Clinical Pharmacology, Institute of Infection and Immunity, St George's, University of London.
St George's University Hospitals NHS Foundation Trust.
Br J Clin Pharmacol. 2018 Nov;84(11):2562-2571. doi: 10.1111/bcp.13709. Epub 2018 Aug 10.
Prescribing is a complex skill required of doctors and, increasingly, other healthcare professionals. Use of a personal formulary can help to develop this skill. In 2006-9, we developed a core list of the 100 most commonly prescribed drugs. Our aim in the present study was to update this 'starter formulary' to ensure its continued relevance for prescriber training.
We analysed large contemporary primary and secondary care datasets to identify the most frequently prescribed medicinal products. Items were classified into natural groups, broadly following their British National Formulary classification. The resulting drug groups were included in the core list if they comprised ≥0.1% prescriptions in both settings or ≥0.2-0.3% prescriptions in one setting. Drugs from emergency guidelines that did not qualify by prescribing frequency completed the list.
Over 1 billion primary care items and approximately 1.8 million secondary care prescriptions were analysed. The updated list comprises 81 drug groups commonly prescribed in both settings; six from primary care; seven from secondary care; and six from emergency guidelines. Eighty-eight per cent of the formulary was unchanged. Notable changes include entry of newer anti-epileptics and dipeptidyl peptidase-4 inhibitors and exit of phenytoin and thiazolidinediones.
The relative stability of the core drug list over 9 years and the current update ensure that learning based on this list remains relevant to practice. Trainee prescribers may be encouraged to use this 'starter formulary' to develop a sound basis of prescribing knowledge and skills that they can subsequently apply more widely.
开处方是医生和越来越多的其他医疗保健专业人员所需的一项复杂技能。使用个人处方集可以帮助培养这种技能。我们在 2006-2009 年开发了一个最常用的 100 种药物的核心清单。本研究的目的是更新这个“起始处方集”，以确保其对处方培训的持续相关性。
我们分析了大型当代初级和二级保健数据集，以确定最常开的药物。项目按其自然组分类，大致遵循英国国家处方集的分类。如果这些药物在两种情况下的处方率都≥0.1%，或者在一种情况下的处方率≥0.2-0.3%，则将其归入核心清单。来自急救指南但不符合处方频率要求的药物则补充到清单中。
分析了超过 10 亿份初级保健项目和大约 180 万份二级保健处方。更新后的清单包括 81 种在两种情况下都常开的药物组；6 种来自初级保健；7 种来自二级保健；6 种来自急救指南。处方集的 88%没有变化。值得注意的变化包括新型抗癫痫药和二肽基肽酶-4 抑制剂的加入，以及苯妥英和噻唑烷二酮类药物的退出。
核心药物清单在 9 年内的相对稳定性和当前的更新确保了基于该清单的学习仍然与实践相关。受训的处方者可能会被鼓励使用这个“起始处方集”来培养他们可以更广泛应用的合理处方知识和技能基础。
