Tuesday, June 28, 2011 1:30 PM
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Lindsay Harding
It is so good when you here of people within the Medical Community who are doing the right thing, but why did JAMA archive it so quickly? Principles of Conservative Prescribing.SourceBrigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Schiff); Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago (Dr Galanter); and Departments of Pharmacy Administration (Mr Duhig and Dr Lambert) and Pharmacy Practice (Drs Lodolce and Koronkowski), Uiversity of Illinois at Chicago College of Pharmacy, Chicago. AbstractJudicious prescribing is a prerequisite for safe and appropriate medication use. Based on evidence and lessons from recent studies demonstrating problems with widely prescribed medications, we offer a series of principles as a prescription for more cautious and conservative prescribing. These principles urge clinicians to (1) think beyond drugs (consider nondrug therapy, treatable underlying causes, and prevention); (2) practice more strategic prescribing (defer nonurgent drug treatment; avoid unwarranted drug switching; be circumspect about unproven drug uses; and start treatment with only 1 new drug at a time); (3) maintain heightened vigilance regarding adverse effects (suspect drug reactions; be aware of withdrawal syndromes; and educate patients to anticipate reactions); (4) exercise caution and skepticism regarding new drugs (seek out unbiased information; wait until drugs have sufficient time on the market; be skeptical about surrogate rather than true clinical outcomes; avoid stretching indications; avoid seduction by elegant molecular pharmacology; beware of selective drug trial reporting); (5) work with patients for a shared agenda (do not automatically accede to drug requests; consider nonadherence before adding drugs to regimen; avoid restarting previously unsuccessful drug treatment; discontinue treatment with unneeded medications; and respect patients' reservations about drugs); and (6) consider long-term, broader impacts (weigh long-term outcomes, and recognize that improved systems may outweigh marginal benefits of new drugs).
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