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Patient factors in prescribing
Patient factors in prescribing. Despite this, clinicians often feel like they lack the knowledge or confidence to prescribe an effective exercise regime for their patients. , 2016), and antibiotic inappropriate prescribing (Fleming et how antibiotic prescribing can be inuenced (e. Gathering sufficient initial information to inform the prescribing process is a vital step and requires the establishment of a therapeutic relationship where the patient is invited by the prescriber to tell their health story. Social prescribing is the formalised process by which primary care physicians either directly or indirectly link primary care patients with non-medical interventions which aim to reduce the burden of health-care concerns. 1 Little is known about the clinical efficacy or patient acceptability of formulations in use at that time, but it is thought that prescriptions were recorded on clay tablets, and 1. Jan 10, 2018 · The identified factors showed that prescribing is not only geared for patient benefit, but also towards personal interest. Contributing causes included work environment, team, task, individual and patient factors. 16 22–24 Reducing AB prescribing in primary care is therefore highly dependent on successful management of patient expectations 25–27 and on shared decision-making. 52 If, after discussion, you still think the treatment or care would not serve the patient’s needs, you should not provide it. Mar 6, 2021 · Several demographic and clinical characteristics, including factors suggesting lack of care coordination and increased clinical complexity, were found to be associated with the new prescribing of potentially inappropriate medications. Most drug classes today include an array of similar products that compete for essentially the same population of patients, and health plans typically choose a small subset of these The risk of experiencing this reaction has been shown to be significantly higher in patients with the human leukocyte antigen allele HLA-B*5701, 14 and current HIV treatment guidelines recommend routine screening for the presence of this genetic susceptibility in patients before prescribing this drug. Before prescribing opioid therapy for acute pain, clinicians should discuss with patients the Oct 13, 2017 · Some providers believe that their patients expect to receive prescriptions for antibiotics 20 and, in addition, that high patient satisfaction scores depend upon the receipt of such prescriptions Feb 1, 2019 · Pediatric medical errors and patient harm both differ in several ways from the errors and harms associated with adults. 13 Errors in prescribing, dispensing, and administering Social prescribing describes the process by which health-care seekers are provided non-medical interventions that seek to treat their health-care query. It has been suggested that 1 in 30 patients are affected by preventable medication-related harm, with the highest prevalence (around 50%) occurring during prescribing 2 . Improving antibiotic prescribing in all health care settings is critical to combating antibiotic-resistant bacteria. Jul 1, 2019 · In this CAPC course, Patient Factors that Influence Prescribing Decisions, learn to incorporate patient and family factors into a safe pain management strategy and identify barriers to the efficacy of the pain management plan. As this body of literature is evaluated, the fact that there are crucial areas about which we know Sep 29, 2023 · Macro factors: The macro environment comprises a range of external factors, such as clinical setting, workforce, legal and ethical frameworks, and cultural and language factors. ” A study in Scottish general practice showed the patient character-istic most strongly associated with high risk prescribing was the number of drugs prescribed. Jun 29, 2022 · This scoping review will describe off-label antipsychotic medication prescribing practices (ie, prescribing for clinical indications other than a primary psychiatric diagnosis) in the acute care setting and will synthesize perceptions on prescribing practices among patients,families and healthcare professionals using qualitative methods and the Theoretical Domains Framework to identify factors Patient factors – a rational prescription also takes into account factors such as co-morbidities and concurrent medicines that might influence the benefit–harm ratio by altering pharmacokinetic handling or pharmacodynamic effects. whether you can share information appropriately after an episode of care (see paragraphs 53 to 58 ). This literature covers the extent of the problem of medication errors and adverse drug events, the phases of the medication-use process vulnerable to error, and the threats all of this poses for patients. Evidence suggests that errors occur more frequently in children than in adults and may be up to three times more […] Jun 8, 2023 · Purpose The development of guidelines tailored to the departments’ needs and counselling during ward rounds are important antibiotic stewardship (AS) strategies. It has developed over the years since the Cumberledge report in 1986 recommended non-medical prescribing from a limited list for community-based nurses (Department of Health and Social Security, 1986; Cope et al, 2016). This knowledge could inform the design of interventions and polic … Nov 30, 2022 · When selecting medicines for children, it is important to consider factors such as the child’s age, swallowing ability, ease of administration and accessibility of suitable formulations of the