Fewer drug prescriptions would save lives and money

Lives and money would be saved if a more cautious approach were taken by medical professionals who prescribe drugs, according to a new study from the University of Illinois at Chicago College of Pharmacy.

The study appears in the online edition of the Archives of Internal Medicine as part of the journal’s “Less is More” series.

According to Bruce Lambert, co-author of the paper and UIC professor of pharmacy administration, several studies over the past decade have concluded that the use of many new and frequently prescribed medications was either harmful or not beneficial to patients.

Using the prior research as a guide, 24 principles were developed that can help prescribers avoid excessive and harmful prescribing, said Lambert, director of UIC’s Center for Education and Research on Therapeutics.

“None of these principles are particularly novel, nor should they be terribly controversial,” he pointed out. “But taken together they represent a radical shift in the way clinicians think about and prescribe drugs.”

The radical shift is known as “conservative prescribing,” and if adopted by every prescriber, could save many lives and dollars, Lambert said.

Physicians need to move away from the mindset that leads them to heavily prescribe the “latest and greatest” new drugs, to “fewer and more time tested is best,” stated Dr. Gordon Schiff, associate professor of medicine at Harvard University, who co-authored the report. Medical and pharmacy schools should not solely teach the pharmacology of drugs, but principles that would make practitioners better and more cautious prescribers and users of drugs, he said.

Some principles of conservative prescribing:

Think beyond drugs. Consider non-drug therapies such as diet, exercise or physical therapy; look for and treat underlying causes rather than just mask symptoms with drugs; emphasize prevention rather than treatment.

Practice strategic prescribing. Defer drug treatment if drugs can be safely started after a trial of non-drug therapy. Avoid frequent drug switching; be circumspect about unproven drug uses; start treatment with only one new drug at a time.

Watch for adverse effects. Suspect drug reactions when patients report problems; be aware of withdrawal syndromes; educate patients about side effects so they can anticipate and report reactions.

Exercise caution regarding new drugs: Seek out unbiased information sources; wait until drugs have proven safe on the market; be skeptical of markers such as improved laboratory test values rather than true clinical benefits; avoid stretching to include patients or diseases different from those in the clinical trials; avoid seduction by molecular studies that have no proven outcome benefits; beware of reporting that highlights positive trials and hides those that fail to show benefit.

Work with patients for a shared agenda. Don’t automatically yield to patient requests for drugs; consider non-adherence before adding additional drugs; avoid restarting previously unsuccessful treatments; discontinue any medications that are not needed or not working; and respect patients’ own reservations about drugs.

Consider long-term, broader impacts. Weigh short-term benefits against long-term outcomes and ecologic impacts. Recognize that improved prescribing and better monitoring may outweigh marginal benefits of new drugs.

The UIC Center for Education and Research on Therapeutics is one of 14 such centers in the United States to study how consumers and clinicians make critical treatment decisions about therapeutic products and interventions. The program is funded by the Agency for Healthcare Research and Quality (AHRQ), part of the US Health and Human Services department.

Other co-authors on the study were Dr. William Galanter, associate professor of clinical medicine; Amy Lodolce, clinical pharmacist, pharmacy practice; and Michael Koronkowski, clinical assistant professor, pharmacy practice, all of UIC.

SOURCE: “Principles of Conservative Prescribing” by Gordon D. Schiff, MD, et.al. Archives of Internal Medicine. Published online June 13, 2011. ABSTRACT

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