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Biomedical subjects

Tom Walley

Publications and source records attributed to Tom Walley.

8 recordsLinked to original sources
PubMed2003

Teaching safe and effective prescribing in UK medical schools: a core curriculum for tomorrow's doctors.

There is a pressing need for medical graduates to be fully prepared to take on the responsibilities of prescribing and to be able to respond to continual inevitable rapid changes in therapeutics. The curricula in UK medical schools were greatly influenced by Tomorrow's Doctors, published by the General Medical Council in 1993. This has recently been updated. While it highlights the management of disease and use of drugs as key learning objectives, it offers little specific guidance. In this document we expand on these broad statements, provide a view of how these learning objectives might be achieved, and identify the key elements of a core curriculum in prescribing and therapeutics.

Attitude of Health Personnel↗
PubMed2003

Influences on GPs' decision to prescribe new drugs-the importance of who says what.

OBJECTIVES: The aim of this study was to understand the range of factors that influence GPs' uptake of new drugs METHODS: A total of 107 GPs selected purposively from high, medium and low new drug prescribing practices in two health authorities in the north west of England were interviewed using the critical incident technique with semi-structured interviews. Interview topics included reasons for prescribing new drugs launched between January 1998 and May 1999; reasons for prescribing the new drug rather than alternatives; and sources of information used for each prescribed drug. RESULTS: Important biomedical influences were the failure of current therapy and adverse effect profile. More influential than these, however, was the pharmaceutical representative. Hospital consultants and observation of hospital prescribing was cited next most frequently. Patient request for a drug, and patient convenience and acceptability were also likely to influence new drug uptake. Written information was of limited importance except for local guidelines. GPs were largely reactive and opportunistic recipients of new drug information, rarely reporting an active information search. The decision to initiate a new drug is heavily influenced by 'who says what', in particular the pharmaceutical industry, hospital consultants and patients. The decision to 'adopt' a new drug is clinched by subsequent personal clinical experience. CONCLUSIONS: Prescribing of new drugs is not simply related to biomedical evaluation and critical appraisal but, more importantly, to the mode of exposure to pharmacological information and social influences on decision making. Viewed within this broad context, prescribing variation becomes more understandable. Findings have implications for the implementation of evidence-based medicine, which requires a multifaceted approach.

Decision Making↗
PubMed2003

Understanding why GPs see pharmaceutical representatives: a qualitative interview study.

BACKGROUND: Doctors are aware of the commercial bias in pharmaceutical representative information; nevertheless, such information is known to change doctors' prescribing, and augment irrational prescribing and prescribing costs. AIM: To explore GPs, reasons for receiving visits from pharmaceutical representatives. DESIGN OF STUDY: Qualitative study with semi-structured interviews. SETTING: One hundred and seven general practitioners (GPs) in practices from two health authorities in the North West of England. RESULTS: The main outcome measures of the study were: reasons for receiving/not receiving representative visits; advantages/disadvantages in receiving visits; and quality of representative-supplied information. Most GPs routinely see pharmaceutical representatives, because they bring new drug information speedily; they are convenient and accessible; and can be consulted with a saving of time and effort. Many GPs asserted they had the skills to critically appraise the evidence. Furthermore, the credibility and social characteristics of the representative were instrumental in shaping GPs' perceptions of representatives as legitimate information providers. GPs also received visits from representatives for reasons other than information acquisition. These reasons are congruent with personal selling techniques used in marketing communications. CONCLUSIONS: The study draws attention to the social and cultural contexts of GP-representative encounters and the way in which the acquisition of pharmacological information within the mercantile context of representative visits is legitimated. This highlights the need for doctors to critically appraise information supplied by representatives in relation to other information sources.

Drug Industry↗
PubMed2002

Using drugs safely.

Explore the source record for details and available documents.

Drug Prescriptions↗
PubMed2002

Lifestyle medicines and the elderly.

Lifestyle medicines are those used to meet patient aspirations rather than traditionally defined medical need. However, in many cases, the boundary between the two is ill defined and a matter of degree or cultural expectation. Such medicines are not yet widely used by the elderly, but this may change in an increasingly consumerist society. There are ethical, clinical and financial issues to be considered around these drugs, which are not independent. The ethical issues relate mainly to the rising consumerism in medicine, and whether these and other medicines are consumer goods available almost on demand. The clinical issues concern the balancing of risk and benefit for these medicines, and how we inform patients of these issues. The financial issues are who should pay and whether third party payers can and should ration these medicines and, if so, how. Lifestyle medicines may provoke a debate on the whole issue of rationing. These issues are not confined to the use of these medicines by the elderly and their resolution will depend on a broader societal debate, in which the elderly need to be active.

Aged↗
PubMed2002

Measuring consultation skills in primary care in England: evaluation and development of content of the MAAS scale.

BACKGROUND: Consultation skills are essential for general practice. Tools for measuring consultation skills in everyday practice are not well developed AIM: To examine and develop the content validity of the MAAS History-taking and Advice Checklist GP (MAAS-GP) tool which is used in The Netherlands for testing consultation skills, with simulated patients in United Kingdom general practice from the perspectives of both general practitioners and patients. DESIGN OF STUDY: Qualitative research using semi-structured interviews. SETTING: Alternate patients attending seven general practices in the north west of England. METHOD: Thematic analysis of the contents of patient and GP interviews, and of focus groups, mapping key themes to the MAAS-GP. RESULTS: There was strong agreement between patients and GPs on issues mapping to 46 out of 68 items of the MAAS-GP. Eight further MAAS-GP items were linked to issues only raised by patients and four to issues raised only by GPs. The remaining 10 items could not be related to issues raised by either. All of the issues raised by GPs could be mapped but 27 patient items could not. These were included in a revised checklist, the Liverpool MAAS (LIV-MAAS). CONCLUSION: the revised tool seems to have content validity in measuring consultation skills. Measurement of its relability is now required.

Adult↗