Better prescribing for safer, more effective healthcare

Written prescriptions for medicinal products can be traced back over 4000 years.1 Little is known about the clinical efficacy or patient acceptability of formulations in use at that time, but it is thought that prescriptions were recorded on clay tablets, and included details of the condition, the formulation of plant and animal products, and dosing instructions.

Prescribing continues to be one of the most fundamental parts of medicine and one of the most common interventions in health care. In the UK, the British National Formulary lists more than 1600 drugs, which range from simple chemical substances that have been available for decades to new, small, interfering RNA molecules and products containing enzymes produced by recombinant DNA technology.2 The number of prescriptions dispensed in the community in England grew by 66% from 686 million prescriptions in 2004 to 1.14 billion prescriptions in 2021-22.34 Polypharmacy has also increased, with around 15% of people in England taking five or more medicines a day and 7% taking eight or more medicines a day.5

With this in mind, The BMJ in conjunction with the Drug and Therapeutics Bulletin has commissioned a series of articles on practical prescribing. These articles will highlight important issues for prescribers to consider and prompts for shared decision making between prescribers, patients, and their carers. The series—targeted at all medical and non-medical prescribers, particularly doctors in training—will cover medicines commonly prescribed in primary and secondary care. The format is designed to help readers recall their understanding of a medication through a series of questions, exploring up-to-date evidence, and reviewing accessible information not readily found in prescribing texts. The series launches with one of the most commonly dispensed medications in the world, proton pump inhibitors (doi:10.1136/bmj-2022-070752).

Alongside possible benefits, all medicines have the potential to cause harm, ranging from minor self-limiting problems to serious adverse effects requiring hospitalisation or worse. A recent meta-analysis estimated that about 10% of hospital admissions are related to adverse drug reactions and adverse drug events, with many being potentially avoidable.6 Prescribing errors constitute a substantial proportion of all medication errors (20% by one estimate),7 despite the optimisation of electronic prescribing.8 The decision to prescribe, not prescribe, or deprescribe any medicine should take into account available evidence on risks and benefits alongside each patient’s preferences, beliefs, values, and needs.9 The Practical Prescribing series aims to equip readers with the knowledge and confidence to make risk-benefit assessments and discuss them effectively with patients.

Aligned with other education articles published in The BMJ, we commission expert authors without financial links to industry, and aim for every article to be co-produced or peer reviewed by a patient with lived experience of the drug under discussion. This allows readers to gain new insights from those whose voices are under-represented in the prescribing literature.

Next year will be the 10th anniversary of the UK-based Prescribing Safety Assessment, a mandatory component of most medical school and foundation training programmes designed to ensure that doctors meet the prescribing competencies outlined by the General Medical Council.10 Although rarely a priority in postgraduate curriculums, safe and effective prescribing facilitates medication adherence, improves clinical outcomes, and saves lives—key priorities for all prescribers.911 We hope you will find the articles interesting, informative, and helpful in practice. We welcome all feedback from readers, to help guide the series going forward.