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We fully agree with the sentiments expressed in Sean Ninan's letter. Prescribing is becoming increasingly challenging in every increasing numbers of our population whose needs are largely ignored in disease specific guidelines. There has been some progress however in the development of guidelines to meet the needs of adults who are complex in terms of fraility or comorbidity. As noted by the author these decisions are best made by the prescriber and patient together to make a decision individualised to that adult.
NHS Scotland has recently released an App version of its 2015 Polypharmacy Guideline [1] that may be of useful assistance to prescribers and patients in making these decisions. It outlines a useful 7 step process for prescribing. It provides a structure that starts and ends with agreeing patient specific goals and understanding of what medication they are taking and why.
Importantly it also contains information on Numbers Needed to Treat for many of the common guideline based treatments. These can be useful to prescribers when trying to get some idea of the likely impact (large or small) that an individual might expect from a treatment strategy. It also aims to give some idea of what populations the trials were based on to give some sense of how applicable and generalisable guideline recommendations may be to a specific adult.
Better understanding by prescribers of what treatments are longer term strategies aimed at populations and which are ones which an adult would expect symptomatic benefit from in the near future is we feel a useful first step in helping prescribers convey that to adults who are often burdened with a high number of medications and medication related issues on the basis perhaps of an unrealistic estimation of potential benefit.
The app is available on android, i phone [2] and desk top versions [3]
Simon Hurding Clinical Lead Therapeutics Branch , Scottish Government, Alpana Mair Deputy Chief Pharmaceutical Officer Scottish Government. St Andrew House Edinburgh
Aids to Individualised Prescribing
We fully agree with the sentiments expressed in Sean Ninan's letter. Prescribing is becoming increasingly challenging in every increasing numbers of our population whose needs are largely ignored in disease specific guidelines. There has been some progress however in the development of guidelines to meet the needs of adults who are complex in terms of fraility or comorbidity. As noted by the author these decisions are best made by the prescriber and patient together to make a decision individualised to that adult.
NHS Scotland has recently released an App version of its 2015 Polypharmacy Guideline [1] that may be of useful assistance to prescribers and patients in making these decisions. It outlines a useful 7 step process for prescribing. It provides a structure that starts and ends with agreeing patient specific goals and understanding of what medication they are taking and why.
Importantly it also contains information on Numbers Needed to Treat for many of the common guideline based treatments. These can be useful to prescribers when trying to get some idea of the likely impact (large or small) that an individual might expect from a treatment strategy. It also aims to give some idea of what populations the trials were based on to give some sense of how applicable and generalisable guideline recommendations may be to a specific adult.
Better understanding by prescribers of what treatments are longer term strategies aimed at populations and which are ones which an adult would expect symptomatic benefit from in the near future is we feel a useful first step in helping prescribers convey that to adults who are often burdened with a high number of medications and medication related issues on the basis perhaps of an unrealistic estimation of potential benefit.
The app is available on android, i phone [2] and desk top versions [3]
1. NHS Scotland Polypharmacy Guidance 2015 SIGN http://www.sign.ac.uk/pdf/polypharmacy_guidance.pdf
2. http://www.knowledge.scot.nhs.uk/home/tools-and-apps/mobile-knowledge/se...
3.http://www.polypharmacy.scot.nhs.uk/
Competing interests: No competing interests