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Re: [Gnumed-devel] clin_medication

From: Karsten Hilbert
Subject: Re: [Gnumed-devel] clin_medication
Date: Tue, 19 Oct 2004 08:56:42 +0200
User-agent: Mutt/

> >Would "gastric acid resistant capsule" also fall under is_CR ?
> I would figure "yes", because to disrupt it (i.e. to disrupt the 
> capsule) would interfere with the gastric acid resistance.
OK. I think I understand the concept now.

> Does such information need to belong in the clin_medication table? 
> Perhaps, if the reason is to identify which *particular* drug 
> *is/was* the one used?
Yes. This is also the ONLY reason why it is there. Any drug
related information in that table is there to allow for safe
programmatic/manual re-identification of the drug. There should
not be ANY drug(!)-related data in that table purely for the
sake of *informing* the user about pecularities of a drug. That
is what a drug database is for. And to find the right drug in
that database we are storing sufficiently detailed information
in clin_medication. That's the point IMO.

> There may be no perfect distinction among is_SR and/or is_CR, and it 
> may come down to what people believe to be the useful (if any) 
> distinctions being drawn.
For me, the only reason this field is there is to allow for
distinction between SR and standard forms of the SAME drug
with the SAME name. If that case does not occur we better axe
this field. People seem to have attested to that it DOES
happen. It also seems likely that when prescribing generics
one does need to record this field as obviously I cannot say
"give this patient methylphenidate" and expect the pharmacist
to read my mind on whether SR or standard prep is wanted. So I
answered my own question, I guess :-)

> -  there are drugs (typically hormones, think insulins, 
> progesterones, also depot forms of drugs) compounded with varying 
> materials which require different dosing schedules but which do not 
> bear one of the above suffixes
Usually, over here, they differ in brandname or have a "depot"
or something appended. However that can't be the case for
generics - by concept.

> ... and then there is this value I suggested, of a field to indicate 
> whether the solid form can be split (but "CR" for "Controlled 
> Release" is here imperfect, for example there are drugs whose 
> granules are micro-encapsulated and which therefore may work properly 
> even if the capsule holding them were to be divided
Which clearly is (although useful) *information about* the
drug not needed for re-identification.

> ... but maybe some of this functions as a *guide* to prescribing and 
> is better stored in some other table?
Again, clin_medication is not intended to serve prescribing
particularly well. It is intended to record medication
*state*. Of course, it allows for deriving some values useful
for generating a new prescription. I may be splitting hairs
here but it helps me deciding what I think belongs in the
table and what does not.

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