Fewer drugs, treating causes would save lives
A new study from the University of Illinois at Chicago College of Pharmacy, suggests physicians should shift their focus from writing the newest and best prescriptions to “conservative prescribing”. Rather than treating illness with drugs, the researchers recommend interventions like exercise, diet and physical therapy in addition to treating causes of illness instead of symptoms.
Bruce Lambert, co-author of the paper and professor of pharmacy administration said, "None of these principles are particularly novel, nor should they be terribly controversial. But taken together they represent a radical shift in the way clinicians think about and prescribe drugs."
Conservative prescribing could save money
It’s not just lives that could be save by following basic principles, say the authors, writing in the Archives of Internal Medicine as part of a series of papers titles “Less is More”. Conservative prescribing would save money, for patients and the healthcare system.
Dr. Gordon Schiff, associate professor of medicine at Harvard University, who co-authored the report says, there is a mindset that leads physicians to prescribe the “latest and greatest” drugs that they should move away from. If every prescriber did so, lives and money would be saved.
When prescriptions are needed, those that are time tested, and fewer of them, is best practice. He says medical and pharmacy schools should put more focus on principles, rather than pharmacology, which would in turn make prescribers more cautious.
The authors put together 24 practices, based on previous research, that they say can help prescribers avoid the harm that can come from writing excessive numbers of prescriptions.
The essence of conservative prescribing is to work with patients, don’t succumb to patient requests for drugs, evaluate for medication compliance before adding more prescriptions and discontinue medications that aren’t working.
The authors warn new drugs may be of little benefit. They suggest clinicians look at the long-term outcome and ecological impact of prescribing new medications.
Emphasis should be on prevention and treating underlying causes of health problems.
Focus on diet, exercise and non-drug therapies before writing prescriptions when it’s safe. When medications are needed, start with one at a time.
They suggest awareness of drug side effects and emphasize educating patients so recognize and can report adverse drug effects.
Most importantly, the authors say, it’s important to seek out unbiased information about the safety of new drugs. Wait until a drug has been on the market and proven safe. Look for true clinical benefits of prescriptions drugs versus improved lab values in studies and be wary of clinical drug trials that highlight positive trials, hiding those that have failed.
The University of Illinois at Chicago College of Pharmacy is one of 14 centers studying consumer, physician treatment decisions, therapies and interventions; funded by the U.S. Health and Human Services Agency for Healthcare Research and Quality (AHRQ). The authors say if all prescribers were more conservative about dispensing drugs, lives and money would be saved.
Archives of Internal Medicine: doi:10.1001/archinternmed.2011.256
“Principles of Conservative Prescribing”
Gordon D. Schiff et al
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