Review Of Good Prescribing Practice And The Risks Involved With Remote Prescribing

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Introduction - Review Of Good Prescribing Practice And The Risks Involved With Remote Prescribing

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It has been observed that remote prescribing has gained prominence in healthcare facilities in order to offer numerous benefits along with addressing several challenging aspects. In this regard, the General Medical Council (GMC), General Pharmaceutical Council (GPhC) and Nursing and Midwifery Council (NMC) have issued guidance in order to ensure an effective and safe remote prescribing option (Gallagher et al. 2022). It has been observed that one of the notable pros of this feature that is remote prescribing is improved access to enhanced services in remote or under-served areas. This can also help in providing timely consultation and advising medical support to the patients from the comfort of their homes with an enhancement in the convenience along with reducing travel-related stress. The approach can be helpful in mitigating the risk of spreading infectious diseases with the limitation of in-person visits to the Healthcare facilities that is a significant advance during the Global Health crisis.

However, it has been observed that remote prescribing is addressing limitations and risks as well. In this regard, the primary concern is the potential for misdiagnosis or inadequate assessment by the healthcare professionals to address limited physical interaction with patients (Kahere, Hlongwana and Ginindza, 2022). This can result in a lack of crucial diagnostic information the compromising aspect in the accuracy of prescriptions. In addition, there can be a risk of technology-related issues that are included with data breaches or communication failure that have the potential to jeopardize patient privacy along with the security of the medical record.

Apart from this, remote prescribing can encourage over-prescription or medication misuse that cannot be managed efficiently. As a result, there is a need to strike a balance between the convenience of remote prescribing and maintaining the quality of the care that has become a challenge in the present time (Piotrowski et al. 2023). In this regard, the GMC, GPhC and NMC guidelines are required to be addressed in order to set a standard for addressing these issues along with ensuring the safe and ethical practices of remote prescribing that can safeguard the patients and health care providers as well.

Prescribing consultation models - advantages and disadvantages

The prescribing consultation models are structured approaches that are used by healthcare professionals in order to engage with patients for prescribing the medication. These models have the efficiency to provide a framework for effective communication aspect decision-making measures and engaging the patient with care. In this regard, there is a need to analyse the advantages and disadvantages of the framework that are discussed below:

