In a Perspective article in the July 28, 2016 issue of the New England Journal of Medicine, Gordon D. Schiff, MD, lead author and general internist at Brigham and Women's Hospital, and his co-authors Enrique Seoane-Vazquez, PhD of the Massachusetts College of Pharmacy and Health Sciences and Adam Wright, PhD, informatics expert at BWH call for including the purpose of medications on prescriptions to inform and enhance safety by narrowing medication choices to those indicated for a specific problem.
"Currently, even though there is a widespread commitment to sharing drug information with patients, the reason for a medication prescription is generally not recorded or shared when it is being written and is therefore missing a key piece of information," Schiff says.
The authors outline how incorporating indication into the prescription can make prescribing better and safer, stating the following reasons:
- Reduce errors including mismatches, prescribing or dispensing errors, and errors related to drugs of similar names.
- Enable patients to better understand and adhere to their medication regimens and question the necessity of a medication.
- Provides clinicians with a system to identify therapeutic alternatives to choose the best drugs for their patients' problems.
- Informs prescribers, pharmacists, caregivers and patients regarding what is being treated and what outcomes are desired.
- Reconciles list of medications by indication, rather than randomly, alphabetically, or chronologically and make duplicates and discontinued medications much easier to spot.
- Permits clearer assessments and comparisons to track and evaluate prescriptions and measure a drug's long term effectiveness.
The Perspective article points out that historically, patients were intentionally kept in the dark about the ingredients and indications for their drugs, which dates back to an 1833 article in the Boston Medical and Surgical Journal which explained why prescriptions should be written in Latin to protect patients from knowledge of the names of, and indications for, the prescribed drugs and allow the patient to rely on the skill of the physician.
With funding from the U.S. Agency for Healthcare Research and Quality (AHRQ), BWH researchers are bringing together information technology design specialists and policy leaders for a three-year project to build a prototype that will allow prescribers to start from the patient's problem and guide users toward best choices.
Due largely to logistics in the way drug prescriptions are written – previously on paper, now on computer – this deficit is one the Brigham researchers say should be fixed and are working to correct and overcome. "We will be testing our hypothesis that electronic prescribing needs to incorporate this missing link and that this system will result in a safer, more efficient way of ordering medications to benefit patients, families, prescribers, pharmacists, and other members of the health care team," Schiff said.
*Dr. Schiff is available for interviews upon request and can cite examples of how patient's lives can be saved by incorporating indications into medication ordering.
Elaine St. Peter