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Drugs, Drugs, Drugs

By March 18, 2010Commentary

The stereotype of physicians’ bad handwriting may be funny, but it has led to quality problems, for example in the filling of prescriptions.  A recent study looked at how many errors there are on prescriptions and how e-prescribing can help reduce those errors.  (JGIM Article) (Abstract Only)  The study examined prescriptions written by 30 physicians at 12 practices in New York State.  About two-fifths of hand-written prescriptions had errors initially.  Some were relatively minor, such as incomplete directions for use, but many were very serious, including wrong dosage and omitting quantity.  Illegible handwriting accounted for many of the errors. When 15 of the physicians switched to an electronic prescribing system, errors dropped to less than 7%.  In part this is because of no legibility issues, but e-prescribing systems also have a variety of edits that help physicians avoid mistakes.  In addition to the quality concerns, having to correct inaccurate prescriptions uses up a lot of pharmacist and physician time and adds to cost.

One of the biggest problems with medications is ensuring that patients actually fill and take them as prescribed.  Patients can’t take a drug if they don’t fill the prescription.  Another recent study examined how often and why patients don’t fill a prescription.   (JGIM Article) (Abstract Only)  This phenomenon, known as primary non-adherence, has been very difficult to research, because many prescriptions were hand-written and an unfilled prescription obviously has no claim associated with it.  The advent of e-prescribing now provides the ability to identify prescriptions written but not filled according to claim files.  The researchers looked at over 195,000 prescriptions.  About 22% were unfilled.  Prescriptions written by primary care doctors were more likely to be filled, as were those by male and older physicians.  Men were slightly more likely than women to fill, and prescriptions for children were more often filled than those for adults.  Pain medication was least likely to be obtained and there were relatively high rates of non-adherence for hypertension, diabetes and high cholesterol drugs.  All in all, fairly disturbing results, especially in regard to chronic disease.  The obvious follow-up is a survey to ascertain why the patients did not get the drugs prescribed.  Earlier research has suggested cost is a major reason.  While some drugs are expensive, many are quite inexpensive and they often provide very significant overall health spending savings.

Finally, a Journal of the American Medical Association story reports on a characteristics of drug comparative effectiveness research.  (JAMA Story) Comparative effectiveness is being counted on as a factor in bringing down health spending.  The authors of the article looked at characteristics of 104 CE studies published in six major medical journals.  Comparative effectiveness studies were only a third of overall medication studies and they were far more likely than other research to be funded exclusively or largely by noncommercial sources.  Few looked at safety and almost none included a formal cost-effectiveness analysis.  The article indicates the likely continued need for government funding of CE research and the desirability of focusing more of that research on safety and cost issues, in addition to efficacy.

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