• Enhanced patient involvement: the prescribing consultation models such as the SHARE model emphasise shared decision-making that enhances the potential to make patients active participants in their care. This can also be understood with the simple phenomenon that the patients are also involved in their care settings by actively engaging with the healthcare providers (Hickmann, Richter and Schlieter, 2022). This facility empowers patients by improving their adherence to medication regimes along with enhancing a collaborative patient-provided relationship between the health care provider and the patient. As a result, the healthcare facilities of an organisation can also be enhanced by collaborating with the patients in order to address their feedback in their healthcare settings. This can further be helpful for the healthcare organisation to frame policies in terms of the feedback.
• Improved Safety and Accuracy: there is a need to follow a structured model such as the Calgary Cambridge model in order to enhance the safety by ensuring thorough assessments along with reducing the likelihood of medical errors. With the help of gathering information in a systematic way and considering the interactions in terms of addressing potential drugs, the prescribers of the health care settings can make more informed decisions for treating the patients with care (Vellela et al. 2023). This can be enhanced with the inclusion of remote prescribing as well for the patients who are not able to get access to the efficient treatment facilities on a long-term basis.
• Efficiency and Consistency: The Healthcare model such as the Ottawa model for addressing smoking cessation has demonstrated advantages in terms of efficiency and consistency in the Healthcare setting. This model has provided a standard approach in order to enhance the prescribing aspects along with helping the healthcare professionals to streamline their processes and minimise the variations in the healthcare setting (Rana et al. 2021). As a result, it can be said that there is a need to enhance the utilisation of this model to reduce the risk data associated with the remote prescribing aspects that can enhance the treatment facilities available to the patients.
• Reduced Medication Errors: There is a requirement for reducing the medication errors that can be addressed with a structured model such as the SOAP model that signifies Subject, Objective, Assessment, and Plan. This can be helpful in reducing medication errors with systematic documentation of the information that has been addressed by the patient along with the thought process behind prescribing the medications while minimising the mistakes (Bourne et al. 2022). As a result, there can be an enhancement in the efficiency of Healthcare practices for the patient by critically analysing their subject matter in order to set objectives along with assessment planning for treating the patients with care.
• Holistic Patient Care: In order to address holistic patient care models such as the Biopsychosocial model that can be addressed as a comprehensive approach to enhancing the patient care (Thomas et al. 2021). This model can encourage healthcare professionals to address the medical aspects along with psychological and social factors that can impact the health conditions of a patient leading to well-rounded care.
• Time-Consuming: Addressing the disadvantages of the model it can be said that the remote prescribing system is a time-consuming process (Maunder et al. 2021). Apart from this, it can be said that there are some models that require detailed assessments and discussion that cannot be considered as visible all the time in the busy clinical settings.
• Resource Intensive: Another disadvantage of implementing the practice with the requirement of additional resources for implementing and maintaining structured prescribing models (Boreskie et al. 2022). The resources can be included with the training documentation and support systems in order to streamline the Healthcare organisation, especially within the resource-limited settings.
• Not One-Size-Fits-All: Prescribing consultation models are not applicable to all the patients in the universe. It has been analysed that every patient is uni and requires a unique healthcare need that cannot be fulfilled neatly with the utilisation of a specific model (Dixon and Isaac, 2023). As a result the healthcare professionals are required to adopt and modify these models to address the individual patient circumstances.
• Resistance from healthcare providers: There are some Healthcare providers facing resistance in terms of utilising the prescribing consultation model that has further restricted the clinical judgement or impeded their autonomy in the healthcare setting (Agénor et al. 2022). This aspect addressed by the healthcare providers has the potential to hinder the adoption and effectiveness of this model.
• Potential for overlooking patient preferences: There are many cases that are not suitable for this model as the model has a focus on clinical factors that can potentially overlook the patient preferences and values (Thomas et al. 2023). Apart from this, the model can lead to a misalignment between the treatment facilities and the goals of the patient.

Pendleton’s model

The model proposed by Pendleton in 1984 presents a structured approach to doctor-patient consultations, highlighting the importance of addressing seven specific objectives in order to achieve comprehensive treatment. A comprehensive comprehension of the patient's motives for seeking medical attention, the identification of any supplementary health or social concerns, and the joint development of a management plan are crucial. The concept places significant emphasis on the importance of mutual comprehension of each issue and active patient engagement in their healthcare decision-making process. Moreover, it facilitates the optimisation of resource allocation and underscores the significance of cultivating a durable and trustworthy rapport between healthcare providers and patients. While the Pendleton approach prioritises patient-centered care, its comprehensive range of duties may present difficulties within the constraints of standard consultation durations. Additionally, its focus on addressing wider health issues may not always correspond with the urgent needs of all patients.

Neighbour

The consultation model developed by Roger Neighbour, as outlined in his seminal work "The Inner Consultation" published in 1987, offers a systematic framework consisting of five distinct stages. This model is specifically designed to improve the quality of doctor-patient interactions. The primary emphasis of "Connecting" is centred around establishing a positive relationship and comprehending the patient's viewpoint. Subsequently, the medical practitioner engages in a process known as "Summarising," when they seek to elucidate their comprehension of the patient's problems, so establishing congruence. The process of "handover" refers to the collaborative stage during which a doctor and patient work together to establish a management plan. This plan encompasses the development of a shared understanding between the doctor and patient, and may involve the transfer of certain obligations to the patient. Safety-netting serves as a precautionary measure, designed to anticipate and address unexpected occurrences or potential misdiagnoses.

