Re: [Gnumed-devel] Medications plug-in, refactored - *Managing* medications

[Busser, Jim]

Coming back to Viabhav's desire to avoid unplanned re-prescribing …

STEP 1
======
It is possible to remove, from consideration in the display, those substances 
which are non-medicinal (alcohol, cannabis) and also those medications which 
may be provided by other clinicians, sometimes specialists, in whose medication 
management we may prefer not to interfere. Here, we can have already avoided to 
mark these as "Approved of".

CAVE: Before removing such medications from view, there remains a 
responsibility to consider one or more drug potential interactions with what we 
*do* prescribe.

WORKAROUND: Keep the drugs in view, only avoiding to mark -- as "Long term" -- 
those which we are not ourselves managing or taking responsibility to prescribe.

STEP 2
======

For those drugs which *are* approved of, consider proposed displays in the case 
of a bleeding ulcer, H Pylorii positive, for which was prescribed 7 days of 
amoxicillin and clarithromycin and 8 weeks of esomeprazole, with a planned 
followup at 28 days.

Suppose, on account of prior bleeds and the patient's having been so far on 172 
days of warfarin for atrial fibrillation, consideration that chronic 
esomeprazole therapy might be required.

At day 28, the patient's medication list could show as

        warfarin                                200 d → ?
or      warfarin                                200 d → ? … ∞ <--- depending if 
it was marked "Long term"
        amoxicillin                     7 d (- 21 d)
        clarithromycin          7 d (- 21 d)
        esomeprazole            28 d → 28 d … ∞
        
Once it has been confirmed with the patient whether the state of medication use 
above is accurate, and also any need to alter or update "the plan", then "the 
list" of what needs prescribing can be solved by focussing on only those 
medications with → and ∞ and asking the patient:

1. do you require more warfarin (which the gastroenterologist may rather defer 
to the GP)

2. perhaps you still have 28 days left of the esomeprazole (if the original 
prescription was indeed for 8 weeks) however if we are deciding now to continue 
you on this medication chronically, in the long term, how much of a supply 
should I provide for you? A new prescription, providing you an additional 3 
months, pre-approved to be renewed x 3 more times, which will provide you an 
additional year of therapy beyond what was already supplied to you?

3. Can GNUmed accept, into the "Duration / until" GUI, for the clinician to 
input

        365 d

the effect of which would cause the existing value for until_date ( = September 
1, 2013) to be incremented by 365 days to August 31, 2014? After which the line 
item would display

        esomeprazole            28 d → 393 d … ∞        

-- Jim