PRESCRIPTION GUIDANCE AND INFORMATION SERVICE

Low Cost Standard Therapeutics (LOCOST) was founded with the goal of promoting rational drup therapy. We seek to promote this by two major activities : (a) supply of good quality essential drugs under generic names and (b) educational efforts.
The Prescription Guidance and Information Services (PGIS) of LOCOST is an educational effort to promote awareness about the correct use of medicines. PGIS is therefore for the benefit of both prescribers as well as patients.

Why this Service?
The average patient suffers from a lack of information. In addition he/she perceives the doctor as a high priest of a magic cult. The patient also has almost unquestioning faith in the power of drurs, tonics and injections. The doctor on the other hand, has his/her own compulsions and limitations, compulsions which make doctors yield to social/peer pressures and current fads of prescribing certain types of drugs. Quite often even senior doctors from reputed institutions are known to respond : "Dr. X.gives this drug to his patients. I how it is irrational but if I do not do the same, I will lose my patients" A scientific attitude to healing is thus sacrified and that too at the expense of the patient.
An added limitation is that doctors quite often do not have the time to update their medical and pharmacological knowledge. A major source of drug disinformation are the drug companies. Through various subtle and not so subtle means, they use medical representatives / agents to perduade doctors to prescribe quite often, irrational brand name combinations. Again the patient as the end user is the one who suffers by way of irrational (and sometimes harmful) prescriptions. PGIS is an attempt to restore this gross imbalance in the healing process, a process in which the patient is more an active than a passive participant.

Two main aspects of PGIS being proposed are :

(1) Information dissemination to doctors who write prescriptions, and

(2) Guidance to the patients regarding the correctness and use of medicines prescribed in a particular condition.

The PGIS Cell
LOCOST has identified a number of epert doctors in the Baroda Medical College and a few from outside also. At least two experts in each of the common specialities have been included in this cell. They will respond to the various requests through LOCOST.

PRESCRIPTION INFORMATION
It is found that the person who is prescribing the medicines does not have enough access to the latest information regarding the disease and related drugs. The PGIS cell will respond to requests for information relating to the use of a particular drug. In all such cases, it will be assumed that the diagnosis made by the prescriber is correct, unless the prescriber specifically requests for assistance in diagnosis also.

The Approach to Prescription Information
The individual requests should be routed through LOCOST office. Only in cases of emergency, the coordinator, PGIS, may be contacted directly. Attempt should be made to send the requests and the experts who give the advice will be kept completely confidential, if required.
An attempt will also be made to approach the doctors working in institutions. Pescriptions from such doctors, if requested, will be discussed in person or at group meetings organised by the institution. One or more experts from the PGIS cell will attend these meetings and the pros and cons of a particular prescription will be discussed in deteail. In such cases we would prefer, if the prescriptions to be discussed along with other related information is given well in advance. (In case of group meeting is being held, LOCOST will require a notice in advance).

PRESCRIPTION GUIDANCE
The objective here, is to help the patient, the end user of medicines to know the correctness of the medicines prescribed. The pGIS will give comments on following aspects of the prescription correct; medicine for a particular diagnosis, adequacy of the treatment, the uselessness or harmful effects of any medicine, the side effects of the medicines, the required dosage, alternatives available both in terms of cost, quality and nature of medicines; etc. wherever possible, other aspects of the therapy will also be explained.
This will help the patient by developing an understanding regarding the treatment given to him/her. This will also equip the patient and relatives or friends to question and to ask for more information from prescribers in future. Thus the ultimate aim is to build up consumer awareness and initiative to bring about a change towards more rational therapy.

The Approach To Prescription Guidance

1. The patient (or the relative/friend) sends the prescription with relevant details to LOCOST. (See Box below).

2. The prescription will be critically studied by LOCOST’s cell. The PGIS cell consists of a group of expert doctors who are conscious of rational therapy practices.

3. The PGIS cell will send its comments on the prescription to the prescriber for his/her reactions. Modifications if necessary, will be made based on the prescriber’s reactions. If no response from the prescriber is received within 10 days of sending comments will be passed on to the patient.

4. The copy of the final comments will also be sent to the prescriber (Note: Suitable modifications of the above procedure will be made as and when. For instance, if the patient does not want the comments and his/her identity revealed to the doctor the PGIS Cell may defer the comments to the doctor by say one to two months. However, requests by patients that the doctor be not informed at all, will not normally be acceded.

INFORMATION NEEDED FOR PRESCRIPTIONS GUIDANCE

While sending the request to LOCOST the patient would required to give the following information:

(a) Name and address of the patient:

(b) Name and address of the prescriber to whom a copy has to be sent;

(c) Age, sex, history of the patient and symptoms at the time of consultation of the doctor.

(d) Diagnosis (preferably written on the prescription in the doctor’s own land);

(e) List of medicines with dosage taken before the current prescription (past six months):

(f) Details of laboratory tests, x-ray tests, special procedures and medicines prescribed by the current prescriber, those taken by the patient and results of the same;

(g) Any other relevant detail/document (copy to be enclosed)

(h) Original prescription or photostat copy;

(I) Present condition of the patient.

A collective Education

In conclusion, PGIS is a person to person service that would hopefully lead to collective awareness about the correct use of medicine. The collective awareness could then result in collective action and programmes in many other areas of drug policy and other issues in health.
LOCOST is aware of the limitations of PGIS: Personal examination of the patient may not be feasible, the scope of PGIS may not cover all diagnostic situations as also the fact that a large number of ‘successful’ treatmentts may not be touched, and so on and so forth. The service may not be useful for the patient as it will take at least 10-15 days to give a balanced view on the prescription. However, querries by doctors for information can be attended to faster. In cases of exceptional emergency, the PGIS coordinator will decide about the mode of response and communication depending on the merits of each case.
LOCOST is keen on not encouraging legal battles between the patients and the director. PGIS is a beginning, a collective effort to facilitate awareness, education and action. Action towards more rational therapy and towards conserving scarce resources of patients as well as that of the community.

An Invitation
LOCOST is also prepared to facilitate prescription/ medical audits of hospitals, dispensaries and community health projects, if so reuqested. You may be a like minded doctor, a patient or a person simply interested in social change. We seek your cooperation and collaboration. Please spread this idea. Put patients and doctors in need in touch with us. Write to us with your views.

Contact us at : prescription guidance and Information Service (PGIS)

LOCOST
1st Floor, Premanand Sahitya Sabha hall
Opp. Lakadi Pool, Dandia Bazar
Baroda - 390 001.