6 medication 'do not dos' for GPs from the PSA
Here’s what doctors should avoid doing to reduce medication misadventure, according to the latest Choosing Wisely recommendations.
With 23% of medication-related adverse events in primary care considered preventable, the six ‘do no dos’ are aimed at preventing misadventure as a result of prescribing cascades, polypharmacy and homeopathic therapies:
- Don’t initiate treatment to treat symptoms, adverse events or side effects without first checking if they are related to a current therapy. Determine if a reduced dose, discontinuation or another treatment is needed.
- Don’t promote or provide homeopathic products as there's no reliable evidence they're effective. If patients access these products themselves, counsel them about the lack of benefit.
- Don’t dispense a repeat prescription for an antibiotic without ensuring it’s clinically appropriate.
- Don’t prescribe medications for patients already on five or more medications, or continue them indefinitely, without a medication review to determine if any can be reduced or discontinued. The review should include over-the-counter medications and dietary supplements.
- Don’t continue benzodiazepines, other sedative hypnotics or antipsychotics in older adults for insomnia, agitation or delirium for more than three months without a review.
- Don’t recommend complementary therapies unless there's credible evidence that they're effective and the benefits outweigh the risks.
The recommendations have been developed by the Pharmaceutical Society of Australia against a background of 230,000 hospitalisations a year due to medication misadventure, costing the health system $1.2 billion annually.
Pharmaceutical Society of Australia president Dr Chris Freeman says: “Prescribing data shows that close to 25% of repeat antibiotic prescriptions were dispensed more than four weeks after the initial dispensing, indicating potentially inappropriate prescribing in the community.”