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.