Guest guest Posted December 18, 2008 Report Share Posted December 18, 2008 Dear Netrumians, Do we really follow `p' drug concept while prescribing? Definitely not!!!!!!!! The concept of P-drugs is still in its infancy. What will be the reason? Lack of awareness regarding `p' drug concept. Many practitioners doesn't know `p' drug though they are prescribing for years together. Failure to diagnose properly. For eg. Prescribing antibiotic for a patient with acute viral infection. Lack of objective data regarding efficacy and safety of various drug categories for comparison Inadequate knowledge and lack of access to independent information about medicines significantly contribute to irrational use of medicines. Most medical and pharmaceutical journals depend on advertisements for income from the companies that manufacture drugs or medical equipment. Such journals cannot provide totally objective information as the articles cannot be too critical of the activities or products of these companies. Availability of different brands of same drug at varying cost Influence of pharma industry. Many pharmaceutical companies offer software to physicians to facilitate the prescribing procedure. The software is easy to use. It generates a prescription for each diagnosis. The snag is that in most cases the drugs displayed for each diagnosis are those manufactured by the company providing the software. The suggested drugs are not necessarily the most effective in treating the illness. With Regards, Chaitali Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 19, 2008 Report Share Posted December 19, 2008 Dear Dr. Desai sir, Thanks sir for your active participation in discussion on concept of 'p' drug. There should be greater emphasis on continuing medical education programme for the health care professionals. Implementing periodic re-licensing certification may help in updating knowledge of practioners. Educational strategies that have been most effective in changing clinical behavior are: an assessment of learning needs, interactive tuition sessions with the opportunity to practice the skills learned and sequenced multifaceted activities. Continuing in-service medical education (CME) can be a effective mean if it is problem based, targeted, involves professional societies, universities and the ministry of health, and is face-to-face. Looking forward to hear more from you! Regards, Dr. Chaitali Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 19, 2008 Report Share Posted December 19, 2008 Dear Netrumians, Who do you think should play the main role in promoting and ensuring p medicine concept? Medical practioner play a key role in promoting `p' drug. But unfortunately, medical practitioners in conjunction with pharmaceutical companies are busy in prescribing and promoting unnecessary drugs just for the sake of monetary gains The way consumers use medicines is influenced by a wide range of factors including: knowledge about use, the cost of medicines at all levels, regulatory systems, cultural factors, community beliefs, communication between them and prescribers to ensure correct use of the drugs, outpatient support, access to objective information on medicines, and commercial promotion. Some patients have misconception that the expensive medicines are more effective than the cheaper generic versions. Patient often have limited knowledge on the use of medicines and therefore sometimes end up pressurizing the prescribers and dispensers for the expensive branded medicines in preference to cheaper generics which are just as effective. Regulating authorities also have responsibilities to establish national drug policies, the essential medicines list, standard treatment guidelines, which are often good sources of unbiased literature on medicines use. With regards, Dr.Chaitali Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 20, 2008 Report Share Posted December 20, 2008 Dear Members, The quality of basic training in pharmacotherapy can have an impact on prescribing in the long term by helping to establish good habits and inoculating students against future negative influences on their prescribing. Developing personal formulary through problem based learning; students can improve skill in decision making and selection of knowledge. After developing a personal formulary, students may judge new drugs more effectively and be more capable of deciding whether or not to include these drugs into their (personal) formulary. Dear members, please share your views regarding developing personal formulary. Regards Dr. Chaitali Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 21, 2008 Report Share Posted December 21, 2008 Dear chaitali, I agree with you that “P drug concept is a very important method to sensitize the undergraduate students for promotion of rational use of medicine. At their formative years in medical colleges, if future practicing doctors know the process of rational selection of a drug by the knowledge of efficacy, safety, suitability and cost it gets imbibed into them more avidly. It is very difficult to get rid of irrational prescribing habit, once it has become a regular practice. However, before sensitizing UG students about p drug, we should first highlight them about “p treatment” ( a piece of appropriate advice, referral at appropriate time, non-drug treatment, etc) Please comment. Trupti Swain Orissa From: chaitali_bajait <chaitali_bajait@...