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Re: [Gnumed-devel] gnumed

From: J Busser
Subject: Re: [Gnumed-devel] gnumed
Date: Wed, 13 Oct 2004 23:56:27 -0700

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?)

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