Family Practice Vol. 16, No. 3, 316-317
© Oxford University Press 1999
Book Reviews |
Medicines management.
Emeritus Fellow, UK Cochrane Centre
R Panton, S Chapman (eds). (213 pages, £19.95.) BMJ Publishing Group, 1998. ISBN 0-7279-1274-7.
The management of medicines concerns patients, doctors, pharmacists and administrators, who all need to work together. They differ greatly in their education and experience and that is one of the obstacles to smoothing collaboration between them. This book should help by providing a broad basis of shared understanding, as well as suggestions for coping with problems that most of us find difficult. It has 12 chapters by 17 contributors who are centred in or around the Department of Medicines Management at Keele University in the Midlands. They include six pharmacists, two GPs, two clinical pharmacologists, a consumer advocate, a health economist, an ethicist and a public health physician.
The first chapter refreshingly discusses four phenomena: "the gap between professionals and lay people; the gap between citizens and consumers; the NHS as a mean spirited enemy; and communicating with patients who don't believe you." These are major challenges and David Dickinson makes good suggestions for meeting them. Another original chapter dissects the ethics of prescribing and proposes a convincing and workable framework for prescribing decisions. An important element is the idea of ‘conditional prescribing’, where the doctor does not know whether the therapy is effective or not. First, the uncertainty should be shared with the patient and, second, both must agree to stop the treatment if after an appropriate trial period the desired outcomes have not occurred.
Colin Bradley reviews the convoluted prescribing patterns in primary care and suggests an agenda for practices to reform their prescribing policies. Others examine the rising expenditure on medicines, explain how the evidence about them is gathered and weighed and show in some detail how prescribing can be analysed. A chapter on health economic and public health aspects of drug usage takes the topical example of donezepil, recently introduced for treating Alzheimer's disease, to present the complex considerations that are needed before such a marginally effective but expensive drug can be used appropriately in a community. The book ends with practical grass-roots material: a guide to national structures that can facilitate good medicine management, how to get research findings put into practice, a new and promising approach to educational outreach to general practices, and local and national agendas for ‘controlling’ prescribing and managing medicines.
This book could easily have been dry and dull, but the enthusiasm of the contributors has made it remarkably stimulating and useful. I noticed only one serious gap; there is almost nothing about the detection, prevention and limitation of harm from medicines; that deserves at least a thirteenth chapter in the second edition.
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