Prescribing for Special Groups
Children and elderly patients comprise a large proportion of the GP’s workload and have very particular prescribing requirements. Fifteen per cent of the population is over 65 years but consume around 45% of all prescriptions. Elderly people with several co-morbidities often require multiple medications but cope less well with them. Calculating dosage in children can be problematic and the effect of drugs idiosyncratic. Most medication information relates to people between these age groups but the bulk of your work will be at these two extremes where particular care is needed in prescribing. As in Chapter 8, we consider necessity, effectiveness, safety and concordance for each group.
Prescribing for Children
Children are not small adults; they respond differently. Attention deficit hyperactivity disorder (ADHD) is treated with amphetamine in children where it functions as a sedative – in adults it is a stimulant.
- Necessity. Most children seen in general practice have minor self-limiting illness. Parents are understandably concerned and may exert considerable pressure on the doctor to prescribe antibiotics. These will rarely be appropriate. You need to understand the patient’s concerns (the child and the parent) and deal with them. You need to develop a safe management plan with the parents so they feel reassured and know what to look for and what to do if things take a turn for the worse (safety netting). Patients requesting antibiotics may do so because ‘that’s want the last doctor did’ or because of particular concerns like high fever (and the dangers they worry it poses). Remember: good communication prevents unnecessary medication.
- Effectiveness.
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