Beruflich Dokumente
Kultur Dokumente
Example: patient 1 (G to GP) You sit in with a general practitioner and observe the following case : A 52-year old taxi-driver complains of a sore throat and cough which started two weeks earlier with a cold. He has stopped sneezing but still has a cough, especially at night. The patient is a heavy smoker who has often been advised to stop. Further history and examination reveal nothing special, apart from a throat inflammation. The doctor again advises the patient to stop smoking, and writes a prescription for codein tablets 15 mg, 1 tablet 3 times daily for 3 days.
Choosing a treatment and writing a prescription seems easymore difficult than it seems Requires a quite complex process of professional analysis, knowledge & systematic thinking scientific process clinical process therapeutic process
Rational Treatment
The process of choosing a treatment
Scientific process
Problem Therapeutic Objective Choose treatment Start treatment Monitor and Evaluation
Treatment for suppres dry cough advice & drug therapy /P-drug P-drugs base on efficacy, safety, suitability, cost
prevent a lot of unnecessary drug use avoid unnecessary prophylactic prescribing to discuss your therapeutic objective with the patient before starting the treatment pharmacotherapy, non pharmacotherapy, or combination Not drugs as a placebo
PLACEBO REACTIONS IN
Headache Diarrhea Cold Neurosis Dysmenorrhea Hypertension Sea sickness Rheumatism Cough Migraine Angina Pectoris 62 % 58 % 45 % 34 % 24 % 17 % 58 % 49 % 41 % 32 % 18 %
Case 1 :
Girl, 4 years, slightly undernourished. Watery diarrhoea without vomiting for three days. She has not urinated for 24 hours. On examination she has no fever (36.8oC), but a rapid pulse and low elasticity of the skin.
Case 2 :
Woman, 24 years. Consulted you 3 weeks ago, complaining of constant tiredness after delivery of her second child. Slightly pale sclerae, but normal Hb. You had already advised her to avoid strenuous exercise. She has now returned because the tiredness persists and a friend told her that a vitamin injection would do her good. This is what she wants.
Problem ? Ther. objectives help her reduce physical and emotional overload. non pharmacotherapy
(it may be necessary to involve other members of the family)
Intervention of therapy
How do you manage to choose the right drug for each patient in a relatively short time? By using P-drugs!
Personal Formulary
P-Drugs
The drugs you have chosen to prescribe regularly, and with which you have become familiar. They are your priority choice for given indications personal , priority Not only the name of drugdosage form, dosage schedule, duration of treatment Formulary essential drugs Enable you to avoid repeated searches for a good drug in daily practice You must up date your P-drugs evidence base
2. Specify the therapeutic objective 3. Make an inventory of effective groups 4. Choose a group according to criteria: Efficacy, Safety, Suitability, and Cost Conclusion: Active substance, dosage form, Standard dosage schedule, Standard duration
How & not What to choose treatment
Safety
Side Effects
Suitability
Contraindications
Safety
Side Effects
Suitability
Contraindications
Safety
Side Effects
Suitability
Contraindications
0.5-30 min 0.5-7 hours 1 - 24 hours 2-30 mnit 0.5-4 hours 0.5-10 hours 1-5 hours 0.5-4 hours -10 hours
4.Start treatment
write prescribing
Prescribing must be complete & every country
has its own regulations Name and address of the prescriber, with telephone number (if possible) Name of drug, dosage form, dosage scedule & duration of treatment Clear hand writing may be print out
} ?
Doctor explained about taking drugs (why & how). The doctor just keeps on talking & talking doesnt encourage a dialogue. 50% Px do not take prescribed drugs correctly (irregularly or not at all)
Patient adherance
Therapeutic success
Information
In some studies less than 60% of patients had understood how to take the drugs they had received. Information should be given in clear, common language Ask patients to repeat in their own words some of the core information, to be sure that it has been understood. Information A functional name, such as a heart pill is often easier to remember and clearer in terms of indication. Make a simple aids (leaflet, figure etc) Information to family/ other person for baby/elderly patients, invalid patients or non cooperative should be assitance to take drugs
personal formulary
- P-drug & P-treatment - information that need for P-drug