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Challenges to Evidence-Based Prescribing in Clinical Practice

Director, Applied Health Research Centre, Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada

Andrew Ching, PhD

Assistant Professor, Joseph L Rotman School of Management, Toronto

Brian Golden, PhD

Professor, Joseph L Rotman School of Management

Magda Melo, BScPharm MSc

Research Manager, Applied Health Research Centre, Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital

Ulrich Menzefricke, DBA

Professor, Joseph L Rotman School of Management

Reprints: Dr. Menzefricke, Joseph L Rotman School of Management, 105 St. George St., Toronto, ON M5S 3E6, Canada, fax 416/978-5433, Menzefricke{at}rotman.utoronto.ca

Although there appears to be widespread support of evidence-based medicine as a basis for rational prescribing, the challenges to it are significant and often justified. A multitude of factors other than evidence drive clinical decision-making, including patient preferences and social circumstances, presence of disease-drug and drug-drug interactions, clinical experience, competing demands from more pressing clinical conditions, marketing and promotional activity, and system-level drug policies.

Key Words: clinical practice, evidence-based prescribing, pharmacy practice

Published Online, April 15, 2008. www.theannals.com, DOI 10.1345/aph.1K283