Re: [Gnumed-devel] gnumed

[J Busser]

At 10:13 AM +1000 10/14/04, scaredycat wrote:
> > There is no such thing as repeats in Germany. For *any* refill
> > you'll need to get a new prescription from a doctor.

But "refills" are used in enough countries (Canada included) to make 
them reasonable to include in the schema? In Canada we can specify a 
number of refills as well as a minimum time that must elapse between 
refills, I assume to discourage excessive use of prn medications.

Even where regulations prohibit "refills", there could be a concept 
of a maximum period, after which the patient would have to be seen in 
order to get a new prescription, but within the maximum period, the 
patient is not permitted (or not required) to be dispensed all of the 
medication at once. Think of patients in a methadone program 
structured to require every dose to be observed, (hopefully) it would 
never be required that every dose be an individual prescription, it 
is just that the patient is (initially) not permitted to take a 
supply with them but over time they can be permitted amounts to 
"carry".

There is a second similar concept in which a patient or pharmacy (or 
maybe doctor) can ask that only a small portion like one or two weeks 
of medication be filled in case there are side effects, which permits 
less to be wasted. If the drug is tolerated then the rest of the 
prescription can be dispensed.

So it might be possible to use the backend a bit differently even in 
a country that does not "permit" refills. A doctor could store a 
maximum interval, after which reassessment must be required but 
within which could be stored a duration or a number of doses which 
the patient is permitted to get filled at any one time.

I am not sure it is desirable, just possible, depending on the 
liberties in a client widget design re GUI labelling of the data.

This functionality could alternatively be supported using dedicated 
fields, or just using the directions (easiest for the time being) but 
in the end I think it reasonable to have refills (INTeger) and 
perhaps min_refill_int (or min_refill_interval) (in days?)