Finally, the practise of "Housekeeping" is urging physicians to acknowledge and discuss any prevailing feelings or thoughts arising from the ongoing session prior to transitioning to the subsequent one. The model proposed by Neighbour is characterised by a structured approach that places equal emphasis on the perspectives of both the patient and the doctor. Additionally, this model takes into account any challenges that may arise during consultations. While more succinct than Pendleton's seven-step model, some practitioners feel Neighbour's model lacks guidance on concluding consultations and that rapport-building should be ongoing, not just an initial step.

Calgary Cambridge

The relationship-building component places emphasis on establishing rapport, employing technical resources such as computers in an effective manner, exhibiting empathy, and confirming the perspectives of the patient. The structural component of the consultation promotes a coherent and orderly flow that facilitates effective communication between the healthcare provider and the patient. The initial step of the paradigm involves the establishment of rapport and the creation of a shared agenda, sometimes referred to as "Initiating the Session." The succeeding phase of "Gathering Information" involves a comprehensive exploration of the patient's concerns through a combination of open-ended and closed-ended questioning, while also maintaining a structured approach to the consultation.

The subsequent stage after the "Physical Examination" is the "Explanation and Planning" phase, which proposes the use of concise information delivery, assessments of patient understanding, and the incorporation of written or visual materials as needed. The proposed methodology reaches its culmination in the "Close the Session" phase, which aims to provide clarity in the action plan that has been mutually agreed upon. This approach not only highlights the interpersonal elements of medical consultations but also guarantees coherence and organisation.

Reviewing existing guidance/standards of prescribing set by GMC, GPHC, NMC governing bodies 

The General Medical Council (GMC), General Pharmaceutical Council (GPhC) and Nursing and Midwifery Council (NMC) have a crucial role in setting and maintaining the standards of the Healthcare settings along with prescribing the respective professions. In this regard, reviewing the existing guidance and standards of prescribing set addressed by these governing bodies are stated below:

• Patient safety and quality of care: The guidelines that are provided by the governing bodies that are mentioned above have prioritized the patient safety and quality of care (Labrague, Santos and Fronda, 2021). The standard has emphasised the importance of thorough assessments along with accurate diagnosis and the use of evidence-based practices in order to ensure that the patients are receiving effective and safe treatment for their issues.
• Ethical and legal responsibility: It has been observed that the governing bodies have emphasised the ethical and legal responsibilities as well for the Healthcare professionals in terms of describing the medication to the patient (?artolovni, Tomi?i? and Lazi? Mosler, 2022). The guidelines are often included with the information in terms of informed consent addressed by the patient along with the confidential aspects and the duty to act in the best interest of the patient.
• Education and training: Apart from all this, the standard that has been set by these bodies has understood the importance of continuous education and training facilities for the healthcare professionals in order to update their skills and knowledge as per the evolving market dynamics (Goh et al. 2022). These aspects can encourage the ongoing professional development facilities in order to ensure the prescribers remain updated with the latest advancements and the best practices for handling the patient with care.
• Collaboration and communication: The guidelines that have been promoted by these governing bodies have highlighted the significance of effective collaboration and communication within the healthcare settings (Schlesinger et al. 2022). In this regard, prescribing often includes multiple healthcare professionals along with clear communications that have the potential to ensure a seamless patient care experience.
• Professional accountability: The governing bodies have emphasised aspects in terms of professional accountability in order to enhance the prescribing facilities (Gore, Rickards and Fray, 2022). There is inclusion of a mechanism in place for addressing the complaints and concerns that are related to prescribing patterns in order to promote transparency and accountability among the patient.
• Patient-centered care: The governing bodies have also emphasised patient-centered care in order to highlight the importance of involving patients in the decision-making process that can further enhance the process of creating them with care (Wilson et al. 2022). The guidelines of these governing bodies have encouraged shared decision-making aspects along with respecting the choices and values addressed by the patient.
• Adaptation to changing healthcare environments: the standards established by the governing bodies are not considered as static (Lyng et al. 2022). There can be enhancement in adaptation to changing healthcare environments along with establishing technology advancements and addressing the emerging Healthcare challenges with ensured relevancy and effectiveness.

