Epidemiological data are very important informations, which can be used in daily work to reduce inappropriate prescribing and reduce healthcare costs. If there are not clear benefits why any drugs are prescribed it is better to avoid polypharmacy. On the other hand if we know that there is bigger possibility for adverse drug reactions if more drugs are used (bigger polypharmacy), why they are prescribed. Secondly, If we know that 10 % patients with depression have also chronic heart failure, why we are prescribing antidepressants and antipsychotics with potential for QTc interval so often (e. g. escitalopram, paliperidone, quetiapine in high doses, antipsychotic polypharmacy)? Why we prescribe quetipaine so often po elderly psychiatric patients, if we know that 25% patients have problems with hypotension? Why we use ciprofloxacin so often If we know that every third elderly patient over 70 have psychopharmaceuticals. On the another hand again, why we do not put clinical pharmacists/pharmacologists in every country if we have good evidence (Ia evidence) that there is big benefit in reducing of medical errors, deaths and total costs. if I conclude, the epidemiological data are very important for 'constructing' 'ideal' pharmacotherapy for every patient, although its use has not been seen often in daily practice.
The answer is yes . The epidemiological data before any drug prescription not only produce reduce healthcost, is the form to contruct Medical evidence and relevance between the disease and its treatment of the subject.
Yes, it is useful to a great extent. Generally prescription of a drug depends on many other input.
I totally agree with both comments which confirmed that epidemiology is very important before drug prescribing.
As clinical pharmacist usually I use this data for avoiding serious DDIs and consequently adverse events. Also we have nice data to suggest the patients about their treatment average durations (e.g. depression, SCH etc ... ). In addition, with use of this data we can prolong patients' lives (e.g. add beta-blockers to patients with CHF etc ...).
Epidemiological data is also important in decision making, when there is need to rank what issues to tackle first and to understand the magnitude of the use. For each individual patient there are individual circumstances. An interesting use of pharmacoepidemiology data is the use of data for individual prescribers and giving feedback to their prescribing pattern compared with other prescribers as done in the Rx-Pad studies (http://www.ncbi.nlm.nih.gov/pubmed/23894178)
Another example of use not on individual patients but in decision making was the recent issue of co-prescribing of different angiotensin-rening blockers (ARBs) and the increased risk of side-effects without added benefit. EMA then did a drug utilisation study to understand better how large the problem really was (not very large) and in what group of patients it was largest (most co-prescribing in the groups with the biggest risk as well) the report is publised on ENCEPP here: http://www.encepp.eu/encepp/openAttachment/studyResult/4612
It is used, but in many cases we have not many choice and we have to use a drug , though we know the problems.
Hi to everybody!
Yes i agree that in some situations it is impossible to avoid prescribing, however this topic (epidemiology and prescribing) covers interesting field of prescribing with the knowledge of the epidemiology.
Mahsa however it is necessary to preescribe, many studies and data show that inappropriate prescribing is seen very common and often we can avoid of inappropriate prescribing with this knowledge. If You know for example that your patient has prolonged QTc (550 ms) why then you prescribe escitalopram to this patient etc ...
I think to say: ' OK we just must prescribe drug' is very arrogant answer, which is not covered by evidence-based medicine (EBM) and is not helpful for our patients. Just keep in mind, that the total cost of inappropriate prescribing is very high (1,7 million pounds in U.K. in 2007) and we can avoid it partially if we use the knowledge about epidemiology with pharmacoepidemiology.
Ivica i don't know how big is this problem in Croatia. In addition ex-Jugoslavian countries, including Slovenia, didn't establish strong clinical pharmacy in the past, which would prevent patients from serious medical errors and inappropriate prescribing. You have clinical pharmacist/pharmacologist now in your hospital who do not give the drug to the patients if serious medical error occur? I am not sure, because i see many hospitals in those countries without this policy. Clinical pharmacist must stop to dispense this drug to the patients and appropriate communication between prescriber and clinical pharmacist should be established. How drugs ordering takes place in Croatia? Via clinical ward to pharmacy without patients' names? This is one of the worst step forward serious medical errors (not only prescribing errors), which is often seen in ex-Eastern Europe.
In U.K. and USA this problem is covered by fantastic teamwork done by clinicians and clinical pharmacists. If I sum up, if we respect EBM results in clinical work (we should do, because guidelines are written with EBM use), then we should respect EBM results in the field of inappropriate prescribing (obligation to our patients)!
Best regards,
Mathew
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