Are You Following These 4 Practical Prescribing Principles?

Most often, when I read research articles, I find them interesting, but not directly applicable to my practice. Or, the article presents an interesting perspective, however the research is young and not widely tested. Recently, however, a journal article was recommended to me that proved to be practical and directly applicable to my work as a nurse practitioner. The article? Principles of Conservative Prescribing published in the Archives of Internal Medicine

I am cost conscious prescriber. Most of my patients cannot afford brand name medications such as those advertised on TV. The patients I treat are on Medicaid, or pay out of pocket for care. However, there are still times when the antibiotic a patient needs is pricey, or, a more expensive medication is the best option for the patient. There are also times when I may not be sure of the most cost effective medications on the market, or the most effective method for prescribing to treat a certain diagnosis. 

Principles of Conservative Prescribing addresses the skill of prescribing, not only as it relates to cost, but also efficacy. Unlike other skills nurse practitioners must master for their practices such as procedures, prescribing is accompanied by significant external pressure. Patients request medications suggested by friends and family, or those advertised in the media. Pharmaceutical companies encourage prescribing habits by dropping by clinics and hospitals to network with providers. Nurse practitioners must prescribe with awareness to filter these influences and make the best decisions when it comes to treating their patients. 

I recommend you read Principles of Conservative Prescribing for yourself, but if you'd like the quick version, here are the most insightful concepts I took away from the publication. 

Use only a few drugs and learn to use them well

Obtaining an in depth knowledge of a handful of drugs is better than prescribing with more breadth. Drugs are complex. They interact with one another. They have side effects. Higher quality prescribing occurs when providers use a more limited formulary. 

Be skeptical about individualizing therapy

According to physician Gordon Schiff, author of the article, "...individualizing therapy can also be a code word for unscientific trial-and-error medicine. Individualization is a mantra of the pharmaceutical industry when it wishes to dismiss disappointing trial results, arguing that they apply only to average patients and not necessarily to the individual patient". Individualized therapy is the buzz these days. Proceed as an informed prescriber. 

Do not rush to use newly marketed drugs

Older drugs are not only generic and therefore less expensive, they also have a proven track-record. The more patients that have been exposed to a medication, and the longer the medication has been on the market, the more we learn about side effects, proper dosing, etc. Data shows that it often takes 5 to 10 years to identify negative side effects of medications. So, when possible, it's best to look to the classics for cures.

Avoid mistakenly prescribing additional drugs for problems, failing to appreciate the potential for patient non-adherence

The first questions you should ask a patient when you notice a prescribed medication is not having the intended effect is "Are you taking it as directed?". Adding new drugs or increasing dosages to remedy a health problem does no good if the patient is not taking the medication, or taking it incorrectly. According to the article's authors, providers "consistently underestimate the extent of this problem". 

Principles of Conservative Prescribing is full of other tips for effective, responsible prescribing practices for nurse practitioners. The advice is basic, practical, and easily applicable to practice. I highly suggest downloading the read and checking it out for yourself. 

Nurse practitioners - what principles do you adhere to for safe and effective prescribing?

 

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