Remote healthcare consultations, which include internet, video-link, or phone conversations, represent a contemporary method of healthcare provision that prioritises convenience and effectiveness. Nevertheless, the rapid expansion of this phenomenon brings about intrinsic difficulties. The lack of connectivity between remote service providers and a patient's primary healthcare physician presents notable risks, such as the possibility of misdiagnoses or the omission of critical medical information. In conjunction with limited availability of full medical information, there exists an increased susceptibility to medication misuse or the issuance of incorrect prescriptions. The ability to consistently monitor individuals with chronic conditions may be impaired. Therefore, although this approach offers improved availability, it is crucial for healthcare practitioners to implement rigorous protective measures. These steps are required to protect the safety of patients, maintain the integrity of prescriptions, and ensure that healthcare professionals participating possess the necessary skills to navigate the complexities of remote consultations.

Pros and cons of remote prescribing

 Pros of Remote Prescribing: 

• There can be increased access to Healthcare facilities as a remote prescribing as the potential to extend healthcare services to the underserved or remote areas (Tan et al. 2023). This can be helpful in making medical care more accessible to the person facing Limited physical access to healthcare facilities.
• There can be an enhancement in convenience for the patients as they can receive medical advice along with the prescriptions and follow-up care from the comfort of their homes (Tan et al. 2023). This can further reduce the requirement for travelling and waiting times.
• There can be improved infection control during the pandemic situations or the healthcare crisis as remote prescribing has the potential to minimise the risk of disease transmission that is associated with in-person healthcare visits.
• There can be enhancement in the continuity of care settings as remote prescribing allows for better continuity of care where the patients are able to consult with their regular healthcare provider without addressing any geographical constraints (Holt, 2023).
• There can be a reduction in healthcare costs as the telemedicine facilities that are included with remote prescribing can be considered as a cost-effective evolution for the patient with the elimination of travel expenses and reduction of the burden and healthcare system (Holt, 2023).
• There can be efficiency in addressing minor conditions as remote prescribing has the potential to address minor elements or routine prescription refills that can be considered as more efficient in terms of saving time for both the patients and Healthcare providers (Holt, 2023).
• Lastly, there can be an expansion in specialist access as the patients will be able to connect with the specialist from distant locations. This can be helpful for the patients to get expert opinions and avoid the need for long-distance travel.

Cons of Remote Prescribing:

• Addressing the corns of the remote prescribing it can be said that there can be limited physical examination that lacks the ability for the healthcare providers to lead to misdiagnosis or incomplete assessments (Battersby et al. 2022).
• There can be enhancement in the potential for misusing the prescribing facility with the increasing risk of overprescription can lead to an incomplete understanding of the condition of the patient (Battersby et al. 2022).
• It can be said that both the patients and the health care providers are required to access the suitable technological advancement along with a stable internet connection in order to reduce the technological barriers, especially in the rural or low-income areas (Preminger, 2022).
• The telehealth platform or the remote prescribing system is required to prioritise data security and patient privacy in order to avoid breaches that can lead to exposure of the sensitive information addressed by the patients (Preminger, 2022).
• Apart from this, there can be a lack of trust and rapport that can be challenging due to no physical connection between the patients and the health care providers that can further impact therapeutic relationships (Preminger, 2022).
• There is a requirement to ensure that the patients are able to receive prescribed medicine along with a controlled substance as it can be difficult to control these aspects on a remote basis that raises concerns in terms of diversion and misuse (Wu et al. 2023).
• Lastly, it can be said that remote prescribing is a subject to different legal and regulatory requirements that can vary as per the jurisdiction (Wu et al. 2023). Hence, it is necessary to stay informed and compliant with the healthcare providers.

