Physicians and dentists are the two professions who have traditionally been given the undisputed right to prescribe. Advance practice nurses, optometrists, and a plethora of other professions are increasingly granted these rights but each state has a different battle. Prescribing practices by physicians have thoroughly been researched by the pharmaceutical industry and I found a few of their findings interesting enough to share.
The National Ambulatory Medical Care Survey collected data on drugs most frequently prescribed by physicians and found that 64.21% of all visits resulted in at least one prescription. The top five prescribed medications were either antidepressants, nonsteriodal anti-inflammatory agents, antihistamines or bronchodilators, antihypertensives, and antihyperlipidemics. These have remained fairly consistent although antimicrobials did fall from the top five more recently.
The National Ambulatory Care Survey offered in 2000 found 8.8% of people visiting general practices received three prescriptions within a single visit, 4.9% received four, 3.2% received five, and 5.3% received six prescriptions! General and family physicians write prescriptions in nearly 80% of their visits.
Some things have changed for the better. A study by Stolley and Lasagna in 1969 found that 95% of all physicians prescribed medications for the common cold, and more than 60% were for antibiotics. In 1972, antibiotics were the most prescribed medication, followed by tranquilizers, nonnarcotic analgesics, oral contraceptives, and antitussives. In 1974, sedatives and hypnotics were at the top of the list, ahead of antibiotics and as the years have progressed sedatives, tranquilizers, and hypnotics have declined. The last twenty years however, have remained fairly consistent. The most frequently prescribed medication in 2000 was Claritin, followed by Lipitor, Synthroid, Premarin, and amoxicillin (Edmunds & Mayhew, 2014).
Less research has been conducted on the appropriateness of physician prescribing practices, although there is literature that demonstrates physicians are writing scripts for problems that might resolve just as well on their own or with an alternative approach. Is this always the physician’s fault, or do consumers demand a quick fix? However, the pharmaceutical companies have expended a significant amount of money trying to determine how to best persuade a clinician to prescribe their particular drug.
Researchers have found however, that 5.4% of all prescriptions written by physicians are new pharmaceuticals and once they begin doing so, this script replaces another one they had previously written and not because it solves a problem for the client but simply out of habit. Pharmaceutical companies recognize that sales representatives with great communication skills enhance their ability to persuade the clinician to adopt their new pharmaceutical. Its the nature of the social system (Edmunds & Mayhew, 2014).
Younger physicians and specialists tend to prescribe more appropriately and to prescribe fewer medications but interestingly, smaller offices prescribed more often which researchers believed is related to having fewer resources for discussing other options. The influence of sales representatives and marketing of pharmaceutical companies have had such a significant impact on prescribers that the U.S. FDA prompted the American Medical Association to issue ethical guidelines that clarify the appropriate relationship between pharmaceutical companies and drug prescribers.
Prescription practices will continue to be much of what we know about the prescriber until other disciplines are also evaluated, but of note, rigorous methods have not been implemented to examine whether physician performance consistently correlates with approved therapeutic practice. The bigger point here is that when physicians are placed in a position of control over advance practice nurses by requiring a written practice agreement for prescription authority, this places an unfair restriction on trade, because even medical doctors lack evidence that their prescribing practices are meeting appropriate standards. Each profession should have the ability to demonstrate their practice is consistent with evidence-based practice and without the problems we are all too familiar are consistent with physicians writing scripts (remaining up-to-date, being influenced by drug companies, over prescribing, illegible handwriting, polypharmacy, and failing to recognize contraindications).