Guidelines for More Conservative Prescribing Practices
Boston, MA - Information on drugs and treatment for specific diseases is abundant in medical education, but a need for guiding principles for ways to effectively prescribe is drawing attention. In a Commentary published in the February 25 issue of the Journal of the American Medical Association, a physician from Brigham and Women’s Hospital (BWH) and his colleague suggest 25 principles to help prescribers improve their effectiveness.
Recent reports from the Association of American Medical Colleges (AAMC) expressed major concern with the current state of pharmacology teaching, specifically, the influence that the pharmaceutical industry has at all stages of medical education. “While addressing these concerns, we also need to think about providing prescribers with a set of comprehensive guiding principles,” said Gordon Schiff, MD, of the Department of Medicine at BWH. “Educational reform alone is not sufficient to ensure the most efficient and successful prescribing practice.”
The Commentary suggests 25 principles to help trainees become more careful, cautious, evidence-based prescribers. The guidelines cover a range of focuses, including strengthening the patient-prescriber relationship, practicing caution and skepticism when prescribing drugs that are new to the market, considering therapeutic options other than drugs when appropriate, and reducing adverse drug events.
“Taken separately, none of the principles are novel, but when combined, they represent a significant shift in current prescribing patterns,” said Dr. Schiff. The authors address the two dueling philosophies of pharmacology by finding a balance between the current thinking pattern that newer and more is better, and the previous idea that fewer and more time-tested drugs are best.
The research was funded by grants from the Agency for Healthcare Research and Quality and the Attorney General Consumer and Prescriber Education Grant Program (the Neurontin settlement).
Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.
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