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Healthy Skepticism Library item: 7705

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

Tully MP, Cantrill JA.
The validity of explicit indicators of prescribing appropriateness.
Int J Qual Health Care 2006 Apr; 18:(2):87-94
http://intqhc.oxfordjournals.org/cgi/content/full/18/2/87


Abstract:

OBJECTIVE: To assess, from the perspective of UK hospital doctors, the content validity and operational validity of a set of 14 previously developed explicit indicators of the appropriateness of long-term prescribing started during a hospital admission. METHOD: A combination of data extraction from medical records and qualitative interviews with a maximum variability sample of hospital doctors. PARTICIPANTS: The indicators were applied to 132 new prescriptions, intended for long-term use, prescribed for 61 patients; 36 doctors, of various grades, were purposively selected for interview. RESULTS: Appropriate prescribing was viewed as prescribing that was indicated, necessary, evidence based (using a broad meaning of ‘evidence’) and of acceptable cost and risk-benefit ratio. These concepts applied to individual drugs for individual patients, rather than at a more general, public health level. Where drugs had failed an indicator, rationales were explored. Often, it was missing data in the medical notes that had resulted in the drug failing the indicator. CONCLUSIONS: The 14 indicators were considered to have content validity, reflecting all aspects of appropriate prescribing discussed by the doctors. Their operational validity was less clear-cut, due to the lack of necessary data in the medical notes. This has implications for the use of explicit indicators for assessing prescribing appropriateness, as these hospital doctors did not consider that the data required for objective, systematic assessment of prescribing would ever be recorded in hospital medical notes.

Keywords:
Publication Types: Research Support, Non-U.S. Gov't Validation Studies MeSH Terms: Attitude of Health Personnel* Consensus Drug Utilization Review/standards* Great Britain Hospitals, Public/standards Hospitals, Teaching/standards Humans Interviews Medical Staff, Hospital/psychology* Medical Staff, Hospital/statistics & numerical data Pharmacopoeias* Pharmacy Service, Hospital/standards Prescriptions, Drug/standards Quality Indicators, Health Care*

 

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909