Re: [Gnumed-devel] gmdrugs structure

[Ian Haywood]

On Mon, 25 Nov 2002 17:22:28 +0100 (CET)
Hilmar Berger <address@hidden> wrote:

> 
> Hallo,
> 
> On Wed, 20 Nov 2002, Ian Haywood wrote:
> 
> > > It's not like there was no prescribing conditions in Germany - they are
> > ...
> > Or, is there extra meta-data about the subsidy? In Australia we have
> > maximum repeats, maximum units at single dispensing, etc.  What would
> > these extra fields be?
> There is other meta-data, basically because the whole system of subsidies
> is quite different. In Germany, patients usually pay only a fixed amount
> of money per package (that amount depends on package size) if they have a
> prescription. The only exception to this rule is patients that have a
> so-called private health insurance - those pay the whole price and than
> the insurance company returns the money paid.
The system allows a country to have any number of subsidy systems, so in 
Australia 
we have "PBS" abd "RPBS" (R=repatriation, i.e war veterans), plus hospitals may
have their own systems.

> So we would need at least a
> field for the fixed price on a particular package (or the standardized
> package size N1-N3).
Sure, a prices table linking packsize_size and subsidy.

> Furthermore there are regulations which drugs are available
> over-the-counter, which need an prescription and so on (one field for all
> possible cases).
Interesting. In Australia, OTC drugs are never subsidised.

A flag in product should suffice.  
> There are drugs ('narcotics') you have to follow special rules of
> prescription (one boolean field).
> There are some more cases we might have to cover. I will try to find out
> which fields we will need and if we can share some of the entries allready
> available. 
In Australia also, but they are generally not in the drug database: its assumed 
you just 'know' them. ;-)

> Maybe I'm wrong here, and probably I didn't say what I meant, but I
> thought that it will be difficult to cover the case of for instance a
> package containing 10 bottles of 10ml each that contain a solution of 1g
> penicillin.
Aha! now I understand.

Yes, you can't. Looks like *another* field in product (sigh). So we have 
unit_size (10 in the '10ml'
in addition to package_size (the '10' in 10 bottles)
 
> > example, still cause ulcers when given rectally.
> IMHO drug route is as important for main and side effects of a drug as is
> dose and adjuvants. Pharmacokinetics depend heavily on resorption,
> metabolism, degradation, elimination and so on - and those are not only
> dependant on the active substance. You might have a first-pass effect and
> intestinal interactions in drugs administered orally and you won't see
> vascular/tissue adverse effects until you inject the drug directly i.v. or
> i.m. 
> To me, *substances* are just abstractions of a broad range of drugs
> containing this substance. The single drug might or might not possess all
> characteristics of the drug - and that's (IMHO) not only an exception, but
> a feature used heavily for adjustion drug effects to particular needs. 

Point taken.

However, I think this level of precision is difficult in our situation.
AMIS achieves it "the hard way": every drug product (Praeparate) is listed then
the interaction tables have a key to this (Verbindingsschlussel).
(As I understand the docs! Please tell me if I have mis-translated) 

This approach is not portable and creates potential inconsistencies, if someone 
forgets to 
link in all the "Praeparate" to an interaction.

The best idea I can come up with is a 'filter' flag in the 
link_drug_interaction and
link_drug_adverse_effect, so we can specify the routes to which this applies. 
These specifications do occur in the Australian Medicines Handbook (a generic
drug handbook, closer to what Horst and I have in mind than Rote Liste) but 
they are unusual.
(online at http://www.amh.hcn.net.au/)

route flag values would be like:
        1 all routes (the default)
        2 only parenteral (IV/IM/SC)
        3 only oral
        4 only IV
        5 only IM (would you use this?)
        6 only systemic (i.e not eye/ear drops)

What to people think?

As a side isse,
AMIS also has seperate lists for "proven" "expected" interactions etc. 
Do we what to add this? 

Ian

 






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