READER RESPONSE:Report on the usage of sedatives was not an exercise in finger-pointing at GPs
Re: Prescribing practices called into question
Dear Sir,
I'd like to respond to a few points raised by Dr Garrett Hayes ( Healthplus) about my report on the usage of minor tranquillisers and sedatives, specifically the issues of reimbursement, hospital-based prescribing and the demands of patients.
Prescriptions may be reimbursed only after they have been dispensed and, by definition, they cannot be dispensed unless they have first been written.
Once a script is written in accordance with regulations, it may be dispensed and is reimbursable.
The high number of prescriptions, doses and long-term usage in the medical card scheme stand in marked contrast to the private scheme, and indicate significant prescribing bias in respect of those in the public scheme. It matters not that one professional group is paid by capitation and another by fee or fee-plus-markup.
The study does not claim the reimbursement regime is the cause of inappropriate prescribing and dispensing. But it does underline that the regime does little if anything to encourage adherence to the best practice prescribing guidelines.
One proposal that has been made to address this issue is to limit reimbursement to a four-week script. My report mentions other steps that could assist.
The issues of a hospital-based culture of prescribing and the pressures from patients are frankly acknowledged throughout my report – the first by experts in the addiction services, and the second, most forcefully as it happens, by the recovering addicts who took part in this research.
It is true that as much as 38 per cent of new and repeat GMS prescriptions come from hospitals, but where do the other 62 per cent come from?
Is no one shouting stop?
Is no one asking where are the service alternatives that would reduce this?
The study is not an exercise in finger-pointing at GPs. It demonstrates that patients, prescribers and pharmacists are all part of the problem and all must be part of the solution.
The hope is that the entirety of the report will prompt reflection and, indeed, action by all.
Yours etc,
Kealan Flynn,
iWrite Consulting,
18 Upper Canal Road,
Galway.
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