Editor's Choice | This Week in BMJ | Press releases
BMJ No 7121 Volume 315 Press Releases Saturday 6 December 1997 Embargoed: 00.01 hrs 5 December 1997 UK time Risk of thrombotic stroke from pill is very small Risk of thrombotic stroke from pill is very small(Case-control study of oral contraceptives and risk of thromboembolic stroke: results from international study on oral contraceptives and health of young women)In this week's BMJ, Heinemann et al reveal that women on the pill have a very slightly increased risk of thrombosis, as compared to women not using oral contraceptives. The high dose ("first generation") oestrogen pills carry a higher risk than the more recent low dose ("second and third generation") pills, but for women aged 16-44 years using modern oral contraceptives, the incidence of thrombosis is very small. Heinemann et al suggest that only three strokes in 100,000 might be attributable to the pill, but that this figure might be lessened by avoiding prescription of the pill in women who have cardiovascular risk factors, such as high blood pressure. See Paper (abstract only) p 1502 Contact:
tel: 00 49 30 9451 0120 There is a cluster of articles on the subject of prescribing in this week's BMJ. Does your doctor think that you think you need a prescription?(The influence of patients' hopes of receiving a prescription on doctors' perceptions and the decision to prescribe: a questionnaire survey)One of the first studies to measure the influence of both patients' hopes and doctors' perceptions on prescribing decisions is published in this week's BMJ. In their paper Britten and Ukoummunne reveal that evidence which suggests that patients' expectations influence GPs' prescribing is ambiguous. In contrast to previous studies, the authors found that the level of patients' hopes for a prescription exceeded both doctors? perceptions and actual prescribing - one fifth of prescriptions were identified as not medically necessary. The study also showed that one quarter of patients who had hoped for a prescription did not receive one. Doctors who felt pressurised were less likely to write a prescription if they thought that the patient wanted one and, if they did write a prescription, it was less likely to be necessary than when the doctor did not feel pressurised. The research concludes that a doctor?s perception of a patient's expectations is the strongest influence on the decision to prescribe. See Paper (abstract only) p 1506
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tel: 0171 735 8881/2 ext. 227 or 221 In a linked editorial in this week's BMJ, Greenhalgh and Gill suggest that the act of issuing a prescription is the culmination of a complex chain of decisions. Prescribing "is open to biomedical, historical, psychological and commercial influences, no aspect of which can be singled out as the 'cause' of non-rational prescribing". The authors recommend that further research be conducted to establish how different factors interrelate to influence the decision to prescribe.
See Editorial p 1482
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tel: 0171 288 5731 What can "PACT" tell us about prescribing in general practice?Prescriptions cost a total of £4.7 billion in 1995, which represented eleven per cent of all NHS spending. The general practice prescribing budget is seen by many managers and health economists as an area where there is scope for considerable savings through more cost-effective prescribing. In a paper in this week's BMJ, Majeed et al discuss the merits of PACT (prescribing analyses and cost) , which is the main source of information on GPs' prescribing in England. The authors advocate that GPs need to be aware of the valuable information available through PACT and advise that they will need to make greater use of the facility when auditing their prescribing to ensure that it is economical.Majeed et al conclude that the recent availability of electronic PACT data on the prescribing of individual drugs has allowed health authorities to look at prescribing in more detail. To make more effective use of PACT, they suggest that GPs should be given access to the electronic data and be trained in its analysis and interpretation.
See Information in Practice p 1515
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tel: 0181 725 2786 (Tues) 0171 533 5253 (Weds/Thurs). Not available on
Friday. Evidence-based practice in mental healthNew journal acknowledges an approach whose time has comeGeddes et al write an editorial in this week's BMJ, heralding the launch of Evidence-Based Mental Health, due to be published early next year. The authors state that this new journal will acknowledge that mental health services, upon which health professionals have widely disparate views, should be fundamentally evidence based and that the best available evidence could help to clarify decision making in this area. The publication hopes to provide easy access, high quality, up-to-date evidence for all clinicians involved in the field of mental health, in order that the best available care is provided for patients.
See Editorial p 1483
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01865 226840
Embargo: 00.01 hrs Friday 5 December 1997 Please contact Public Affairs Division for the text of the paper & the authors for further comment For further information, please contact:
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