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Re: [Gnumed-devel] clin_medication

From: Ian Haywood
Subject: Re: [Gnumed-devel] clin_medication
Date: Fri, 15 Oct 2004 19:05:57 +1000
User-agent: Mozilla Thunderbird 0.8 (X11/20040918)

Karsten Hilbert wrote:

What field  should carry the bid tid etc?

clin_medication.directions - free text

This is ambiguous: the same data is being stored twice.
The client should parse the directions string for bid tds etc. and
then *remove* those words from the comment. The comment is
for stuff that can't be broken down into the structure.

dosage_form text

                not null, --check (form in ('spray', 'cap', 'tab', 'inh', 
'neb', 'cream', 'syrup', 'lotion', 'drop', 'inj', 'oral liquid'))

We should try to rationalise this list to forms [=Preparation] where the distinction is clinically significant, viz. tab -- all *solid* objects designed for oral or sublingual use, including capsules
   syrup -- all *liquid* drugs for oral ingestion
cream -- all creams, lotions, solutions, tars, shampoos and pastes for putting on skin or hair.
   supp -- suppositories and peissaries
   neb -- solutions for use in a nebuliser
   inh -- all other inhalers, MDIs, Turbuhalers, etc.
   drop -- drops for eyes/ears
   IV -- all solutions/drugs/dissolvable powders for IV/IM injection
inj -- solutions specifically *not* for IV inection (think: vaccines, procaine penicillin)
   patch -- transdermal patches, e.g. GTN, fentanyl, oestrogen

--      is_SR boolean   -- ???

Some drugs have both a slow-release and standard preparation available under the same brandname,
for some (tramadol, sertraline) distinction is crucial.

we want it to tell us what each drug contains ? No (but we want
the widget to allow us to *jump to* that information in
Hilmar-space). Will there be cases where more detail is needed
Yes, but, IMHO we need enough information to find the preparation (or clinically equivalent preparation) in any database, otherwise we are locked in by our own records. You have a suitable non-vendor specific ID (PZN), we don't. ATC is nearly, but not quite, specific enough, hence my desire to replicate a lot of drugref stuff. PBS item codes are specific, and sound like the analogue of PZN, but only cover drugs subsidized by the government.

Am I thinking correctly that when we prescribe generics we
would do this:

phenoxymethylpenicilline 1.5 Mio i.E.
clavulanic acid 3g

which being TWO SEPARATE ROWS in clin_medication ?
Whereas when I would prescribe a particular drug by brand name
containing both of the above it would be just one row. This is
how I designed the table anyways

IMHO bad, as this means duplicates of all the other fields, poor normalisation in other words. A linked separate table is the SQL-pure way of representing this data, but I understand your relunctance.

Perhaps the generic text field can be upgraded to a parseable "generic drug expression" such as "amoxycillin 875mg/clavulanic acid 125mg", effectively a name-based substitute of PZN, which is also poor normalisation of course, but doesn't pollute the schema with what is, I have realised, a hack around the incompetence of my own just re-elected government [sob]


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