September 11th, 2018
A recent study in the Annals of Internal Medicine made waves this week with the finding that almost 30% of opioid prescriptions written in outpatient settings between 2006 and 2015 did not have a documented diagnosis of pain. This high number of opioid prescriptions without an indication of pain shows that doctors are prescribing inappropriately or not documenting diagnoses appropriately (or both).
The problem of prescribing without an appropriate indication goes beyond opioids. As polypharmacy – or excessive prescribing – has become a more serious problem over the past decade, doctors are more likely to encounter patients taking five or even ten medications. And often, neither the doctor nor the patient knows why some of these medications were originally prescribed.
Prescribing without an indication can happen for many reasons. Doctors are allowed to prescribe medications off-label, which means prescribing them for a condition for which they haven’t been approved. While often useful, off-label prescribing can also lead to indication creep — when a medication (or other medical intervention) becomes used on a broader and broader population, for which the intervention has not been shown to benefit.
When a patient is hospitalized, they may be put on a medication to help them sleep, relieve anxiety, treat acid reflux, or another reason. While many of these medications are meant to be used only in the short term, often they are continued indefinitely. This complicates older patients’ already confusing medication regimens – for patients over 65, almost 90% can’t name all of the medications they’re supposed to be taking after being discharged from the hospital.
It’s baffling how this simple and essential information of why a drug was prescribed can be so difficult to find. As Dr. Tisamarie B. Sherry, lead author of the AIM study and associate physician policy researcher at RAND, said in a statement to the Boston Globe, “Whatever the reasons, lack of robust documentation undermines our efforts to understand physician prescribing patterns and curtails our ability to stem overprescribing.”
To solve this problem, we need better information available to both doctors and patients. It’s much more difficult for patients to maintain their drug regimens if they don’t know what each medication is for and how to take it; and doctors need to know why medications were prescribed originally so they can evaluate whether taking the medication is still beneficial for the patient. “We need a comprehensive, portable, and truly informative medication list…including not only the drug name, dose, and schedule, but the indication for each drug, the target symptoms and signs it is meant to address, and how its effectiveness and adverse effects should be monitored,” writes Dr. Michael Steinman writes in JAMA Internal Medicine.
Gathering basic information like drug indications should be our first step in ensuring patient safety against potential adverse drug events.