How Physicians Renew Electronic Prescriptions in Primary Care: Therapeutic Decision or Technical Task?

In long-term pharmacotherapies, the renewal of prescriptions is part of the medication use process. Although the majority of medicines are used with renewed prescriptions, little research has focused on renewal practices. The aim of this study was to explore current renewal practices from a primary care physician’s perspective to identify system-based challenges and development needs related to the renewal practices. This qualitative study was conducted in two phases in public primary health care centres of Kirkkonummi, Finland. First, five physicians were shadowed on-site while they renewed prescriptions. The findings of the shadowing phase were further discussed in two focus group discussions with seven other physicians than in the shadowing phase. Inductive content analysis was used for data analysis utilizing Reason’s risk management theory as a theoretical framework. Due to problems in the renewal process, including impractical information systems, a lack of reconciled medication lists, and a lack of time allocated for renewing prescriptions, physicians felt that monitoring and reviewing each patients’ medications for renewal was complicated. Therefore, they felt that renewing, at times, became a technical task rather than a therapeutic decision. The physicians suggested information system improvements, enhanced interprofessional cooperation, and patient involvement as strategies to ensure rational pharmacotherapy and patient safety in the renewal of prescription medicines.

Case Report: Managing a COVID-19 Nursing Home Outbreak A Physician’s Perspective

I am the medical director and sole physician at a 35-bed nursing home in Western Galilee in Israel. At the end of December 2020, the nursing home experienced a COVID outbreak in which nineteen residents were infected. Four of them were symptomatic, and two died. Ten staff members, including our administrator, likewise caught the disease, and five of them were symptomatic. All recovered. The first part of this paper will examine why, despite all our precautions, the outbreak occurred when it did, and why it spread extensively within the home. The second part will describe how the nursing home functioned after the outbreak, until its residents recovered.