Challenges to evidence-based prescribing in clinical practice.

Area of Science:

• Medical Practice
• Clinical Decision-Making

Background:

• Widespread support exists for evidence-based medicine (EBM) in rational prescribing.
• Significant and often justified challenges impede the universal application of EBM.

Purpose of the Study:

• To identify and discuss the multifaceted factors influencing clinical decision-making in prescribing beyond EBM.

Main Methods:

• Literature review and synthesis of factors impacting prescribing behavior.
• Analysis of influences on clinical judgment in pharmaceutical selection.

Main Results:

• Clinical decisions are driven by numerous factors beyond scientific evidence.
• These include patient preferences, social contexts, drug interactions (disease-drug and drug-drug), clinical experience, competing clinical priorities, marketing, and health system policies.

Conclusions:

• Rational prescribing requires acknowledging and integrating diverse influences beyond EBM.
• A comprehensive approach is needed to address the complexities of clinical decision-making in real-world settings.