Relationship And Prescribing With Patients

Patient readiness: what do patients have to be partners? The best outcomes from prescribed medicines are just possible with significant insight from the patient. To become able to provide this input patients need to play an active part in the assessment including participating in shared decision making, and patients also need understanding through the provision of information that is understandable and accessible. Although much attention has been paid lately to increasing health professionals’ consultation skills the same can’t be said for patients.

The options for information provision include spoken information, written information, and web‐structured information. Most spoken information provided during connections with medical researchers is forgotten 14 and there is certainly often little time available for this in consultations. People also need to absorb information they are given and questions might only arise later.

Finally, the review demonstrated that people would like written information for just two reasons. First for preliminary decisions about whether to take a medication or not. Hence people would value information about the number of treatments available prior to the prescribing decision is made. Second they need information for ongoing decisions about the management of medicines and interpreting symptoms. This suggests the necessity for just two types of written information.

Provision of functional information plays a key role in offering patients’ self-confidence to take part in decisions about their medicines. This can relate with very easy issues such as how to pronounce a medication name. This is utilized in leaflets supplied in the US and Australia commonly. It is highly empowering to allow patients to be confident in saying the name of their medicines correctly.

It is also important to tailor information (both spoken and written) according to patients’ desires and needs. This may relate to the known level or extent to which patients want information. It can also relate with taking account of physical impairments notably visual impairment in the elderly which may affect manipulation of written documents. Web‐based information is possibly a powerful tool in informing patients due to its availability before, after and during consultations. However allowing patients to find information that is reliable is an important job that medical researchers can help with.

A main factor in effective information provision is making certain information obtained from different resources including spoken, written, and internet is constant and will not give differing advice. One option to help achieve this would be for medical researchers to use the mandated patient leaflet given all medications as the basis for the info they provide to patients about the medications they prescribe for them. Particularly important to aid the process of partnership in medication taking is the provision of understandable and useful information about the likelihood of harm and advantage.

The appearance of the probability of side effects has been found to be optimum when natural frequencies are used, for example, ‘impacts less than one in a hundred patients’24. However, the ultimate way to provide benefit information is not yet known, numerical benefit information particularly. Ongoing research by one of the authors (DKR) has so far shown that the utilization of a patient-friendly version of ‘numbers had a need to treat’ to describe benefits has significant drawbacks. Without similarly understandable information about the likelihood of advantage and damage, patient leaflets cannot help patients in making informed decisions about going for a medicine.

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Formal decision aids are available to support decision‐making by patients, with a directory website of such helps available on the National Prescribing Centre (NPC) website 25. At present these are available for only around 30 medications specifically circumstances. They are designed for use by medical researchers to help patients make decisions about medications.

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