E-drug: Inappropriate prescribing (cont.)
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Dear E Druggers:
I've had a chance to review the Canadian study on inappropriate prescribing
that was the subject of a posting a few weeks ago. The study in question
"A preliminary review of the causes of inappropriate prescribing and its
costs in Canada" is a selected review of the literature on the topic. The
authors list 8 sources of inappropriate prescribing: lack of established
guidelines; lack of awareness of established guidelines; inexperience in
prescribing; personal characteristics of physicians; the practice of
"off-labelling"; social and professional influences; patient demands; and
promotion by pharmaceutical representatives. Other possible causes of
inappropriate prescribing such as whether physicians are paid by
fee-for-service, knowledge of drug costs, the use of restrictive
formularies, etc. are not dealt with.
I think that the authors put too much emphasis on guidelines and ignore the
reasons why guidelines are underused by doctors. The main personal
characteristic that is discussed is the gender of physicians and other
characteristics such as job satisfaction, rural/urban setting of practice,
country of qualification are not mentioned. They also do not deal with the
question of patient demand as a function of the quality of communication
between doctors and patients. Finally, as I mentioned in my earlier
message about this study I believe that they vastly downplay the influence
of pharmaceutical promotion.
The estimated Can $0.84 to $2.56 annual cost of inappropriate prescribing
includes direct and some indirect costs; however the data necessary to make
such an estimate is extremely limited and these figures should be viewed as
nothing more than a reasonable guess.
Rather than go into any more detail about the study in this message I would
be happy to respond personally to anyone who would like to know more.
Anyone interested in the study should write to:
Health Promotion Research
705 Carlaw Avenue
Toronto, ON
CANADA M4K 3K8
Joel
Joel Lexchin MD
121 Walmer Rd.
Toronto, Ontario
CANADA M5R 2X8
Phone: (416)-964-7186
Fax: (416)-923-9515
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