>Subject: Re: Concept of 'p' medicinenetrum Date: Sunday, December 21, 2008, 10:12 AM Dear Members, The quality of basic training in pharmacotherapy can have an impact on prescribing in the long term by helping to establish good habits and inoculating students against future negative influences on their prescribing. Developing personal formulary through problem based learning; students can improve skill in decision making and selection of knowledge. After developing a personal formulary, students may judge new drugs more effectively and be more capable of deciding whether or not to include these drugs into their (personal) formulary. Dear members, please share your views regarding developing personal formulary. Regards Dr. Chaitali Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 21, 2008 Report Share Posted December 21, 2008 Dear Trupti madam, Thanks for your valuable suggestions. You have brought out an important point related to `p' treatment. There is a difference between P-drugs and P-treatment. The key point is that not all diseases need to be treated with a drug. Not every P-treatment includes a Pdrug! `p' treatment include solving problems in therapeutics, prescribing appropriate drugs for a disease condition and delivering drug- and disease-related information in a meaningful way to patients and timely referral if necessary. In case of a child with acute watery diarrhoea with mild dehydration, the main objective of the treatment is to prevent further dehydration and to rehydrate; the goal is not to cure the infection. The inventory of possible effective treatments (`p' Treatment) is therefore: Advice and information: Continue breast feeding and other regular feeding; Careful observation. Non-drug treatment: Additional fluids (rice water, fruit juice, homemade sugar/salt solution). Drug treatment: Oral rehydration solution (ORS), oral or by nasogastric tube. Referral for treatment: Not necessary. Regards, Dr. Chaitali Nagpur > > From: chaitali_bajait chaitali_bajait@...> Subject: Re: Concept of 'p' medicine> netrum > Date: Sunday, December 21, 2008, 10:12 AM> > > > > > > > Dear Members,> > The quality of basic training in pharmacotherapy can have an impact on prescribing in the long term by helping to establish good habits and inoculating students against future negative influences on their prescribing. Developing personal formulary through problem based learning; students can improve skill in decision making and selection of knowledge. After developing a personal formulary, students may judge new drugs more effectively and be more capable of deciding whether or not to include these drugs into their (personal) formulary.> > Dear members, please share your views regarding developing personal formulary.> > Regards> Dr. Chaitali> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 21, 2008 Report Share Posted December 21, 2008 Dear Trupti madam, Thanks for your valuable suggestions. You have brought out an important point related to `p' treatment. There is a difference between P-drugs and P-treatment. The key point is that not all diseases need to be treated with a drug. Not every P-treatment includes a Pdrug! `p' treatment include solving problems in therapeutics, prescribing appropriate drugs for a disease condition and delivering drug- and disease-related information in a meaningful way to patients and timely referral if necessary. In case of a child with acute watery diarrhoea with mild dehydration, the main objective of the treatment is to prevent further dehydration and to rehydrate; the goal is not to cure the infection. The inventory of possible effective treatments (`p' Treatment) is therefore: Advice and information: Continue breast feeding and other regular feeding; Careful observation. Non-drug treatment: Additional fluids (rice water, fruit juice, homemade sugar/salt solution). Drug treatment: Oral rehydration solution (ORS), oral or by nasogastric tube. Referral for treatment: Not necessary. Regards, Dr. Chaitali Nagpur > > From: chaitali_bajait chaitali_bajait@...