Prescribing Guidelines (prescribing + guideline)

Distribution by Scientific Domains

Selected Abstracts

Unintended Harm from Opioid Prescribing Guidelines

PAIN MEDICINE, Issue 2 2009
Scott M. Fishman MD
No abstract is available for this article. [source]

Barriers to physician adherence to nonsteroidal anti-inflammatory drug guidelines: a qualitative study

Summary Background, Despite wide availability of physician guidelines for safer use of nonsteroidal anti-inflammatory drugs (NSAIDs) and widespread use of these drugs in the US, NSAID prescribing guidelines have been only modestly effective. Aim, To identify and describe comprehensively barriers to provider adherence to NSAID prescribing guidelines. Methods, We conducted interviews with 25 physicians, seeking to identify the major influences explaining physician non-adherence to guidelines. Interviews were standardized and structured probes were used for clarification and detail. All interviews were audio-taped and transcribed. Three independent investigators analysed the transcripts, using the constant-comparative method of qualitative analysis. Results, Our analysis identified six dominant physician barriers explaining non-adherence to established NSAID prescribing guidelines. These included (i) lack of familiarity with guidelines, (ii) perceived limited validity of guidelines, (iii) limited applicability of guidelines among specific patients, (iv) clinical inertia, (v) influences of prior anecdotal experiences and (vi) medical heuristics. Conclusions, A heterogeneous set of influences are barriers to physician adherence to NSAID prescribing guidelines. Suggested measures for improving guideline-concordant prescribing should focus on measures to improve physician education and confidence in guidelines, implementation of physician/pharmacist co-management strategies and expansion of guideline scope. [source]

Antibiotic utilisation in community practices: guideline concurrence and prescription necessity,

Susan Jelinski PhD
Abstract Purpose To evaluate the indications, concurrence with prescribing guidelines and potential necessity for antibiotic (AB) prescriptions written in community practice. Methods We reviewed the charts of all patients with infection-related illnesses seen by family physicians during two random days of regular practice between 1 Oct 1997 and 30 Jan 1998. Guideline concurrence of AB prescribing was assessed using regional AB prescribing guidelines. Likelihood of AB indication for respiratory tract infections was assessed using published clinical practice guidelines for determination of likely viral versus bacterial etiology. Results Of 4218 visits captured, 949 (22%) were for newly acquired infections. Sixty four percent (n,=,604) of consultations for newly acquired infections resulted in an AB prescription. Based on the doctors' diagnoses, 61% of AB prescriptions were concurrent with prescribing guidelines, 10% were for the wrong drug, 20% were not indicated and in 10% of cases a lower line AB was available. For respiratory tract infections, 12% of these infections were likely bacterial, whereas the physicians determined that 56% were bacterial. Conclusions A large proportion of ABs administered in community practices were not in concurrence with community AB prescribing guidelines. Improvements can be made in AB choice and in decisions about likely viral etiology for respiratory tract infections. Copyright 2004 John Wiley & Sons, Ltd. [source]

Depression: current approaches to management in primary care

PRESCRIBER, Issue 4 2009
Ian Reid PhD, MRCPsych
Our Drug review describes current prescribing guidelines and the properties of the antidepressant drugs available and discusses recent controversies surrounding antidepressant use. This is followed by further sources of information in Resources and an analysis of prescription data. Copyright 2009 Wiley Interface Ltd [source]

Electronic e-isotretinoin prescription chart: Improving physicians' adherence to isotretinoin prescription guidelines

Mark BY Tang
ABSTRACT Oral isotretinoin is a highly effective treatment for refractory nodulocystic acne. However, it can be associated with serious adverse effects such as teratogenicity and hepatitis. Inadequate cumulative dosing may also result in reduced therapeutic efficacy and higher disease relapse. A preliminary audit had previously revealed a poor and inconsistent adherence to local isotretinoin prescribing guidelines by physicians. To achieve greater than 90% adherence to isotretinoin guidelines for all acne patients prescribed systemic isotretinoin at the National Skin Centre, Singapore, key areas and the reasons for non-adherence were identified. A specifically designed ,one-stop' electronic isotretinoin chart was launched within the electronic medical records (EMR) system to address important safety areas; namely, informed patient consent, pregnancy testing, baseline laboratory tests, and automatic calculation of cumulative and target doses of isotretinoin. Physician adherence to prescribing guidelines improved from a baseline of 50,60% to greater than 90% (range 95,100%) for 30 consecutive months post intervention. The e-isotretinoin chart has resulted in significant improvement in physicians' adherence to isotretinoin prescription guidelines and highlights the utility of EMR technology in influencing safe prescribing behaviour among doctors. [source]