A situation that happened in my practice this week motivated me to look up some information about American's use of prescription drugs for chronic disorders. The results of my search (below) are consistent with what everyone already knows. We are a heavily medicated country. There's a medication for every disorder. And the most frightening part of the whole equation is the rapidly increasing inclusion of children. Statistics show that up to 25% of insured children are on some medication (asthma, attention deficit and diabetes are the most common condition)
51% of all insured Americans (including children) take at least one prescription drug
20% of insured Americans take three or more Rx drugs
75% of older adults take one or more Rx drugs
25% of older adults take five or more meds on a regular basis (28% of women and 22% of
The fact that many older Americans are on long term medications is startling because of the know consequences and side affects of these medication. And unfortunately, the monitoring of these medications over times is sometimes inadequate
Older adults are seven times more likely to be hospitalized for an adverse drug event than
Warfarin, insulin, and digoxin together account for over one-third of emergency department
visits for adverse drug events among older adults.—Budnitz DS, Pollock, DA, Weidenbach KN, et al. National
Surveillance of Emergency Department Visits for Outpatient Adverse Drug Events. JAMA. 2006;296:1858-1866.
“About one in three older persons taking at least five medications will experience an adverse
drug event each year, and about two thirds of these patients will require medical attention.”—
Hanlon JT, et al. Adverse drug events in high risk older outpatients. J Am Geriatr Soc. 1997;45:945-8.
“If the findings of the present study are generalized to the population of all Medicare enrollees,
then more than 1,900,000 adverse drug events—more than a quarter of which are preventable—
occur each year among 38 million Medicare enrollees; furthermore, estimates based on our
study suggest that there are in excess of 180,000 life threatening or fatal adverse drug events
per year, of which more than 50% may be preventable.”—Gurwitz JH, Field TS, Harrold LR, et al. Incidence
and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003;289:1107-16.
The situation that prompted this blog was an elderly woman who recently had surgery. II saw her in the office to verify that she had healed her incision completely. As I was discharging her from my office, she asked if I could writer her a couple of refills on prescriptions. Her politely told her that I was not comfortable with that because I think, unless its an emergency, one physician should manage a patients medications. Well that lead to a discussion about how doctors are fleecing America
From Medco Drug Trends Report 2008, May 2008 (data from 2007)
Percent of prescriptions filled with brand name drugs declined from 45.9% in 2003 to 30.6% in
May 2008.—WSJ July 16, 2008 “Patients Curb Prescription Spending”New research reveals that one-third (34%) of seniors are taking medications prescribed by two or more physicians and that seven out of ten (72%) seniors reported taking medications that were first prescribed for them more than six months ago. Commissioned by the American Society of Health-System Pharmacists (ASHP), the survey of 275 Americans, age 65 and older, questioned seniors on their medication use as well as their knowledge and concerns about potentially harmful drug interactions.
Suffice to say that I encourage all of us who are on medications or who have family members on them to monitor the meds closely and ask for periodic reviews about how effective they are, what medications can be decreased or eliminated. We have to be our own advocates.
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