News Flash The 24 principles of conservative prescribing: • T hink beyond drugs: Consider nondrug therapies
Conservative prescribing could save lives, money
such as diet, exercise, or physical therapy; look for and treat underlying causes rather than just masking
symptoms
with
drugs;
emphasize
prevention rather than treatment. • Practice
strategic
prescribing:
by Sam Hostettler According to a new study from the College of Pharmacy, lives and money could be saved if a more cautious approach were taken by medical professionals who
Defer
drug
treatment if drugs can be safely started after a trial of nondrug therapy; avoid frequent drug switching; be circumspect about unproven drug uses; start treatment with only one new drug at a time. • W atch 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. • E xercise 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. • W ork with patients for a shared agenda: Do not automatically yield to patient requests for drugs; consider nonadherence 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. • C onsider 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.
prescribe drugs. The study appears in the online edition of the Archives of Internal Medicine as part of the journal’s “Less is More” series. 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, says Bruce Lambert, coauthor of the paper and professor of pharmacy administration. Using existing research as a guide, 24 principles were developed that can help prescribers avoid excessive and harmful prescribing, says Lambert, who directs UIC’s Center for Education and Research on Therapeutics. “None of these principles are particularly novel, nor should they be terribly controversial,” he says. “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 says. Physicians need to move away from the mindset that leads them to heavily prescribe the “latest and greatest” new drugs, to one where “fewer and more time tested is best,” says Gordon Schiff, associate professor of medicine at Harvard University and a coauthor of 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 says. 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, part of the U.S. Department of Health and Human Services. Other coauthors of the study are William Galanter, associate professor of clinical medicine; Amy Lodolce, clinical pharmacist, pharmacy practice; and Michael Koronkowski, clinical assistant professor, pharmacy practice.
6 | UIC Pharmacist | Winter 2012 | pharmalumni.uic.edu