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[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
- [Gnumed-devel] outline of clinical prescribing process,
J Busser <=