2011 Potpourri XV

A survey of 1500 people conducted by University of Pennsylvania researchers found that 20% said they had not filled a prescription because of financial concerns and another 5% were worried they might not be able to afford to do so.  Dispense as written prescriptions, which often require use of a brand name, were more likely not to be filled.  Being poor, smoking, using illegal drugs and having money issues were all linked to higher rates of non-filling.  For people with chronic disease this is a particularly troublesome trend.  The survey also points to the need for laws requiring the use of generics unless there is a very solid reason not to.   (Reuters Article)

The Associated Press ran a story on supposed concerns that concierge medicine may make it harder for some seniors to find doctors who will take Medicare.  Concierge medicine generally involves a patient paying a physician a flat fee to pay special attention to them; spend more time, be available quickly, coordinate care, etc.  In other words, do what doctors generally did before government became such a huge and cheap payer through Medicare and Medicaid.  Thank goodness one expert quoted had the good sense to make this point.  The more government gets involved in health care, the less responsive doctors have been to patients.  Might be time to reverse that trend.   (AP Story)

PharmaTimes carried a story on two surveys of physicians regarding drug company sales reps.  In one of the surveys, of 500 American Medical Association members, over 90% said they found drug rep information useful and valuable.  In a separate survey of over 5400 doctors, most said they prefer in-person interactions to electronic or phone ones, including 79% of primary care physicians and 74% of specialists.   A large percent, 61% of PCPs and 50% of specialists, still have an open-door policy with sales reps whereby they can come in without an appointment.  (PharmaTimes Story)

The Kaiser Family Foundation publishes three more briefs in its usually excellent series on Medicare and Medicaid data.  These three have a common theme focusing on the out-of-pocketing spending by seniors on health care and on the current and future affordability of their health care needs.  Some findings include that Medicare households spend about 15% of their income on health care, with the largest piece of that going to health insurance premiums, presumably Medigap.  Spending on health insurance premiums has gone up in recent years, while spending on prescription drugs has gone down, which is what might be expected with the introduction of the Part D program.  Health spending as a portion of income goes up with age, also as expected.   (KFF Briefs)

An article in the Archives of Internal Medicine gives further evidence that telemedicine can provide equivalent or better quality.  The meta-review looked at the practice of using remote monitoring and management of ICU patients, examining 13 studies covering 41,000 patients.  Overall, remote management showed a reduction in ICU mortality and length of stay compared to the traditional approach, although not a reduction in overall hospital mortality or length of stay for the patients.  (Archives Article)

Some semi-good news regarding EHRs.  The Medical Group Management Association conducted a survey of EHR use last year that covered 4588 organizations with over 120,000 physicians.  The results indicate that 72% of users with installed EHRs are happy.  Productivity loss fears are the biggest barrier keeping doctors who don’t have EHRs from getting one.  And only 26% of those with an EHR in place say it has increased productivity and 50% say they underestimated the training time.  (MGMA Survey)