> Subject: Re: Concept of 'p' medicine> netrum > Date: Sunday, December 21, 2008, 10:12 AM> > > > > > > > Dear Members,> > The quality of basic training in pharmacotherapy can have an impact on prescribing in the long term by helping to establish good habits and inoculating students against future negative influences on their prescribing. Developing personal formulary through problem based learning; students can improve skill in decision making and selection of knowledge. After developing a personal formulary, students may judge new drugs more effectively and be more capable of deciding whether or not to include these drugs into their (personal) formulary.> > Dear members, please share your views regarding developing personal formulary.> > Regards> Dr. Chaitali> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 21, 2008 Report Share Posted December 21, 2008 Dear members, Research over the years has shown that students who have been trained by problem-based learning methods gain about the same level of knowledge, but perform better on skills and attitude compared to students from traditional curricula. But there are certain practical limitations. In this interdisciplinary problem based learning, teacher's role changes from that of a disseminator of information to a facilitator of learning. Some teacher find it difficult to acclimatize with this changed role. Hence there is a need for orientation classes for teachers also. Formulating a clinical problem is sometime difficult because each disease has multiple variants and the students become confused about which variant to consider. Sometimes there is Difficulty in evaluating efficacy of drugs due to lack of head to head comparisons of drugs. The lack of good, independent, unbiased reference sources is also a major problem. The large number of brands and the cost variation between brands especially in the Indian market is also a major problem. Regards, Dr.Chaitali Nagpur Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2008 Report Share Posted December 22, 2008 Dear Dr Trupti, Rather than teaching students theory, we can give them case based learning, theory of topic should only act as a guide. Through cases, we can make them aware of p-treatment where drugs are needed and those places where we can manage non-pharmacologically like in URTIs, mild diarrhoea etc. -Anupama From: chaitali_bajait <chaitali_bajait@...>Subject: Re: Concept of 'p' medicinenetrum Date: Sunday, 21 December, 2008, 7:20 PM Dear Trupti madam, Thanks for your valuable suggestions. You have brought out an important point related to `p' treatment. There is a difference between P-drugs and P-treatment. The key point is that not all diseases need to be treated with a drug. Not every P-treatment includes a Pdrug! `p' treatment include solving problems in therapeutics, prescribing appropriate drugs for a disease condition and delivering drug- and disease-related information in a meaningful way to patients and timely referral if necessary. In case of a child with acute watery diarrhoea with mild dehydration, the main objective of the treatment is to prevent further dehydration and to rehydrate; the goal is not to cure the infection. The inventory of possible effective treatments (`p' Treatment) is therefore: Advice and information: Continue breast feeding and other regular feeding; Careful observation. Non-drug treatment: Additional fluids (rice water, fruit juice, homemade sugar/salt solution). Drug treatment: Oral rehydration solution (ORS), oral or by nasogastric tube. Referral for treatment: Not necessary. Regards, Dr. Chaitali Nagpur > > From: chaitali_bajait chaitali_bajait@ ...> Subject: Re: Concept of 'p' medicine> netrumgroups (DOT) com> Date: Sunday, December 21, 2008, 10:12 AM> > > > > > > > Dear Members,> > The quality of basic training in pharmacotherapy can have an impact on prescribing in the long term by helping to establish good habits and inoculating students against future negative influences on their prescribing. Developing personal formulary through problem based learning; students can improve skill in decision making and selection of knowledge. After developing a personal formulary, students may judge new drugs more effectively and be more capable of deciding whether or not to include these drugs into their (personal) formulary.> > Dear members, please share your views regarding developing personal formulary.> > Regards> Dr. Chaitali> Add more friends to your messenger and enjoy! Invite them now. