Considerations when prescribing: Enhancing access to care and promoting patient safety
When it comes to the prescribing process, there are ways the family physician can improve patient access to care and promote patient safety. Here we summarize some practical, easy-to-implement considerations that are sometimes overlooked.
A long-standing issue with medication-prescribing is cost. With 40% of Canadians lacking private drug coverage, one in five families may report an inability to use a prescription because of its cost.1To address uncertainties regarding which medications are covered, we compiled a list of online formularies by province/territory, where clinicians can easily search up medications to check if they are covered under government plans (Table 1).
Medication-ordering errors also lead to adverse patient outcomes more often than one might think. 30-70% of these errors can be prevented through an independent double-check by a pharmacist, but the utility of this independent double-check is often not maximized if the family physician does not include pertinent details on the prescription.2. Two key pieces of relevant patient information that are often missed are the specific indication when prescribing an anti-biotic, as well as the weight of the patient when prescribing high-alert or pediatric liquid medications that require appropriate weight-based dosing.
Furthermore, a patient-centred approach to prescribing requires the family physician to allocate time during appointments to discuss factors that are important for patient safety and adherence. It is important to discuss naloxone kits when prescribing opioids. Most opioid overdoses are accidental, with prescription opioids significantly contributing to opioid-related harm.3 These naloxone kits are dispensed by community pharmacists, often free of charge, or accessed without a prescription from community sites.4 Discussions about compliances aids for chronic conditions should also take place, as medication adherence for chronic conditions may be as low as 50%.5 One solution is blister package preparation, which has been shown to improve adherence when introduced early.6
Some of these changes, such as the introduction of a blister package, would require communication with the pharmacist in advance to allot adequate time for medication verification and package preparation. Consideration for the pharmacist—such as through using digital prescriptions instead of hand-written or double-checking that faxed prescriptions are confirmed as “sent”—helps ensure timely delivery of care to the patient. If digital prescriptions are unavailable, handwritten prescriptions should include secondary patient information, such as date of birth, to save time in verifying patient identity with the pharmacy. All in all, safe and efficient prescribing emphasizes the synergy of interdisciplinary healthcare collaboration between the family physician and pharmacist, and these considerations can go a long way in improving patient care.
Erica Ai Li is a second-year medical student at Schulich School of Medicine and Dentistry, London, Ontario.
Aileen Liang is second-year medical student at Schulich School of Medicine and Dentistry, London, Ontario.
Dr. Jeffrey Gutierrez is a community pharmacist practicing in London, Ontario. He completed his PharmD at Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
References
1. A Prescription for Canada: Achieving Pharmacare for All. Government of Canada. 2019. https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/implementation-national-pharmacare/final-report.html
2. Wheeler AJ, Scahill S, Hopcroft D, Stapleton H. Reducing medication errors at transitions of care is everyone's business. Aust Prescr. 2018;41(3):73-77. doi:10.18773/austprescr.2018.021
3. Antoniou T, Martins D, Campbell T, et al. Impact of policy changes on the provision of naloxone by pharmacies in Ontario, Canada: a population-based time-series analysis. Addiction. 2021;116(6):1514-1520.
4. Publicly-funded take-home naloxone in pharmacies across Canada. Canadian Pharmacy Association. 2019. https://www.pharmacists.ca/cpha-ca/assets/File/cpha-on-the-issues/Naloxone_Scan_Nov_2021.pdf
5. Conn VS, Ruppar TM, Chan KC, Dunbar-Jacob J, Pepper GA, De Geest S. Packaging interventions to increase medication adherence: systematic review and meta-analysis. Curr Med Res Opin. 2015;31(1):145-160.
6. Jensen ML, Jørgensen ME, Hansen EH, Aagaard L, Carstensen B (2017) Long-term patterns of adherence to medication therapy among patients with type 2 diabetes mellitus in Denmark: The importance of initiation. PLOS ONE 12(6): e0179546.