product. Foundation doctors made more errors than other doctors, but undertook the majority of prescribing, making them a key target for intervention. Factors that were drug-related or that involved policy-related programs tended to be more influential than indirect factors. Prior to this, the patient was using tramadol 50mg three times per day for analgesia. Sep 22, 2023 · Effective prescribing requires an understanding of the patient’s individual needs, preferences and values. , 2009), decrease inappropriate prescribing in elderly patients (Riordan et al. [1] Beyond the challenge of predicting a drug’s therapeutic value to a new patient, an unrelated factor further complicates the prescribing decision: plan formularies. Conclusions: Those who seek to implement programs to alter medication use should recognize and employ factors that are most influential in the decision-making process. A mean value of prescribing errors with the potential for adverse effects in patients of about 4 in 1000 prescriptions was recorded in a teaching hospital. prescriber, patient characteristics). The model displays an array of direct and indirect commercial impacts on physician prescribing decision. 7 Approximately 60% of U. Nov 13, 2023 · The BMJ’s new “practical prescribing” series aims to improve decision making. 81 Providing medication Nov 17, 2023 · Introduction Consultation has been defined as “a process for converting a problem into a plan” [1] . The role of the prescriber is to ensure […] Jan 6, 2023 · Indeed, physical activity and exercise prescription should be a part of every patient’s treatment plan, but the prescription needs to be individualised to their needs. However, there are many instances where prescribed medications resulted in patient morbidity and mortality instead. Another example is that of glucose-6 Oct 16, 2023 · Optimizing inpatient antibiotic prescribing results in improved treatment effectiveness and patient safety, minimizes the risk of antibiotic-associated infections (e. vasodilators, central Background: Suitably qualified non-medical healthcare professionals may now prescribe medicines. Mar 18, 2024 · Background. The reported incidence of medication errors in acute hospitals is approximately 6. Our goal is to understand patient, provider and context Understanding the condition Patient’s understanding of the causes of acute condition/symptoms A more protracted negotiation between a patient and a dentist in GDP took place where the patient strongly desired antibiotics but the dentist (who had not previously treated this patient) declined to prescribe them, explaining they were not Mar 6, 2021 · For example, provider and health-system factors leading to prescribing of PIMs are thought to include lack of communication between different prescribers, providers’ lack of knowledge in geriatric medicine and pharmacology, and insufficient time allocated to prescribing. A lack of public understanding of non-medical prescribing remains, even with patients treated by NMPs. After taking four doses of MST, the patient was confused, hallucinating and drowsy. g. genetic factors, physiological changes with age and pregnancy, or impaired kidney, liver, or heart function) Take into account the patient’s ideas, concerns, and expectations Sep 23, 2021 · Nurse prescribing has become well established in the UK. lack of safety concerns) and the lack of proactive medication reviews (e. The use of valid and reliable practice guidelines could reduce the negative impact of wide ranges of factors and promote the rational prescribing effectively. Take into account the patient’s medication history before prescribing. Prescribing decision-making can be complex and challenging; a number of influences have been identified among medical prescribers but little appears to be known about influences among non-medical prescribers (NMPs). vasodilators, central 4 days ago · Introduction The principle of ‘patient safety’ is preventing avoidable patient harm in healthcare 1 . A greater understanding of key determinants of contemporary prescribing in UK general practice could inform strategies to promote evidence-based prescribing. 1,2,5-7 Prescribing errors involve underlying factors such as the knowledge and skills of the prescriber, in addition to supervision, patient factors, and prescribing system failures. Nurse prescribing is now an integral part of advanced level practice. 1 1). Primary care Nov 28, 2023 · History taking skills are fundamental for safe pharmacy practice and preparing to prescribe [1,2] . The patient was admitted to hospital and stayed for six days after receiving There is a large and growing body of research addressing medication safety in health care. Information for patients about the licence for their medicines; Sports Objectives Despite widespread availability of evidence-based guidelines to inform rational use of medicines, considerable unwarranted variation exists in prescribing. patient wishes, fear of depression recurrence), few perceived continuation problems (e. Methods A retrospective prescribing-analysis of 3 months (P1, P2 Oct 19, 2020 · Patient factors influencing decision-making on antibiotic prescribing include compliance with patient expectations and pressures. Oct 1, 2019 · Medication errors are complex and involve multiple stakeholders. For example, patient expectations (social influence) was identified as a factor influencing prescribing decisions, and a number of BCTs (problem solving, goal setting and information about health consequences) were identified Apr 21, 2021 · Patient factors such as lack of knowledge regarding the disease, fear of severe illness, patients’ expectation and demand, as well as misconceptions about antibiotic effectiveness in treating viral URTI may put pressure on the attending doctors to prescribe antibiotics. 