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Prescribing and Patient Group Direction

Clinical situations when PGDs maybe appropriate and may not be appropriate

While the use of PGDs may seen as a useful tool, practitioners should consider if the PGD being proposed is the best way to address the clinical situation being considered. This section will present clinical situations when PGDs maybe appropriate and not appropriate.

1. Examples of clinical situations when a PGD may be appropriate

  • medicine use follows a predicable pattern, such as patients attending for contraception
  • patients with an acute need seek unscheduled care, such as in a walk-in centre for minor ailments
  • managing a discrete treatment episode where supplying or administering a medicine is needed such as treating chlamydia
  • There is a homogeneous patient group, such as at-risk groups of patients needing immunisation.

2. Examples of clinical situations when a PGD needs careful consideration

  • the medicine being used off label
  • the medicine is a black triangle medicine
  • the medicine is a controlled drug
  • the medicine is an injectable preparation for self-administration
  • treatment or response to treatment needs careful monitoring
  • managing a small number of patients in a specific patient group, because the appropriate resources and expertise may not be available
  • supplying and/or administering a range of medicines to the same patient (this may be appropriate in some cases when a discrete episode of care involves treatment with morethat one medicine)
  • an antimicrobial is needed (this may be appropriate in some circumstancessuch as chlamydia treatment in a sexual health clinic)

3. Examples of clinical situations when alternative options to PGDs should be used

  • managing complex long-term conditions, such as hypertension or diabetes
  • in a particular setting, significant uncertainty remains about the differential diagnosis
  • the medicine needs frequent dosage adjustments, for example warfarin
  • the medicine needs frequent or complex monitoring, for example immunosuppressants
  • the medicine is a high risk medicine, for example insulin
  • the medicine is unlicensed