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New ways to take our medicine
Research Triangle Park - As the
implementation date for Medicare's Part D prescription drug benefit
approaches, seniors are inundated with information on available choices and
registration deadlines.
While
the debate over the cost and scope of prescription drug coverage continues,
there is no argument that the availability of such drugs is key to the
modern-day treatment of disease. Presumably, as seniors' access to vital
medications improves, so will their ability to more effectively battle
debilitating disease and chronic illness.
However,
in order for drugs to be safe and effective, patients have to faithfully
follow their prescribed plan- of-care. "Patient noncompliance,"
originally noted by Hippocrates, is a significant public health problem
with an almost unbearable cost.
It is
estimated that upwards of 125,000 Americans die every year as a direct
result of not following prescribed physician orders. The General
Accountability Office estimates that the direct annual cost of patient
noncompliance to health insurers exceeds $100 billion. It is the cause of
10 percent of all hospitalizations and 23 percent of all nursing home
admissions. Moreover, 21 percent of all prescriptions are never dispensed.
Overall, about half of all ambulatory patients are
"noncompliant."
Most
Americans enjoy access to some of the best health care in the world,
manifested in the education and skill of providers, in innovative
technologies and in broad availability of sophisticated, effective drug
therapies. This is especially true in the Triangle. So why are we
noncompliant?
Numerous
scientific studies consistently point to three reasons: Forgetfulness,
misunderstanding of requirements and being asymptomatic.
Forgetfulness,
is entirely understandable: as seniors with chronic conditions are faced
with an ever- expanding medicine cabinet it is easy to appreciate the
difficulties of managing complex regimens. And with physician encounters
averaging eight minutes, it becomes impossible to properly educate a
patient on key self-care issues.
Lastly,
the asymptomatic patient has no pain or discomfort to compel adherence. It
is no surprise that oral contraceptives have adherence rates which exceed
90 percent, while drugs that attack hypertension or high cholesterol have
adherence rates of less than 50 percent.
It is
painfully obvious that simply improving the overall availability of
prescription medications via Medicare benefits or discount cards will not
necessarily result in improved health outcomes and may even result in an
increase in hospitalizations and nursing-home admissions, as more patients
are left to fend for themselves in managing complex self-care requirements.
Prescribing complicated regimens without proper education and ongoing
surveillance is akin to providing patients with a scalpel and an
instruction sheet for do-it-yourself surgery at home. A hazardous outcome
is virtually guaranteed.
At the
heart of the problem lies the traditional model for ambulatory care, in
which physicians diagnose illness and provide consultative advice in the
form of prescriptions and orders. There is typically little or no follow-up
until the next office visit, when the effects of noncompliance may have
already set in.
So how
do we ensure that seniors are receiving the quality care they deserve while
tax dollars are used in a cost-effective manner? The solutions may be
closer to home than we realize.
Those
of us who are caregivers to others with disease must take a more active
role in educating ourselves as to the health care requirements of loved
ones. We need to understand their medication regimens, monitor adherence
and not hesitate to contact providers when questions or concerns arise.
The
pharmaceutical industry, well represented in this region, needs to improve
its efforts to discover and develop drugs whose format may improve
adherence. For example, it is easier to be compliant if you have to take
only one pill daily. Improved compliance equals increased drug sales.
Our
universities and colleges should initiate research into methods to promote
adherence, and medical schools can educate new physicians on the value of
properly instructing and monitoring patients between visits.
Finally,
health insurers must realize that the primary care physician is the person
best suited to educate, advise and monitor the patient. Doctors should not
be expected to provide these services for free, and new reimbursement
methodologies need to be designed to properly compensate physicians for
managing chronic patients' disease. After all, avoided hospitalizations
greatly increase the financial viability and profitability of insurers.
That, in turn, benefits their customers.
Only through measures such as these will seniors truly
benefit from improved access to prescription medications. Merely flinging
more drugs at people with disease may result in an outcome society can ill-
afford.
Adee
Feinstein is CEO of Clinication,
Inc., an RTP-based health information technology developer.
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