gnumed-devel
[Top][All Lists]
Advanced

[Date Prev][Date Next][Thread Prev][Thread Next][Date Index][Thread Index]

[Gnumed-devel] outline of clinical prescribing process


From: J Busser
Subject: [Gnumed-devel] outline of clinical prescribing process
Date: Thu, 10 Feb 2005 17:38:23 -0800

Hi all

I have been asked to advise IT planners locally/regionally on what is involved in prescribing, with a view to best helping electronic prescribing. As I do not yet use an EMR I can only conjecture how it might work. I must admit in a paper practice the patient points out to me things I had forgotten about and/or which were not accessed easily from the thick chart, and/or the pharmacy phones me about something which, in an EMR, might more easily have been an issue avoided (especially policy related / approval. cost matters).

Anyhow this is a first cut at expressing it in a way that hopefully non-doctors could understand. Input, alternative views, and any experiences working toward electronic prescribing welcome. Also would open health (or drugref) be useful places to post this? (I believed I was on a drugref list but have not gotten any traffic on it.)


Medication prescribing:

- clinical problem (indication) is identified
- interventions / therapies considered
  (from memory OR using print or online guides)

when drug therapy is appropriate:

- review current & prior drug history
  ?are they already under treatment
  ?what (if anything) have we tried before

- review allergy & intolerance info
  (info may derive from others' care)

- consult guidelines for medical condition
  ? are there drugs of choice

- check comorbidity (problem) list for influences
  (may factor "for" or "against" candidate drugs)

- select drug based on above plus gestalt of
  - safety / tolerability (adverse effects)
    (patients need to be advised)
  - drug interactions
  - cost, benefits coverage, & whether affordable
  - authorization / procedural demands

- decide prescription information
  - select strength (cost considerations if pills can be split)
  - select form (duration of action, convenience, tolerability)
  - specify whether do not substitute (DNS)
    (a consideration when generics may not be interchangeable)
  - decide amount to supply
    - arbitrary calculation for "take as needed" (prn)
    - benefit policies affect amounts eligible to be dispensed

- repeat for each medication that is
  - to be initiated OR renewed OR
  - to be altered AND requires additional supply
    (otherwise no prescription event happens)
    (also no prescription event for medications stopped)
    (all extant renewals remain available)

- print / submit prescription




reply via email to

[Prev in Thread] Current Thread [Next in Thread]