://www.health.gov.au/pbs/pubs/pbbexp/pbjun/bookp01.htm.

3. http://www.med.rug.nl/pharma/ggp.htm.

4. de Vries T P G M, Henning R H, Hogerzeil H V, Fresle D A. Guide to good prescribing. Geneva: World Health Organisation, 1994.

5. de Vries T P, Henning R H, Hogerzeil H V, et al. Impact of a short course in pharmacotherapy for undergraduate medical students: an international randomised controlled study. Lancet 1995; 346: 1454–1457.

6. Wong M, Rawlins S. Guide to safe prescribing. Clinical Excellence for Nurse Practitioners 2000; 4(3):133–137.

7. Chambliss M L. Choosing the best medications. Am Fam Physician 1996; 53(8):2565–2570.

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8. Benitez J. Preparing a personal formulary as part of a course in clinical pharmacology. Clin Pharmacol Ther 1991; 49(6):606–608.

9. Robertson J, Fryer J L, O’Connell D L, Smith A J, Henry D A. Personal formularies: An index of prescribing quality? Eur J Clin Pharmacol 2001; 57(4):333–341.

10. http://nps.unisa.edu.au/front/index.htm

11. Celebrex Product Information.

12. Wright J M. Choosing a first line drug in the management of elevated blood pressure: what is the evidence? Thiazide diuretics. CMAJ 2000; 163(2):188–192.

13. Pahor M, Psaty B, Alderman M H, et al. Health outcomes associated with calcium antagonists compared with other first line antihypertensive therapies: a meta-analysis of randomised controlled trials. Lancet 2000; 356:1949–1954.

14. Anonymous. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. Lancet 2000; 355:253–259.

15. Hansson L. Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish trial in old patients with hypertension-2 study. Lancet 1999; 354:1751–1756.

16. Hansson L. Randomised trial of effects of calcium antagonists compared with diuretics and beta blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 2000; 356:359–365.

17. Brown M J. Morbidity and mortality in patients randomised to double blind treatment with a long acting calcium channel blocker or diuretic in the International Nifedipine GITS study: Intervention as a goal in hypertension treatment (INSIGHT). Lancet 2000; 356:366–372.

Correspondence
Dr Sepehr Shakib
Department Clinical Pharmacology
Royal Adelaide Hospital
North Terrace, SA 5000
Email: sshakib@mail.rah.sa.gov.au

Conflict of interest: none declared.