Healthy Skepticism Library item: 20505

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Shenfield G
Knowledge into action
Australian Prescriber 1996; 19:(1):

Abstract:

Final session
The final session consisted of presentations from three workshop groups followed by general discussion. An attempt was made to translate the many ideas and issues raised during the meeting into specific actions that could be taken to improve prescribing by junior doctors.
It rapidly became apparent that the main outcome of the meeting had been an awareness of how little is known about prescribing behaviour and the factors that influence it. The first set of issues addressed therefore related to the need for further knowledge.

Knowledge required
1. Dr Isobel Rolfe’s literature review was universally agreed to be excellent and valuable. It highlighted the limited literature on the subject and demonstrated the need for further work in this area.

Proposed action
• Dr Rolfe to publish her review.
• Studies to be designed to provide good data on influences on prescribing behaviour.

2. It was widely believed that “opinion leaders” have a major influence on prescribing. There seemed little doubt that in order to improve the practice of the “young prescriber” it would be essential to change the habits of “old prescribers”.

Proposed action
• Investigate the role and behaviour of opinion leaders in a systematic manner.

3. It was felt that there could be further information available that had not yet been identified. It was also felt important to identify other resources which had the potential to promote rational prescribing.

Proposed action
• Find out from pharmaceutical industry what information they have on influences on prescribing.
• Use data from Government sources e.g. DUSC (Drug Utilization Sub-Committee of the Pharmaceutical Benefits Advisory Committee) and HIC (Health Insurance Commission) for information on patterns of prescribing in Australia.
• Utilise data available from the New Zealand GP Prescribing Scheme.
• Liaise with the NSW Postgraduate Medical Council for both collection and dissemination of information.

Other issues
It was acknowledged that little progress could be made until at least some of the information outlined above was available.
However, it was possible to identify a number of general issues that needed to be addressed and on which some preliminary actions could be taken.

Teaching programmes
l. It was felt essential to establish an educational continuum from students through to young doctors. The present system, in most institutions in Australasia, was for students to be taught by pharmacologists and clinical pharmacologists to a strict curriculum which usually bore little relationship to every day prescribing on hospital wards or in community practice. It was felt absolutely essential to make teaching of students and young doctors consistent, transferable and “seamless” so that principles of rational prescribing were introduced at an early stage and integrated into core undergraduate knowledge.

2. It was agreed that medical students and young prescribing doctors needed a wider education than they had at present. They should be given knowledge and skills in areas such as health resource allocation, communication and how to interact with drug representatives. It was thought possible that the trend towards postgraduate medical courses with integrated curricula and problem based learning might help to address some of these issues. It would be helpful if examinations reflected a true clinical context rather than a simple regurgitation of facts.

• Many present felt that students should be encouraged to understand and work in multidisciplinary environments with interactions with nurses, pharmacists and consumers. The influence of nurses on early prescribing was universally agreed to be a major but generally unacknowledged factor.

• Both students and young doctors need to have a better understanding of resource material to help them with prescribing. In particular they should understand the role of prescribing guidelines, have teaching exercises using guidelines and understand how guidelines are developed.

• The issue of medication costs was discussed at some length. It was acknowledged that at the start of the meeting the majority of speakers had indicated that rational prescribing could and should be considered independently of cost and that economic issues should only be introduced after all other factors had been considered. By the end of the meeting there was a shift in emphasis so that a majority of those present expressed the view that cost could not be ignored and that it should be one of the factors considered and integrated into the whole process of drug choice.

• It was agreed that the behavioural sciences would be essential for producing any permanent changes in prescribing habits and that multidisciplinary teams would be necessary to achieve progress. It was also considered that the core groups to take the process forward would consist of clinical pharmacologists, medical educators and drug utilisation clinical pharmacists.

3. It was felt that for early implementation of a postgraduate programme the best organisation to approach could be the Postgraduate Medical Council of NSW which is well established with clinical teachers in all hospitals that have accredited junior medical staff. Some participants felt that it would be unfortunate to try to produce generalisations from a model that is not available in other areas. The consensus seemed to be that we have so little information and so few resources in this area that the process must start somewhere as a matter of urgency. It would therefore be appropriate to use the NSW system for pilot studies both to obtain information and to trial teaching programmes.

Proposed action

• Liaise with NSW Postgraduate Medical Council to implement simple teaching exercises, (e.g. how to use guidelines) and obtain information about prescribing habits.

• Develop strategies to encourage senior medical staff to be aware of their role as prescribing models and to encourage them to supervise junior doctor prescribing.

• Encourage team approaches within institutions to acknowledge the vital role of nurses and pharmacists in prescribing.

• Encourage development of national (and supranational) drug utilisation review activities including the development of multidisciplinary guidelines for Australasia.

• Consider the appointment of an Australasian co-ordinator to carry the process further.

Recommendation

It was agreed that all recommendations arising from the meeting should be referred back to ASCEPT which had helped meeting should be referred back to ASCEPT which had helped to sponsor the meeting. The Clinical Interest Group of ASCEPT would then be asked to prioritise recommendations and determine appropriate mechanisms for obtaining resources. It would be likely that some recommendations would be for specific research projects that could be referred to PHARM or other sources for possible funding.

All agreed that the conference had been extremely valuable but like many such exercises it raised more questions than it answered. It had addressed an issue not previously considered in any detail and had exposed our major level of ignorance in this vitally important area.