Always question: Tests, Treatments and Procedures

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The following are recommendations when prescribing to patients from the National Prescribing Service (NPS) MedicineWise developed in partnership with Australia’s health professional colleges, societies and associations. It enables clinicians to start important conversations with patients about tests, treatments and procedures where evidence shows they provide no benefit, or in some cases, lead to harm.

Do not initiate medications to treat symptoms, adverse events, or side effects (unless in an emergency) without determining if an existing therapy or lack of adherence is the cause, and whether a dosage reduction, discontinuation of a medication, or another treatment is warranted. 

Be aware that the symptom you might be prescribing for is a side effect of the original drug the patient may be on rather than a new condition requiring treatment. 

Do not promote or provide homeopathic products as there is no reliable evidence of efficacy. Where patients choose to access homeopathic treatments, health professionals should discuss the lack of benefit with patients.

Patients can purchase homeopathic products from supermarkets and even the internet and often times, these products are not adequately tested or approved. Some of these off the shelf products can even put consumers health at risk. It is the obligation of the healthcare practitioners “to educate consumers so they can make an informed decision about how best to manage their health using evidence-based medicine.”

Do not dispense a repeat prescription for an antibiotic without first clarifying clinical appropriateness.

Ensure that the dispensing of antibiotic scripts whether for repeat or original prescription is considered because inappropriate use can lead to resistance, infection progression and even patient morbidity and mortality.

Do not prescribe medications for patients on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications, including over-the-counter medications and dietary supplements, to determine whether any of the medications or supplements should or can be reduced or discontinued.

Deprescribing is advised for older patients and patients on more than five medications to manage polypharmacy to balance the potential harm and benefit of each medication.

Do not continue benzodiazepines, other sedative hypnotics or antipsychotics in older adults for insomnia, agitation or delirium for more than three months without review. 

Use of these medications should be for the shortest duration possible in treatment for insomnia, agitation or delirium as they can be associated with a range of adverse effects.

Do not recommend complementary medicines or therapies unless there is credible evidence of efficacy and the benefit of use outweighs the risk.

Vitamins, herbal products, aromatherapy and homeopathic products all fall under the ‘traditional’ or ‘alternative’ complementary medicine. The products have limited evidence of efficacy and health practitioners are encouraged to seek further information before recommending such products.

For more information, visit Choosing Wisely

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The materials provided are for educational purposes only. Whilst all reasonable care has been taken in preparing these materials, including the accuracy of the information supplied, MIPS does not accept any liability whatsoever arising out of the use or reliance of the information provided. Contact MIPS 24/7 Clinico-Legal Support 1800 061 113 or education@mips.com.au for specific advice.