Our major teaching hospitals care for the most complex patients, but their immediate therapeutic care is managed by our least experienced prescribers, albeit under the supervision of experienced clinicians. In contrast to community prescribing, there is little information available on drug use in hospitals due to a lack of co-ordination and poorly developed information systems. Characteristics of the drug use environment Poor prescribing is not simply due to a lack of access to drug information or training of the prescriber. A complex array of factors impact on prescribing and since therapeutic decision-making is loaded with uncertainties, the environment in which prescribing occurs has a powerful influence. Time pressures on the prescriber are great, resulting in hasty decision-making.
Resources are limited, defining the boundaries of care and forcing priorities to be made.
Prescribers have expectations of a drug's efficacy and adverse effects moulded by experience, peers and advertising, but these expectations may not be consistent with the evidence. Patients have expectations that cannot always be met, however, every patient has the right to understand treatment options and participate in decisions about what will happen to them. Commercial incentives are a reality and drive the pharmaceutical industry, which in turn is driving developments in health care. Improving drug use Improving drug use is not easy. Presenting prescribers with research and evidence, or identifying a problem rarely changes practice.