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2008 Report Share Posted December 22, 2008 Dear Anupama, I am fully agree to you in using the method of case-based approach, it engages students in discussion of specific situations, typically real-world examples. Case-based method is learner-centered, and involves intense interaction between the participants. Case-based learning focuses on the building of knowledge and the group works together to examine the case. Therefore; it is imperative to have case-based method parallel to theory in order to promulgate more about P Medicine.Best Regards Mohammad Bashaar From: chaitali_bajait <chaitali_bajait>Subject: Re: Concept of 'p' medicinenetrumgroups (DOT) comDate: Sunday, 21 December, 2008, 7:20 PM Dear Trupti madam, Thanks for your valuable suggestions. You have brought out an important point related to `p' treatment. There is a difference between P-drugs and P-treatment. The key point is that not all diseases need to be treated with a drug. Not every P-treatment includes a Pdrug! `p' treatment include solving problems in therapeutics, prescribing appropriate drugs for a disease condition and delivering drug- and disease-related information in a meaningful way to patients and timely referral if necessary. In case of a child with acute watery diarrhoea with mild dehydration, the main objective of the treatment is to prevent further dehydration and to rehydrate; the goal is not to cure the infection. The inventory of possible effective treatments (`p' Treatment) is therefore: Advice and information: Continue breast feeding and other regular feeding; Careful observation. Non-drug treatment: Additional fluids (rice water, fruit juice, homemade sugar/salt solution). Drug treatment: Oral rehydration solution (ORS), oral or by nasogastric tube. Referral for treatment: Not necessary. Regards, Dr. Chaitali Nagpur > > From: chaitali_bajait chaitali_bajait@ ...> Subject: Re: Concept of 'p' medicine> netrumgroups (DOT) com> Date: Sunday, December 21, 2008, 10:12 AM> > > > > > > > Dear Members,> > The quality of basic training in pharmacotherapy can have an impact on prescribing in the long term by helping to establish good habits and inoculating students against future negative influences on their prescribing. Developing personal formulary through problem based learning; students can improve skill in decision making and selection of knowledge. After developing a personal formulary, students may judge new drugs more effectively and be more capable of deciding whether or not to include these drugs into their (personal) formulary.> > Dear members, please share your views regarding developing personal formulary.> > Regards> Dr. Chaitali> Add more friends to your messenger and enjoy! Invite them now. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2008 Report Share Posted December 22, 2008 Dear Dr. Anupama, You are very right regarding problem based learning in pharmacotherapy. This type of teaching forces students to be active, trains their skill in communication and selection of knowledge which is believe to improve skill in decision making in future medical doctors. In the clinical phase of the undergraduate medical training, most future prescribing habits are acquired. Hence pharmacotherapy teaching in the clinical phase should be objective-based, problem-based (with a focus on common conditions), interdisciplinary (both for teachers and students) and constantly referring to national or hospital Standard treatment guidelines and Essential drug list. Regards, Dr Chaitali Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2008 Report Share Posted December 22, 2008 Dear Dr. Chaitali and all NetRUMians, Good discussion is going on. I was out of station. Today I have read all the postings. We have implemented "Prescription Writing by Problem Solving Excecises using 'P' drug concept" since the year 2000. Students enjoy this module of teaching a lot. Our practical manual is placed on our IPS website. Anybody can go through it and have fair use of it. Of course, we have revised our manual after this several times. Thank you. Bharat Gajjar. DR. BHARAT GAJJAR ASSOCIATE PROFESSOR, DEPARTMENT OF PHARMACOLOGY, PRAMUKHSWAMI MEDICAL COLLEGE, KARAMSAD-388325. DIST.-ANAND (GUJARAT) INDIA. MOBILE- 09428153344. From: chaitali_bajait <chaitali_bajait@...>Subject: Re: concept of 'p' medicinenetrum Date: Monday, December 22, 2008, 7:03 PM Dear Dr. Anupama, You are very right regarding problem based learning in pharmacotherapy. This type of teaching forces students to be active, trains their skill in communication and selection of knowledge which is believe to improve skill in decision making in future medical doctors. In the clinical phase of the undergraduate medical training, most future prescribing habits are acquired. Hence pharmacotherapy teaching in the clinical phase should be objective-based, problem-based (with a focus on common conditions), interdisciplinary (both for teachers and students) and constantly referring to national or hospital Standard treatment guidelines and Essential drug list. Regards, Dr Chaitali Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2008 Report Share Posted December 22, 2008 Dear Dr. Bharat, I would like to welcome you on this discussion forum and thanks for supporting discussion on concept of `p' medicine. Definitely your practical manual on "Prescription Writing by Problem Solving Excecises using 'P' drug concept" will be beneficial for students. Along with `problem based learning in pharmacology' what other measures can we take to promote `p' medicine concept in actual practice? Your suggestions are valuable for us! Regards, Dr. Chaitali Nagpur > > > From: chaitali_bajait chaitali_bajait@...