Drug safety monitoring started with detailed studies of suspected adverse drug effects in hospitalised patients. Recently most pharmaco-vigilance work of an observational nature has been confined to domiciliary practice, because the number of drugs used and the number of underlying conditions experienced by patients are generally fewer there than in hospitals. This leads to easier interpretation of data but does leave a gap in our knowledge of the safety of drugs whose use is confined to the hospital setting, such as anaesthetics and several third-line antibiotics. There will need to be some efforts directed from time to time towards correcting these omissions, probably by ad hoc studies in hospitals such as have been undertaken by the Boston Collaborative Drug Surveillance Program in the 1970s and 1980s, and the Medicines Evaluation and Monitoring Organization in Dundee.
Such studies would be facilitated by more widespread use of computerised prescribing systems in hospitals. Their benefit would be enhanced greatly were such systems to be linked directly with patients' general practice records. This is entirely practicable if the will, finance and issues of patient confidentiality can be resolved.
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