Evaluate the non medical influences on prescribing practice.

Topics: Pharmaceutical industry, Pharmacology, Pharmaceutical marketing Pages: 6 (1901 words) Published: October 14, 2013
Evaluate the non medical influences on prescribing practice.

In the UK, nurse prescribing was born out of the need to increase efficiency in the NHS by making best use of its resources. Nurse-led services are one means of improving healthcare provision and a string of legislative change has gradually broadened the scope of nurse prescribing in the UK. (Courtenay et al 2007). The role expansion of nurses to meet efficiency targets has meant that nurse-led services in the healthcare setting are expanding as one means of coping with a growing, increasingly ageing population. For those nurses running nurse-led services the focus for that reason, needs to be on treatment that improves the quality of someone’s life and represents an effective use of NHS resources. Prescribing is therefore one stage in making a rational treatment decision. If prescribing is to be effective, the practitioner must be able to: •Identify the problem in terms of the patient’s needs and the ultimate goal of any treatment •Break the problem down into more explicit questions, such as ‘what are the treatment options?’; ‘how well do they work?’; ‘what are the resource implications?’ •Check the evidence

In order to do this, the efficacy of treatment options must be considered. This involves considering efficacy and clinical effectiveness, which are quite different. Efficacy is when a drug is proven to have a pharmacological effect greater than a placebo which does not necessarily translate into improved clinical outcome. Clinical effectiveness is when that efficacy results in a proven clinical outcome. Knowing that a drug represents value for money is as much a part of evidence-based prescribing as clinical effectiveness. If two drugs have the same clinical effect then it makes sense to prescribe the cheapest alternative – known as cost minimisation – without any other coercement being involved. The pharmaceutical industry has traditionally denied attempts to influence prescribing behaviour, instead insisting that marketing efforts are simply intended to educate physicians on new products in order to ensure that their prescribing choices are well informed and based on the latest available evidence. (Cruddas and Gannon 2009) However, an increasing number of studies are also revealing that pharmaceutical marketing does impact on prescribing habits (Kravitz et al 2005; Grande et al 2009) and there is some evidence that these studies are beginning to exercise the minds of nurses as well as doctors. Lakeman and Cutcliffe (2009) propose that:

‘Now, more than ever, nursing needs to examine its relationship to the pharmaceutical industry and (if it is to maintain its integrity and impartiality) maintain some considerable distance.’

There are 53, 813 nurse prescribers in the UK who have recorded their qualification on the NMC register (NMC Register 2010, unpublished data) With more than 912 million prescriptions dispensed in the NHS in 2007, prescribing remains one of the most common therapeutic interventions. (The Association of the British Pharmaceutical Industry 2010) The impact of the global economic downturn on public spending is likely to make the need for cost-effectiveness in prescribing even more acute in the future and the need to influence nurse prescribers a higher priority for the pharmaceutical industry. Evidence already exists to suggest that the pharmaceutical industry actively seek out nurse prescribers through workplace visits and the offer of special events ( Kessenich 2000) and with the growing number of nurses able to prescribe this controversial aspect of professional practice is becoming more prevalent. Lipley (2000) claimed that three quarters of nurse prescribers would change their practice for a ‘glossy leaflet or sandwich’. Bearing this in mind nurse prescribers need to be aware of the potential influences on their prescribing. These may include: •Patient expectation and knowledge

Drug company promotional activities
•...
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