> Subject: Re: concept of 'p' medicine> netrum > Date: Monday, December 22, 2008, 7:03 PM> > > > > > > > Dear Dr. Anupama,> You are very right regarding problem based learning in pharmacotherapy.> This type of teaching forces students to be active, trains their skill in communication and selection of knowledge which is believe to improve skill in decision making in future medical doctors. In the clinical phase of the undergraduate medical training, most future prescribing habits are acquired. Hence pharmacotherapy teaching in the clinical phase should be objective-based, problem-based (with a focus on common conditions), interdisciplinary (both for teachers and students) and constantly referring to national or hospital Standard treatment guidelines and Essential drug list. > > Regards, > Dr Chaitali> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2008 Report Share Posted December 22, 2008 Dear members, I am snding an article in which process of selection of 'p' drug is explained nicely with suitable example. Please go through it. Regards, Dr. Chaitali Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 22, 2008 Report Share Posted December 22, 2008 Dear Members, On the last day of discussion, I would like to add, what measures can we take to promote concept of `p' medicine for rational prescribing? 1. What's An Honest Doctor To Do? Physians should be aware of the marketing pressures placed upon them. Try to make your personal formulary of drugs (following STEP criteria) using an information from unbiased sources. Don't jump to use the latest drug until you are convinced that it is better than what you are currently using and that it is safe.. Resist your patients' requests for the latest hot drug unless it is appropriate for their condition. Remind them that the TV ad is not presenting medical information-it is simply an advertisement to sell a product. And when the invitation comes, remember that there is no free lunch. 2. Problem-based training in pharmacotherapy in undergraduate curricula The quality of basic training in pharmacotherapy for undergraduate medical and paramedical students can significantly influence future prescribing. Implementing `p' drug concept, linked to clinical guidelines and essential medicines lists, can help to establish good prescribing habits. Training is more successful if it is problem-based, concentrates on common clinical conditions, takes into account students' knowledge, attitudes and skills, and is targeted to the students' future prescribing requirements (WHO 1994). 3. Continuing in-service medical education Continuing in-service medical education (CME) is a requirement for updating knowledge of docters in practice. Often due to lack of public funds CME is heavily supported by the pharmaceutical sector and may thus be biased. CME is likely to be more effective if it is problem based, targeted, involves professional societies, universities and the ministry of health, and is face-to-face. Governments should therefore support national professional associations to give independent CME. 4. Independent information on medicines Provision of independent (unbiased) drug information is essential for choosing `p' medicine. There should be alternate and reliable source of information (Drug information centres (DICs) and drug bulletins) to cross check all the tall claims put forth by pharmaceutical companies. Unfortunately most of the correct information in the literature is published in journals which are not accessible to most people living in developing countries. There is an urgent need to have a forum wherein all the tall claims on new drugs can be discussed by experts and the information is made widely available to all practitioners. 5. Empowerment of consumers It is essential that the general public have the skills and knowledge to make informed decisions about when and how to use medicines, and to understand their potential risks as well as benefits. Governments have a responsibility to ensure both the quality of medicines and the quality of the information about medicines available to consumers Set up a website with information for consumers on identical drugs and their manufacturer was stressed. The current package leaflet should be replaced by a patient package insert. Direct to consumer advertisement for medicines that have to be prescribed by a doctor should be banned. Dear members, waiting for more suggestions from you! Regards, Dr. Chaitali Nagpur Quote Link to comment Share on other sites More sharing options...
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