Ken Harvey wrote:
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.
Twenty-one per cent of the 192 363 veterans aged 70 years, with an
eligible gold card, were dispensed at least one potentially
inappropriate medicine in the first 6 months of 2005.
About ten years ago, I attended a seminar at which Libby Roughead
presented the results of some research that she'd done to see whether
telling GPs that NSAIDs cause peptic ulcers had reduced the number of
admissions to hospital with perforated peptic ulcer. The finding was
that the number of admissions to hospital with perforated peptic ulcer
did reduce after the campaign to tell GPs how bad NSAIDs were. The
researchers were obviously pleased that they had saved a number of
people from this serious adverse effect of NSAIDs.
During the question time, I stood up and asked whether the researchers
had measured or even asked how many arthritic oldies now were lying
awake at night in pain from their arthritis, how many had stopped
bowling, how many could not walk to their letter box at all or without
significant pain, and so on. The answer was no. All they had done was
to measure the number of admissions to hospital with perforated peptic
ulcer. They had made no attempt to measure changes in patient's quality
of life, ability to perform their daily activities or use of other
medications.
I was not impressed with this study, because I believe that it is
relatively easy to change GPs' prescribing by telling them that drug X
or drug class Y can have serious adverse effects. The hard part is if
GPs are discouraged from prescribing medications that are useful and
increase patients' quality of life, it is important to examine the other
intended and unintended consequences of that change. I believe that the
withdrawal of TGA approval for quinine for the use of cramps falls
into this category. Little old ladies (and men) who had taken quinine
for years and found it top be the only effective treatment were suddenly
told that it is dangerous and may kill them, and we now have to tell
them this, but explain to them that this is unlikely to happen after ten
or twenty years of use.
--
Oliver Frank, general practitioner
255 North East Road, Hampstead Gardens, South Australia 5086
Phone 08 8261 1355 Fax 08 8266 5149 Mobile 0407 181 683
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