‘Evidence-based medicine’ is the new buzz term used to describe that which virtually all prescribers have been striving for throughout their professional lives.
EVIDENCE-BASED MEDICINE
‘Evidence-based
medicine’ is the new buzz term used to describe that which virtually all
prescribers have been striving for throughout their professional lives. With
better evidence from large clinical trials, there is increasing information to
suggest that additions of several more medicines to the base package of
treat-ment can result in better outcomes. What is not known is the effect of
adopting this approach in real life. Will patients comply with all the
additional medicines or will they attempt to reduce and rationalise the number
of pills they have to take? If the latter, will they take the most important
ones or will they take a random selection such that they end up worse off than
before? So far, the large databases have been used primarily to study the
effects of medicines on patients. They have rarely been used to study
prescribers’ or patients’ behaviour. For obvious reasons, this area is complex.
It could also be perceived as being potentially threat-ening to the very
practitioners who supply the data in the first place! Nevertheless, these
problems could easily be surmounted by ensuring adequate anonymi-sation for
prescribers, and indeed this has been a feature of some of the large databases
throughout their existence. Practitioners have nothing to fear about such
developments if they are conducted in an inquir-ing mode rather than in a
potentially inquisitorial mode. Indeed, they could learn substantial amounts
from them. Guidelines and other advice from central sources now have the
potential for considerable influ-ence on prescribing decisions. Multipurpose
databases are well placed to allow study of the sequelae of this trend. This
includes not only drug utilisation studies linked to cost containment
strategies, but also much needed outcome studies that might tell if such advice
has any real clinical benefit for patients.
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