Research on Clinical Indications: What Is Known and What Is Not

What has been published?

Letters, a commentary, two hospital studies and a systematic review. The evidence page lists them with links. They run from Dr Masters’ letters in the BJGP (2004 and 2015) and the BMJ (2013), through a 2016 NEJM commentary, to hospital studies in the UK (2019) and New Zealand (2025) and a 2026 systematic review.

Dr Masters first described clinical indications in 2003.

The site also holds his own early work at Highfield Surgery: a statin compliance study and departure and destination audits (both April 2006), and a patient focus group (October 2005).

What is known?

• In one study, a compulsory field raised recording. In a hospital system in Christchurch, New Zealand, the share of medicines with an indication rose from 29% to 76%, with only a small increase in “rubbish text” and no change in medicine use (2025).
• In a 2019 study, most UK trusts did not require indications for every medicine. Only 4 of 64 did, and 15 required none. Pharmacists called indications “helpful” or “useful”, but the authors warn that mandatory fields “may be counterproductive”.
• Dr Masters reported high coverage. At Highfield Surgery, his departure audits found indication labelling on 89% of repeat scripts in January 2004 and 100% in August 2004, and a 2006 audit of Highfield Surgery patients at a residential home found 90%. The site’s other figures (85% after one and a half years, 85% over two years, over 80%) come from different points as the practice built up its indications.
• Statin compliance was high in Dr Masters’ single-practice study. Average compliance was 93% over a year, and 91% when the study was repeated in January 2006.

What is still open?

• Whether indications improve adherence. FAQ 6 says “at present there is no evidence that clinical indications assist with adherence”. The compliance study lists other possible reasons for its result, such as the enthusiasm of the doctors and nurses, patient understanding and cost-free prescriptions.
• Errors. Dr Masters knows of no study that measured prescribing or dispensing errors before and after indications were added.
• Prescriptions for all medicines. In the 2026 review, 16 of 24 studies covered antimicrobials and only one examined prescriptions for all medicines.
• Agreed standards. The review’s authors call for “agreed international standards to guide system vendors”.
• Wording. FAQ 7 suggests that careful wording on the label, such as “to promote positive mood”, may enhance drug performance, and that this “needs careful evaluation”.
• Uses of the data. FAQ 7 expects indication data to be of great value for research on drug costs and off-label use. A 2015 Quebec study reported on this site, using an electronic health record that supports treatment indications, found an association between off-label use and adverse drug events.

How can I work with Dr Masters?

By email, or through the contact page. FAQ 13 says Clinical Indications “would like to encourage research” but “does not have access to funds”, and Dr Masters is still happy to help healthcare staff with research. Email him at mastersnigel@gmail.com.