28–31 It is known that clinicians weigh Jun 2, 2019 · Improving patient safety is a priority in healthcare, and reducing prescribing errors and identifying factors that predispose risk can help to achieve this (Royal et al, 2006). Mar 21, 2024 · Introduction: Prescribing long-term opioid therapy is a nuanced clinical decision requiring careful consideration of risks versus benefits. For over-the-counter medications, prescriptions Nov 4, 2022 · Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider opioid therapy for acute pain if benefits are anticipated to outweigh risks to the patient. 9,10 During 2013 in the United States Results A range of factors across 12 domains of the TDF were found to influence prescriber behaviour, and 40 BCTs were identified as supporting appropriate prescribing. (Fig. There are 5 different levels of scheduling for controlled medications (I-V), with schedule I having the tightest controls and V being the least restrictive. Prescriptions are written for controlled and noncontrolled medication categories. The aim was to analyse the impact of AS ward rounds and institutional guidelines as well as patient-related factors on antibiotic use in vascular surgical patients. 8 In other developed countries, approximately 80%–90% of antibiotic use occurs among outpatients. Jul 20, 2021 · To understand factors influencing patients’ adherence to treatment: Factors impacting on adherence with cardiovascular patients : Cardiovascular disease: Singapore: Kucukarslan et al. Apr 30, 2018 · This review found that patients’ views of non-medical prescribing were mixed, with many patients appreciating the time taken and holistic approach of the NMP, whereas others expressed concerns. Medication errors can happen at any step of the medication use process, but a substantial burden of medication-related harm is focused primarily on three priority A Patient Group Direction is a written direction relating to the supply and administration (or administration only) of a licensed prescription-only medicine (including some Controlled Drugs in specific circumstances) by certain classes of healthcare professionals; the Direction is signed by a doctor (or dentist) and by a pharmacist. interact with one of the patient’s dis-eases – so-called drug-disease inter-actions. Patients may prefer to access healthcare services face-to-face or through May 10, 2017 · Take into account other factors that might alter the benefits and harms of treatment; Consider other individual factors that might influence the prescription (e. Previous research on patient factors associated with the prescribing of Prescribing is a complex task that requires interpretation of evidence from clinical trials in light of individual patient factors Rational prescribing describes a logical approach that includes making a diagnosis, estimating prognosis, establishing the goals of therapy, selecting the most appropriate treatment and monitoring the effects of the Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider opioid therapy for acute pain if benefits are anticipated to outweigh risks to the patient. Establish an accurate diagnosis whenever possible (although this may often be difficult) Be clear in what way the patient is likely to gain from the prescribed medicines. Knowing whether and which patient factors are associated with physicians prescribing antibiotics inappropriately could help optimize antibiotic prescribing in the future. 80 Further, researchers have reported that there are five key factors for physicians to consider with regard to prescribing cascades. Written prescriptions for medicinal products can be traced back over 4000 years. Does the mode of consultation meet the individual needs of the patient and support safe prescribing? 21. patients only present in crisis) contributed to further antidepressant prescribing growth over time (Fig. Therefore, a consultation can be seen as a conversation with a purpose between the healthcare professional and relevant parties, for example a patient and/or a carer. If you consider this statistic in the context of an average prescriber, a pharmacist who prescribes for ten […] This discussion will help you take account of the factors that are significant to the patient and assess whether providing the treatment or care could serve the patient’s needs. Understanding the characteristics of each formulation can assist with choosing the most appropriate medicine for a child. Be clear about the reasons for prescribing. 2 Patient behaviours Dietary habits and how drugs are taken can also affect pharmacokinetics Feb 20, 2023 · Factors such as an inadequate workplace where prescribers are distracted or interrupted during prescribing, 28, 34, 45 inadequate patient information due to impaired CPOE access, multiple, hybrid (electronic and paper) or missing medical charts, 28, 29, 31, 32, 34, 36, 45 inadequate or variable training on information systems for (new Feb 12, 2024 · Medication errors are the most common and preventable cause of patient injury. Prescription errors account for 70% of medication errors that could potentially result in adverse effects. For example, elderly patients are particularly vulnerable to adverse effects (e. 5 per 100 admissions. , 2012: Exploring patient experiences with prescription medicines to identify unmet patient needs: Implications for research and practice: Focus group Assuming that all pharmacists who would refuse to refill Mr T’s prescription would be acting in good faith and exercising independent professional judgment in the patient’s best interests and that pharmacists’ judgments are supported by a chain-of-command and relevant boards of pharmacy, Dr O’s position would become less tenable because it would appear very likely that the pharmacists The prescribing cascade has been incorporated into many deprescribing protocols, 65,78,79 and process mapping can be used by clinicians to identify prescribing cascades in their patients. , 2016; Walsh et al. While prescribing remains one of the most common interventions by the NHS, the impact of drug errors on patients, the prescriber and organisations is increasing ( Barber . 