Risks associated with remote prescribing

It has been analysed that remote prescribing along with offering numerous health benefits also addresses several risk factors that are required to be carefully considered and managed for ensuring the safety and well-being of the patients. In this regard, some of the risk factors that are associated with remote prescribing have been addressed below:

• Limited assessment: One of the notable risk factors that is associated with remote prescribing is the Limited assessment of patients' physical conditions. In this regard, it can be said that the Healthcare providers are not able to access a comprehensive understanding of the symptoms addressed by the patients or their healthcare status without being able to conduct a physical examination (Simmons et al. 2023). This can further lead to misdiagnosis are incomplete care. As a result, there can be reputational damage to the organisation along with diminishing efficiency in order to treat the patient.
• Incomplete medical history: The healthcare providers are not able to gather a detailed medical history for dealing with the patient that can be challenging in a remote setting. Patients will not be able to disclose their complete medical history and may lack access to the relevant medical records (Zeidan et al. 2023). This can further hinder the accuracy of addressing valuable and effective prescriptions with thorough decisions.
• Medication errors: It has been analysed that remote prescribing has the potential to increase the risk of medication errors (Jessurun et al. 2022). In this regard, the errors can be addressed in terms of miscommunication confusion or technology glitches that can result in incorrect dosages medications are interactions that have the potential to harm the health of the patient.
• Overprescription and misuse: The healthcare providers can lack physical examination findings and may over-prescribe medication that can be considered as the misuse of the remote prescription facility especially with controlled substances (Chalkidou et al. 2023). This can further contribute to the growing issue of prescription drug abuse.
• Lack of in-person follow-up: has been analysed that monitoring and ensuring medication adherence can be challenging in a remote location (Bulman et al. 2022). Apart from this, the absence of in-person follow-up can result in the inappropriate intake of medication as prescribed along with experiencing adverse effects that go on unnoticed.
• Data security and privacy: The telehealth platform that is used for remote prescribing should uphold strong data security and patient privacy standards (Ali et al. 2023). There can be addressing of serious legal and ethical implications in terms of breaches or unauthorised access to medical information of the patients.
• Inadequate patient education: it can be said that the remote prescribing has the potential to limit the healthcare provider's ability in terms of educating the patient regarding their condition and medication in an adequate manner (Doheny et al. 2021). This in turn can limit the patient to fully comprehend their treatment plan that can lead to noncompliance or misunderstandings.
• Technological barriers: There are frequent cases where the patients have faced barriers in terms of technology access due to a lack of internet connectivity or suitable devices (Zander et al. 2021). As a result, it can be said that the barriers can hinder their ability to engage with the remote prescribing facilities in the underserved areas to get access to the valuable treatment to cure their healthcare issues.
• Legal and regulatory compliances: It has been noted that the legal and regulatory landscape for the remote prescribing facility can be considered as a complex environment that has varying requirements across the jurisdiction (Brown and Desai, 2023). In this regard, healthcare providers should navigate these regulations in order to ensure their practices remain compliant with the rules and regulations framed by the regulatory authorities.

As a result, it can be said that remote prescribing offers valuable advantages along with the risk factors that are associated with the advantages. In this regard, there is a need to navigate these challenges carefully considering the limitations of remote assessment by the health care providers. This can be helpful in ensuring the safety of the patients in terms of accurate meditation decisions along with addressing the issues that are related to the data security and privacy aspect help it can be said that it is crucial to establish a comprehensive protocol that can prioritise the education of the patients along with remaining informed regarding the evolving legal and regulatory requirements that can be helpful in mitigating the risk in an efficient and effective way. This can also be helpful in efficient deficient making by engaging the patients in the decisions for addressing their cure facilities. Apart from this, the inclusion of the remote prescription facility can be helpful in addressing the requirements of the patients who were not able to get the equipped and equal treatment facilities in the underserved areas.

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