Influences on Prescribing Practice

Influences on Prescribing Practice

Overview

• Medication is the most common intervention in healthcare.
• The way medicines are prescribed hinges on a variety of intersecting influences.

GPhC ILOs (Institute of Learning Outcomes)

• Professional Judgment: Apply professional judgment while considering legal and ethical reasoning.
• Clinical Therapeutics: Implement principles of clinical therapeutics, pharmacology, and genomics when prescribing.
• Evidence Base: Critically appraise evidence and apply clinical reasoning for safe and logical decision-making.
• Guidelines Evaluation: Utilize national guidelines to ensure safe and cost-effective prescribing of medications.
• Legal and Ethical Consideration: Apply relevant legislation and ethical decision-making in all prescribing scenarios including remote prescribing.

Learning Outcomes of the Lecture

• Understand the framework that underpins prescribing practices for all healthcare professionals.
• Recognize the various influences affecting prescribing practices.
• Identify attributes and attitudes influencing both patients and prescribers in the prescribing process.
• Classify the modifiable and non-modifiable influences on prescribing.
• Highlight the significant role of context (e.g., prison settings) in prescribing influences.

RPS Prescribing Competency Framework

• The Consultation Steps:
  1. Assess the patient
  2. Identify evidence-based treatment options
  3. Present options and reach a shared decision
  4. Prescribe
  5. Provide information
  6. Monitor and review
• Domains of Competency:
  • Domain 1: The Consultation
  • Domain 2: Prescribing Governance
  • Emphasis on safe prescribing, professionalism, and teamwork in practice.

Key Elements of the Prescribing Process

• Factors include:
  • Prescriber: Attributes such as cognitive bias, expertise, and experience.
  • Patient: Factors like age, weight, and health literacy influence adherence and outcomes.
  • Context/Setting: Variations in care environment (community, secondary care, prison, etc.) impact prescribing.
  • Medicine: Attributes such as cost, availability, pharmacovigilance, and licensing requirements.

Prescriber Influences

• Personal Attributes:
  • Workload and decision fatigue.
  • Professional confidence and training levels.
  • Attitudes towards pain management influenced by patient pressure and clinical context.
• Professional Influences:
  • Mentorship, peer interactions, and pharmaceutical influences (i.e., sponsorship).
  • Effects of media portrayals impacting professional perceptions and decisions.

Non-modifiable Factors Affecting Context

• Clinical Guidelines: Evidence-based guidelines provide structure.
• Legal Frameworks: Laws dictate controlled drug prescribing and professional accountability.
• Ethical Considerations: High-cost drug prescribing relates to healthcare inequalities.
• Organizational Culture: Attitudes within institutions greatly affect care provisions.

Patient Influences

• Demographics: Age, gender, and specific health conditions.
• Patient Preferences: Personal beliefs and previous treatment experiences affect acceptance and adherence.
• Social Media Impact: Perceptions shaped by media can create biases and varying expectations about treatments.

Conclusion

• Prescribing is influenced by a complex interplay of medicine, prescriber attributes, patient factors, and context within which prescribing occurs.
• Understanding these influences is critical to optimizing prescription practices and outcomes for patients.

Summary of Influences

• Medicine: Attributes, availability, and guidelines.
• Prescriber: Attributes, workload, media influences, and profession hierarchy.
• Context: Legal frameworks, ethical considerations, and organizational culture.
• Patient: Age, beliefs, health literacy, and media perceptions.