Table 1

Emerging/evolving rationale and role for indication-based prescribing: going beyond adding indication simply to inform patient and pharmacist1

DomainEmerging functionExample
Decision support for
drugs of choice
Help prescribers recall and access best/current Rx for diagnosis.Enter: rheumatoid arthritis—CPOE suggests appropriate next drug to order.
Facilitating antimicrobial stewardship.Enter: cellulitis—CPOE lists the narrowest spectrum antibiotic choice based on local resistance rates and current recommendation.
Safer prescribingSecond piece of information to cross-check for wrong drug, patient and dose.Erroneous orders of hydroxyzine 25 mg for hypertension, hydralazine 25 mg for itching would be easily recognised.
Forcing function to filter CPOE choices to avoid look-alike sound-alike or computer menu ‘pull down’ errors.Erroneous ordering of penicillamine instead of penicillin (next to each other on pull-down lists) is not possible since it does not appear as a choice for dental infection.
Patient education
and adherence
Permit pharmacists and nurses to more meaningfully counsel patients on their medications.Explain to patients why (and how) they need to take their prednisone or warfarin (so don’t have to guess among scores of indications).
Help patients understand what each medication is for and avoid confusion leading to erroneously mixing up meds.Patients stopping their drug for diabetes thinking it was the med for their depression, which had resolved.
Medication reconciliation
and deprescribing
Group meds together to visually facilitate spotting duplicates or candidates to stop (or start).Group/visualise all of patient’s blood pressure meds to assess current regimen for that problem, aiding in deciding on any needed changes.
Reluctance to stop meds started by another clinician if uncertain why it was started.Why is the patient taking a chronic PPI or digoxin? Depends on the indication whether it can be safely stopped (or tapered).
Prior authorisation (PA)Prescriptions meeting indication-based criteria could have orders automatically approved without added ‘PA’ paperwork.‘Headaches refractory (or allergic) to 1st line medications’ (this is the indication) automatically approved for second-line more expensive agents.
Artificial intelligence
machine learning
Expanding role of mining of big databases for real-world drug discovery and research. Indications needed to evaluate drug’s effectiveness (and adverse effects) for that problem.Exploring subsets of patients who most favourably respond or are more likely to experience an adverse effect.
Outcome research of long-term effectiveness for a particular indication.
  • CPOE, computer provider order entry; PPI, proton pump inhibitor.