McKenna's Pharmacology for Nursing, 2e

6

Challenges to effective drug therapy

Learning objectives Upon completion of this chapter, you should be able to: 1. Discuss the impact of the media, the Internet and direct-to-consumer advertising on drug sales and prescriptions. 2. Discuss the importance of quality use of medicines and the role of nurses and midwives. 3. Explain the growing use of over-the-counter drugs and the impact they have on safe medical care. 4. Discuss the lack of controls on herbal or alternative therapies and the impact this has on safe drug therapy. 5. Define the off-label use of a drug.

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Glossary of key terms alternative therapy: includes herbs and other “natural” products as often found in ancient records; these products are not controlled or tested by the TGA and MEDSAFE (NZ); however, they are often the basis for discovery of an active ingredient that is later developed into a regulated medication cost comparison: a comparison of the relative cost of the same drug provided by different manufacturers to determine the cost to the consumer Internet: the worldwide digital information system accessed through computer systems off-label use: use of a drug that is not part of the stated therapeutic indications for which the drug was approved by the TGA and MEDSAFE (NZ); off-label use may lead to new indications for a drug self-care: tendency for people to self-diagnose and determine their own treatment needs street drugs: non-prescription drugs with no known therapeutic use; used to enhance mood or increase pleasure

T he dawn of the 21st century arrived with myriad new considerations and pressures in the healthcare industry. For the first time, consumers have access to medical and pharmacological information from many sources. Consumers are taking steps to demand specific treat- ments and considerations. Alternative therapies are being offered and advertised at a record pace, and this is causing people to rethink their approach to medical care and the medical system. At the same time, finan- cial pressures have led to early discharge of people from healthcare facilities and to provision of outpatient care for people who, in the past, would have been hospitalised

and monitored closely. Healthcare providers are being pushed to make decisions about care and prescriptions based on finances in addition to medical judgement. Illicit drug use is at an all-time high, bringing increased health risks and safety concerns. There are increasing concerns about the environment and the need to protect it from contamination. Nurses and midwives are often caught in the middle of all of this change. People, as con- sumers of healthcare, are demanding information but may not understand it when they get it. Health teaching and home care provisions are vital to the success of any health regimen. The nurse or midwife is frequently in