5-7 Jan 3, 2014 · Prescribing errors are frequent and of complex causation. Our goal is to understand patient, provider and context factors that impact the decision to prescribe opioids in patients with cancer. antibiotic expenditures for humans are related to care received in outpatient settings. Supplementary prescribing: A voluntary partnership between a doctor or dentist and supplementary prescriber, to prescribe within an agreed patient-specific clinical management plan (CMP) with the patient’s agreement. Before prescribing opioid therapy for acute pain, clinicians should discuss with patients the Jul 1, 2019 · Patient-related factors include having multiple medical conditions managed by multiple subspecialist physicians, having chronic mental health conditions, and residing in a long-term care facility A patient was prescribed MST (morphine) 60mg twice per day for arthritic pain as an initial dose. 2. This article introduces the principles of person-centred practice and how they can be implemented in pharmacist prescribing. Such errors are also frequent in ambulatory settings [4–6]. Jul 1, 2016 · Patient factors – a rational prescription also takes into account factors such as co-morbidities and concurrent medicines that might influence the benefit–harm ratio by altering pharmacodynamic handling or pharmacodynamic effects. This study explored (1) current influences on prescribing in general Jun 12, 2019 · These studies indicated that, as far as patient care is concerned, a multidisciplinary team is better indicated to reduce inappropriate or multiple prescribing (Garcia, 2006; Kaur et al. Children are at greater risk of medication errors than are adults because of childhood development, demographics, dependency on parents and other care providers, and the different epidemiology of medical conditions. , Clostridioides difficile infection: [CDI]) and the selection and transmission of antimicrobial-resistant bacteria in individual patients within and across hospitals, countries Aug 20, 2016 · The context within which prescribing occurred was important in influencing prescribing decision-making; a team approach to prescribing with peer support and encouragement from doctors helped to build participants’ confidence and helped them to resist patient pressure to prescribe (32, 33). S. Micro factors: These include clinical competence, interpersonal skills, personal beliefs, physical and emotional factors, and patient/clinician relationship dynamics. [1] These errors typically involve administering the wrong drug or dose, using the wrong route, administering it incorrectly, or giving medication to the wrong patient. Further, it may be important to consider differences Jan 9, 2024 · Prescribing clinicians are often visited by patients looking for medications to remedy their chief complaint. At the time of publication, nurses, midwives, optometrists, pharmacists, physiotherapists, podiatrists, radiographers Apr 5, 2021 · Shared care prescribing; Raising concerns 83-85; Reporting adverse drug reactions medical device incidents and other patient safety incidents 86-92; Reviewing medicines 93-97; Repeat prescribing and prescribing with repeats 98-102; Prescribing unlicensed medicines 103-109. Jun 17, 2017 · The ongoing pressures to maintain prescribing (e. These errors affect around 13% of paediatric prescriptions and can have lethal consequences [2,3] . This article has discussed the traditional approach to prescribing in which individualised drug selection is based on clinical trial evidence gathered from groups of similar patients mixed with best-guess judgements about the variability introduced by specific patient and drug factors. Prescribers need the skills to effectively extract relevant information from an individual, make a […] Oct 29, 2023 · Prescription errors, dispensing errors, administration errors, and monitoring errors are the most common types of medication errors. Jun 30, 2017 · Kyle et al. Factors contributing to medication errors include patient Mar 21, 2024 · Introduction Prescribing long-term opioid therapy is a nuanced clinical decision requiring careful consideration of risks versus benefits. These factors could then be considered more Dec 15, 2020 · Pharmacotherapy is the most common therapeutic intervention in healthcare to improve health outcomes of patients. May 9, 2023 · Introduction Paediatric medication errors — more specifically, prescribing errors — are some of the most important threats to patient safety in children [1] . 29 made efforts through literature review to develop a qualitative prescribing model that assesses the influence of economic factors on physician prescribing behavior. Apr 5, 2021 · patient’s needs and obtain consent (see paragraphs 34 to 38) d.
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