Prescribing & Medicines Management
page PM1
December 2005

Features

Focus on prescribing science will grow

In 1961, the horror of the thalidomide disaster hit the western world. This drug, promoted as a safe sedative and anti-emetic for pregnant women, caused over 10,000 severe birth deformities, the most well-known being phocomelia. One of the consequences of this terrible legacy was the realisation that pharmacology alone was not enough. We need pharmacology, of course, because an adequate understanding of its principles is a prerequisite of safe and effective prescribing and dispensing. But far-sighted researchers realised that it was also essential to study the ways in which doctors prescribed, pharmacists dispensed, nurses administered and patients consumed medicines. Studies of these practices began to be undertaken at individual, group (eg, hospital), area, regional, national and international levels.

By the 1980s the World Health Organization (WHO) labelled this tranche of studies “drug utilisation research”. This was a European activity to begin with. In the US, greater emphasis was placed on the study of the adverse effects of drugs post-marketing, which the Americans called “pharmaco-epidemiology”.

What is prescribing science?

Prescribing science includes all of the foregoing, from pharmacology to pharmacoepidemiology. All are, to some extent, interlinked and all must be understood if one is to work in the field of improving medication outcomes, whether to research, to teach or to intervene at any level. If the appalling statistics, across the developed world, of a pandemic of preventable prescription-related disease and death, are ever to be controlled,¹ then prescribing science has a pivotal role to play in keeping all health care professionals aware of the therapeutic minefield in which they operate and in guiding administrators at every level of quality assurance.

Pharmacists have always been at the forefront of the prescribing science movement in the UK and Europe. The UK was the pioneer and catalyst, through the UK Drug Utilization Research Group (UKDURG), a group of around 100 researchers. The success of this group was largely due to a young woman pharmacist, Kath Griffiths. She single-handedly organised the scientific meetings from 1988 to 1992, sent out calls for abstracts and arranged speakers and refreshments in venues as diverse as the Royal Pharmaceutical Society headquarters and London Zoo.

The DURG meeting at which the drug utilisation research movement in Europe really took roots was also organised by an academic pharmacist, Joyce Ferguson. This took the form of a large UK, Irish and pan-European scientific conference on prescribing science, held at Christ Church College, Oxford, in 1992. The following year, under a UKDURG chairman, the constitution of EuroDURG was hammered out in Stockholm and the movement has since gone from strength to strength. Its latest pan-European congress was held in Coleraine, Northern Ireland, in July. Delegates from 18 European countries attended.

To describe the breadth and importance of prescribing science, one has only to relate the seven main topics of this congress (each of which had four and a half hours devoted to it):

· Indicators of prescribing quality— their evaluation and use as feedback-led audit

· Creating nationwide prescription and morbidity databases

· Non-physician prescribing (ie, pharmacists, nurses and others)

· Measuring non-compliance (and its causes) and fostering informed concordance

· Prescribing for the elderly, children and pregnant women

· Reducing the threat of antimicrobial resistance

· Drug information centres (the bridge between pharmacology, clinical pharmacy and the prescribers)

The EuroDURG 2005 conference proceedings were published in a supplement to Pharmacoepidemiology and Drug Safety.²

Evidence is accumulating worldwide of the tens of thousands of patients harmed by prescribed medicines and the figures are likely to increase over the coming decade. As this happens, prescribing science, in all its facets, will become more and more essential as the primary monitor of patient safety and therapeutic quality.

References

1. McGavock H. Prescription-related illness — a scandalous pandemic. Journal of Evaluated Clinical Practice; 2004.10:491–7.

2. Abstracts of the European Drug Utilization Research Group conference; 2005 29 June–2 July; Coleraine, Northern Ireland. Pharmacoepidemiology and Drug Safety 2005; 14 (Suppl):S1–39.