Prescriber-patient communications

A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems including prescribing order communication product labeling, packaging, and nomenclature compounding dispensing distribution administration education monitoring and use. 

Non-compliance issues appear more prevalent in some non-Western cultures. One study in South Africa revealed non-compliance rates to oral neuroleptics in two-thirds of Black patients and one-half of colored patients compared to only one-quarter of Caucasians (Gillis.Trollip, Jakoet etal., 1987). Cultural and communication factors were considered to be significant barriers apart from those related to cost and social factors. Kinzie et al. (1987) reported that despite prescribing adequate doses of tricyclic antidepressants (TCAs) to depressed Asian refugees,... 

Having more than one prescriber increases the risk of inappropriate drug use (Piecoro et al. 2000, Dhalla et al. 2002). Thus, it is important that frail elderly have a physician that has knowledge of the patient s entire pharmacotherapy. It also emphasises the need for communication between different care givers. 

Elliott RA and Stewart DC (2008) A systematic review of interventions to improve medication taking in elderly patients prescribed multiple medications. Drugs Aging 25 307-324 Epstein RM, Alper BS, Quill TE (2004) Communicating evidence for participatory decision making. JAMA 291 2359-2366... 

Physicians may consciously or unconsciously communicate to the patient whether or not they are concerned about the patient s problem, or certain about the diagnosis and about the value of prescribed therapeutic measures. In the care of a physician who projects personal warmth, competence, and confidence, the patient in turn feels comfortable and less anxious and optimistically anticipates recovery. 

For a new medicine to obtain public subsidy for patients in the community, the sponsor must successfully apply for the product to be included in the Pharmaceutical Benefits Scheme (PBS). Data are required on relative cost and effectiveness, and the scrutiny of this information according to prescribed criteria is described as the fourth hurdle, that is, in addition to quality, safety and efficacy requirements that medicines must overcome, to be readily available to the Australian public. 

In some mainly rural areas the doctor may also dispense the medicines prescribed, but more usually the patient takes the prescription to a community pharmacist, also under contract with the NHS, who dispenses the medicines and claims reimbursement at predetermined rates. Unless they are exempt, patients pay a prescription charge at the time of dispensing. 

Suicidality in children and adolescents Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of trazodone or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Trazodone not approved for use in pediatric patients (see Clinical worsening and suicide risk and Children sections in Warnings). 

For infections frequently encountered outside hospitals, e.g. uncomplicated urinary tract infection in young women, surveillance of resistance data of the most likely pathogens Escherichia coli) allows physicians to prescribe empiric therapy without performing cultures in the individual patient. However, in severely ill hospitalised patients, it is necessary to take samples for culture before starting empiric therapy. Microscopy of the Gram stained smear can help fine-tune empiric therapy at an early stage. Whether the infection is community-acquired or hospital-acquired, and whether the patient has been exposed to previous antimicrobial therapy should also be taken into account when choosing empiric therapy. 

Patients noncompliance with doctors orders is a widespread phenomenon and well analyzed in the medical and social science literatures. While physicians, wedded to assumptions of rationality, often attribute noncompliance to poor communication between doctors and patients, sociologists are much more likely to stress the symbolic meanings attached to aspects of treatment, including medications. When our conversation turned to her repeated efforts to stop her medications despite the relief they were providing, Rachel contrasted psychotropic drugs with medications prescribed for physical ailments Swallowing pills to deal with emotional pain is a completely different thing. It s a much harder pill to swallow. ... 

Poor communication with the prescribing physician, coupled with a decline in cognitive abilities, make older patients particularly vulnerable to misuse of medications,... 

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