Adding a Diagnosis to Every Prescription – A Key to Stopping Polypharmacy

add a diagnosis

Pharmacists spend a ton of time authorizing, clinically reviewing, and verifying prescriptions. We also spend time reviewing what information we have about a patient. Unfortunately, in a community pharmacy type setting, a diagnosis is often not given on the prescription for the medication.  Depending upon the setting the pharmacist works in, information to provider notes can be extremely limited. Even in my work as a long term care consultant, sometimes it wasn’t clear why a medication was started until the notes were at the facility. Notes to the chart could be delayed for various reasons leaving the diagnosis in question. The diagnosis can be vital to determining if a dose and drug is appropriate.  I’m going to give you a few examples where adding a diagnosis to a prescription can help improve patient care and allow the pharmacist to be of more help in preventing errors and polypharmacy.

One of my most popular posts to date has been the 10 Commandments of Polypharmacy. I’m always looking for ways to try to prevent catastrophes like this. Now I have not worked a ton of my time in pharmacy as a pharmacist who dispenses medications. I can tell you that I have had numerous times where I have wanted to know what the diagnosis is.

The Institute for Safe Medication Practices is an excellent resource on this and many other topics.  Here’s further discussion on why we need an indication for every medication. As is common with my blog, I wanted to give you some real world examples that demonstrate the importance of knowing the diagnosis.

PPI for NSAID prophylaxis. Without a diagnosis, we won’t know whether the PPI (omeprazole, pantoprazole, etc.) is for GERD, Barrett’s, or peptic ulcer disease.  In the situation of using a PPI for NSAID prophylaxis, we would likely be able to discontinue the PPI when the NSAID is discontinued.

Beta-blockers can have numerous indications which I talk about on this podcast. Propranolol is a Swiss army knife.  I would strongly encourage any provider who uses this medication to put the diagnosis with it.  Whether for tremor, migraines, portal hypertension, or other diagnosis, this can help us understand what we are treating and we can help ensure that the patient is actually benefitting from the medication.

Duloxetine for stress incontinence. While duloxetine is most commonly used for neuropathic pain or depression, it can possibly be used for stress incontinence.  It would certainly be nice to know this to help monitor for beneficial effects.

These are just a few examples of where having a diagnosis would help the entire healthcare team.  I would strongly encourage anyone who writes prescriptions for medications to write the diagnosis right with the order.

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5 Comments

  1. Vee

    It is indeed a very good point that you bring up. I hope this becomes a standard practice in community settings as much as it is in a hospital setting.

    Reply
  2. Bertram

    HIPPA does not always permit you to ask a physician for a diagnosis code, and ICD9. When I practiced retail pharmacy, I called doctor’s offices for a code if I thought the Rx was questionable. Legitimate prescribers usually but not always gave me the information I needed to determine if I was going to fill the Rx.It may not even be correct to ask for the information under HIPPA.

    Reply
    • Carol Bell

      The pharmacist is directly involved in the patient’s care. Would you please give a few examples of situations where it would be a HIPAA violation to ask for a diagnosis? Thank you very much.

      Reply
  3. Alan

    During he 1960s I sent a monthly newsletter to most of the Physicians in my practice area.
    In addition to observations and comments regarding medicine, Pharmacy and and new drugs,
    I would suggest exactly what you said…..”please indicate what the medication is to be used for”.
    Some suggestions were not too complicated or revealing, but they helped me and my patients.
    Not surprisingly, considering we had just come out of an era where everything was a secret. We,
    as Pharmacists were not permitted to tell patients ANYTHING about their drug therapy. Therefore,
    it was not in Physican’s training to let anyone know why certain medications were used. As I
    remember, only one (1) Physician routinely indicated why the drug was being used.
    Also, at that time in history patient confidence in the Physician was part of the cure.

    Reply
  4. Kristina

    I’ve brought up the same issue. It would make such an improvement in the community. Sometimes patients themselves don’t remember why they’re taking a medication.

    Reply

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Written By Eric Christianson

November 21, 2018

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