Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Quality improvement expertise needed at the coalface
- Peter S Kidd (10 April 2008)
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Clinical indications - the future of prescribing is already here
- Nigel J Masters (20 April 2008)
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Reasons
- Mark E McConnell (24 April 2008)
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Psychiatric ADRs are often overlooked as being caused by current treatment.
- Millie Kieve (15 October 2008)
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Peter S Kidd, Manager of Clinical Pharmacy Services Galway, Ireland
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I have just completed a review of problems facing patients and carers in the management of adverse drug reactions. It seems quite clear to me that whilst electronic, high-technology solutions are desperately needed there is much we can do at an organisational level to improve the management of ADRs. Fundamental gaps have been identified in our organisation whcih are relatively easy to address with low-technology solutions. Most importantly ensuring that the patient is adequately informed!!! I would hope that we can implement these solutions by the end of 2008. Unfortunately there is a desperate shortage of health professionals who understand HOW to make real quality improvement gains in a highly political environment such as a large teaching hospital. In my opinion all health-care professionals need to receive training in this area at under-graduate level. This is one of many highly significant solutions to the problem of optimising drug therapy. P Kidd BPharm(Hons), MScClinPharm, PGDip(Technology Management) Competing interests: None declared |
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Nigel J Masters, General medical practitioner Highfield Surgery Highfield Way Hazlemere High Wycombe HP15 7UW
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At many surgeries across the United Kingdom some general medical practitioners are using the multi-award winning clinical indications: this medicines delivery concept informs patients about the purpose of their medication and in addition provides simple safety messaging directly onto the pharmacist label and also onto their repeat prescription request paper slip. Once implemented in practice on all repeat medication it is difficult to return to the past with prescriptions without a visible clinical indication. There is no official research published on this concept and it has yet to be automated with a computer directory of indications. Nevertheless there is no doubt in my mind that it increases safety, knowledge and efficiency in medicines management. More recently I have included lists of adverse drug and allergic drug reactions and this has been well received by patients. The patients at Highfield Surgery carry a list of their current medications with the purpose of each drug clearly stated, simple safety messages and a list of their current allergic and adverse drug reactions. This is the future of prescribing for the elderly and it is already here. For more information visit www.clinicalindications.com . Competing interests: None declared |
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Mark E McConnell, physician VA, 54601
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My anecdotal observations are that the reasons for the ADRs we often see may include: 1) Prescribers failing to realize that patients often obtain precriptions from more than one provider which can result in confusion for patients and prescribers alike. 2) The possibility of liability (whether perceived or real). That is, plavix may be added to ASA in cases where there may not be any proven benefit but where a prescriber may feel criticized if the patient has a vascular event. Oddly, it seems it is easier to explain an ADR ("We were trying to prevent a heart attack") than a natural consequence of disease. This is perhaps a result of the growing impression that we are able to "prevent" (rather than "delay") bad events. 3) Marketing 4) Finally, perhaps, the most important: Guidelines. While guidelines are good and helpful, we do not have guidelines for what to do when more than one guideline applies to a patient. And with the increase in pay-for-performance, we are at risk of treating numbers rather than patients. It is simply hard to know what to do when multiple guidelines overlap in an individual patient and I suspect the result of good intentions is overmedication. Competing interests: None declared |
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Millie Kieve, Chair APRIL charity APRIL (Adverse Psychiatric Reactions Information Link W9 2HU
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I just found the article about ADRs and would like to draw attention to a problem that I hear about on a daily basis. Some people suffer from depression that begins shortly following the prescribing of drugs for acne, and acid reflux for example. When they stop taking the drug their depression lifts. However I hear many complaints that doctors prescribe antidepressants and do not consider the possibility that current treatment may be causing depression. Recognition by doctors of risk of suicide due to sudden withdrawal from antidepressants or following sudden drug induced onset of psychosis or akathisia, could save lives. I know parents of young people who died by suicide including students of medicine and pharmacology. The sudden onset of suicidal thoughts and actions cannot be anticipated unless one has the kind of knowledge that is rarely taught in medical schools. I go to many medical meetings where adverse drug reactions are not discussed, or patient perspectives heard. To fill the gap in education I have organised a conference with leading experts on ADRs, clinical pharmacologists, doctors, academics, patient representatives and the UK's only Professor of Pharmacogenetics. This third psychiatric ADR conference will be all day,in London, on November 6 2008. Details are on the charity web site www.april.org.uk Students can register for £5. The aim is to open up the discussion and to give students an opportunity to hear experts in the field of ADRs, resulting in benefits for them and their patients in the future. Competing interests: I founded a charity to create awareness of psychiatric ADRs caused by medicines and anaesthetics. |
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