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This article explores the current confusion and debates surrounding self-medication and prescription practices. Topics include the possibility of wider access to medications, the influence of the internet, nurse prescribing, patient safety concerns, the role of pharmaceutical industry, and the need for objective data. It also discusses the implications of medication availability over the internet and the role of the FDA in regulating medication access.
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Online Medication Farrokh Alemi, PhD Based on Grahame-Smith, D. G. CBE lecture
Confusion on What Works • Self medication is allowed in some societies • Medication requires physician prescription • Non-physicians can prescribe
What shape will wider access take? • Extension of OTC categories. • Nurse & pharmacist prescribing. • Other professional health care staff prescribing, e.g. optometrists, chiropodists, health visitors, paramedics. • The influence of the internet. • Patient self-management. • Response of the pharmaceutical industry. • The special case of ‘life-style drugs. Objective data is needed
Why are we so restrictive about prescribing? • Professional restrictive practice? • Powerful drugs potentially dangerous to patients and others. • Dangerous in disease, e.g. anticoagulants. • Controlled drugs (addiction). • Erroneous self-diagnosis and therefore wrong medicine
Why now? • The need to save money. • Patient convenience. • Perceptions of Doctors' ignorance. • Promotion of medical ‘team’ activity. • The factor of patient power. • Change in culture • Improved patient care -- genetics.
Nurse Prescribing • Virginia does not allow but Maryland does for mental illness • England & Canada are allowing more nurse practices
Nurses attitudes towards prescribing • Prescribing is complicated and nurses recognize that. • The clinical risks are considerable in many cases. • Safety is a major concern. • Linked to safety is the risk of litigation if things go wrong. • Responsibilities and workload increase. • Less close nurse-patient contact ensues because of the distraction of prescribing. • Added to all this, nurses do not get paid more for doing it! Plainly a mug's game! 30% actually doing it
Safety • Truly independent prescribing could be dangerous • Doctors make mistake too • Pharmacists could act as a gatekeeper and advisor • Law suits can reduce errors
Medication on Internet • Illegal drugs on Internet • Legal drugs • Medical prescribing over the internet. • The obtaining of medicines over the internet by patients themselves. • The supply of information.
Medical Prescribing Over Internet • Questionnaire assessments without physical exam • Assessments via telemedicine • Second opinions • Lack of follow up • Across visit information
Patients getting medicines over the Internet • Life style medicine pushed • Medication available at lower cost • Medication available at lower quality
Supply of Information • Growth in medical information • Who is better informed, the patient or the MD? • Misleading information
Life Style Drugs • Industry pushed • Changing norms • Based on patient preferences not medical needs
What is needed from the industry? • Simplification of prescribing • Presentation of information • Implications for advertising • Clarification of safety issues of OTC drugs
FDA’s role • Restricted from OTC drugs • Cumbersome data collection and communication means • Bureaucracies are naturally absorbed by industries they regulate • Work after government jobs • Who is willing to listen and engage me
Your Opinion What changes you like to see?
