Patient-centred prescribing, autonomy and concordance

Patient-centred prescribing is putting the patient at the centre of everything we do. Simon et al (2020) advise that the fact a medication can be prescribed for a particular condition does not mean it necessarily should be prescribed. This means the paramedic prescriber must ask themselves (among other things) ‘what are the risks versus benefits’? Autonomy is one of the four ethical principles from Beauchamp and Childress’ seminal work on medical ethics (1979) (the others being beneficence, non-maleficence and justice), and it means recognising and respecting a patient's ability to come to their own decisions about their care. Concordance is the accuracy with which the patient follows the prescribed treatment regimen; a high level of concordance means that the patient takes the prescribed medication correctly, at the correct times of day and for the correct length of time (Joint Formulary Committee (JFC) 2020). A high level of concordance is however rarely the case, which will be later discussed. These topics are important to all prescribers, but to paramedic prescribers in particular as the newest prescribers on the block. The Royal Pharmaceutical Society (RPS) (2016) prescribing framework advises that prescribing is not a right, but a responsibility. This means it is our duty as paramedics to prove we are equal to that responsibility. The Health and Care Professions Council (HCPC) (2019) have adopted the RPS (2016) framework for their own paramedic prescribing framework and expect all paramedic prescribers to adhere to it. Paramedic prescribers are fully capable of driving the paramedic profession forward and upward but—in the words of Spiderman's uncle—‘with great power comes great responsibility’.