Horst Herb wrote:
On Tuesday 26 June 2007 11:20, Ken Harvey wrote:
[I'd be interested in whether people thought an computer alert
(generated at the time of prescribing one of these drugs in an elderly
patient) might be a useful way of addressing the problem?]
Roughead EE, Anderson B, Gilbert AL. Potentially inappropriate
prescribing among Australian veterans and war widows/widowers. Internal
Medicine Journal 2007; 37 (6): 402–405.
ABSTRACT: This study examined the extent of potentially inappropriate
medicine, as defined by explicit criteria, dispensed to Australian
veterans using the Repatriation Pharmaceutical Benefits Scheme Pharmacy
Claims database.
Pity that the full article does not seem to be available online.
I would be interested in the methodology, especially how they checked whether
prescriptions were really (as opposed to potentially) inappropriate.
I have a number of oldies where I definitely think that drugs like
Amitriptyline (considered "potentially inappropriate" in that "study") are
entirely appropriate and effective benefit outweighs potential harm; in fact
I would claim that this is the case in all of them.
Likewise, before any of my patients gets a Benzodiazepine, I go great length
to investigate indication and less harmful alternatives, and to instruct
patients on risks (of which I regard "dependence" the least problem of all) -
so I consider those few who get them as "appropriately prescribed" too.
So, would my patients have been labelled in this "study" as prescribed
something "potentially inappropriate", or did they undertake the effort to
investigate whether there was an acceptable indication where no alternative
drug would have been likely to yield a better benefit/risk ratio?
If the did undertake the effort, I will try to source the original article and
read it with great interest.
If they did not undertake the effort, I would label the study as entirely
irrelvant ("academic wank" if I would name a spade a spade). Subsequently, I
woudl see computerized prompting as unhelpful since not based on evidence and
hence often (rightly?) percived as mere nuisance
Ken, you seem to have read it - did they undertake the effort of checking the
indications?
Horst
Good comments and I suspect that the "academic wank" description will
turn out to be the correct one. You will probably also find that the
authors were not medicos but rather pharmacists (a guess on my part)
T
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