{"id":1064,"date":"2015-07-01T12:38:13","date_gmt":"2015-07-01T12:38:13","guid":{"rendered":"https:\/\/blogs.bmj.com\/case-reports\/?p=1064"},"modified":"2015-07-01T12:39:09","modified_gmt":"2015-07-01T12:39:09","slug":"safer-prescribing-by-empowering-patients","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/case-reports\/2015\/07\/01\/safer-prescribing-by-empowering-patients\/","title":{"rendered":"Safer prescribing by empowering patients?"},"content":{"rendered":"

By Kristian Dye<\/strong><\/p>\n

For this post, I have chosen to write about a Case Report<\/a> that comes from the United Kingdom. It\u2019s about a patient with a complex set of management challenges, however none of them are rare \u2013 and the United Kingdom is almost certainly one of the best places in the world to be with such a complex constellation of conditions.<\/p>\n

So far, this does not sound like compelling global health territory, however it addresses a problem that is universal within health care systems globally \u2013 polypharmacy. This is an issue which affects certain populations more than others (for example, in elderly populations<\/a> (1), an average of 2-9 medications are taken daily, with one in six<\/a> (2) over 65s taking 10 or more daily).<\/p>\n

The issue, in this case, is further complicated by the prescriptions not all originating from a single physician. In an older person, they maybe taking antihypertensives, a statin and drugs to reduce cardiovascular risk \u2013 however, they will likely all originate with the primary care physician.<\/p>\n

\u2018The patient\u2026 is supported regularly by general practice, the school nurse, ear nose and throat specialists, general and community paediatrics, dietetics, specialist dentistry and ophthalmology\u2019<\/em><\/p>\n

From this list of involved specialties, the potential formulary that prescriptions will come from is probably as wide as in any case imaginable. This opens up an enormous range of potential drug interactions.<\/p>\n

This is a real day-to-day patient safety issue faced in all healthcare settings, whether the system is well integrated or highly fragmented.<\/p>\n

\u2018An example where the lack of an up-to-date medication list led to a potential medication-related problem was the prescription of azithromycin for an ear infection by an ENT surgeon. There is a documented drug interaction between azithromycin and domperidone, a medicine used regularly to treat the patient\u2019s gasto-oesophageal reflux\u2019<\/em><\/p>\n

The solution suggested in the case is to centralise the patient\u2019s records, but not in the way we usually imagine.<\/p>\n

Integrated health care records are usually conceived of as a centralised database that healthcare workers are able to tap into and pull down records for their patient. These systems are highly resource intensive and logistically difficult to deliver over large geographical areas. The alternative is wonderfully elegant.<\/p>\n

We trust our patients. If we ensure that when we prescribe something, we add it to a patient-held record, then we know that our colleagues will know what we have done, and are able to factor this in to their own treatment decisions. The solution in the case is a smartphone app<\/a> (3), which is highly convenient for the more than 1.75 billion smartphone users<\/a> (4) worldwide \u2013 however there\u2019s no reason why a similar approach couldn\u2019t be undertaken on old-fashioned paper for those who don\u2019t have access to the technology \u2013 in the UK we\u2019ve been doing this for child health<\/a> (5) for years.<\/p>\n

Surely, then, this seems like an easy decision. We can improve the safety of our patients, by trusting our patients. If we can trust patients with the risk of possessing the medicines, why not trust them with the records too?<\/p>\n

    \n
  1. http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4295469\/<\/a><\/li>\n
  2. http:\/\/www.bmj.com\/content\/347\/bmj.f7033<\/a><\/li>\n
  3. https:\/\/itunes.apple.com\/gb\/app\/medication-passport\/id595970381?mt=8<\/a><\/li>\n
  4. http:\/\/www.emarketer.com\/Article\/Smartphone-Users-Worldwide-Will-Total-175-Billion-2014\/1010536<\/a><\/li>\n
  5. http:\/\/www.rcpch.ac.uk\/improving-child-health\/public-health\/personal-child-health-record\/personal-child-health-record<\/a><\/li>\n<\/ol>\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    By Kristian Dye For this post, I have chosen to write about a Case Report that comes from the United Kingdom. It\u2019s about a patient with a complex set of management challenges, however none of them are rare \u2013 and the United Kingdom is almost certainly one of the best places in the world to […]<\/p>\n

    Read More…<\/a><\/p>\n","protected":false},"author":206,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[203,263,4477],"tags":[],"class_list":["post-1064","post","type-post","status-publish","format-standard","hentry","category-editors-choice","category-global-health","category-student-editor"],"yoast_head":"\nSafer prescribing by empowering patients? - BMJ Case Reports blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/case-reports\/2015\/07\/01\/safer-prescribing-by-empowering-patients\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Safer prescribing by empowering patients? - BMJ Case Reports blog\" \/>\n<meta property=\"og:description\" content=\"By Kristian Dye For this post, I have chosen to write about a Case Report that comes from the United Kingdom. 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