A quarter of patients do not fill new prescriptions

As our regular Word on Health readers will know, I’ve had more than my fair share of trips to the pharmacy recently.  Painkillers, antibiotics, anti-inflammatories…the list goes on.  It’s not that I like taking tablets, I needed them.  Having taken time out of my busy life to see a doctor and get a prescription it would never occur to me to leave it languishing in the bottom of my purse.  However, according to a new study almost 1 in every 4 American’s does just that.

The study, published in the November issue of the American Journal of Medicine, evaluated more than 423,000 e-prescriptions written in 2008 for more than 280,000 patients. It was conducted by researchers at Harvard University, Brigham and Women’s Hospital, and CVS Caremark, who matched e-prescriptions with resulting claim data or those who did not claim prescriptions within 6 months.

What they found was that 24% of patients given a new prescription did not fill it. This percentage is higher than that seen in earlier studies.

While some recent research has used e-prescribing data to evaluate primary non-adherence, we were able to study a nationwide sample of patients. Our finding that 24% of patients are not filling initial prescriptions reflects slightly higher primary non-adherence than seen in earlier studies,” said Michael Fischer, MD, MS, with Brigham and Women’s and Harvard Medical School, and lead author of the study.

Most prior research about medication adherence could not review prescriptions that were never filled by patients. However, the advent of electronic prescribing has provided an opportunity to track initial prescriptions that may have been previously undetected and gives healthcare providers a broader look at patients who never fill their prescriptions.

Researchers said the factors that are predictive of primary non-adherence include:

  • the out-of-pocket cost of medications
  • socioeconomic factors
  • the integration of doctors’ health information systems
  • the types of medications.

Prescriptions that are sent directly to mail-order systems and pharmacies are more likely to be filled than e-prescriptions that doctors print out and give to patients, according to the study. The researchers found that medications for hypertension and diabetes resulted in primary non-adherence rates in excess of 25%, while prescriptions for antibiotics and medication for infants were almost always filled.

SRxA works closely with a number of leading health outcomes experts and specializes in providing effective patient adherence programsContact SRxA today to learn more.

The provider will see you now!

Back in the days when I was training, medical students had to study Latin in order to achieve fluency in the language of medicine.  Today, it seems, doctors are learning an entirely new lingo consisting of buzzwords and business speak! According to Pamela Hartzband and Jerome Groopman, two Harvard Medical School / Beth Israel Deaconess Medical Center physicians, current healthcare reforms mean that hospitals are becoming factories and clinical encounters are becoming little more than economic transactions. Writing in the latest edition of the New England Journal of Medicine they claim that, “Patients are no longer patients, but rather ‘customers’ or ‘consumers’. Doctors and nurses have transmuted into providers.” The combination of the ongoing economic crisis and efforts to reform the health care system have resulted in many economists and policy makers proposing that patient care should be industrialized and standardized and that hospitals and clinics should be run like modern factories.  At the sane time, archaic terms like doctor, nurse and patient are being replaced with terminology that fits this new order. In the process, the special knowledge that doctors and nurses possess and use to help patients understand the reason for and remedies to their illness get lost in a system that values prepackaged, off-the-shelf solutions. “Reducing medicine to economics makes a mockery of the bond between the healer and the sick,” they write. Hartzband and Groopman say the new emphasis on ‘evidence-based practice’ is not really a new phenomenon at all. ‘Evidence’ was routinely presented on daily rounds or clinical conferences where doctors debated numerous research studies. Back then, the exercise of clinical judgment, which permitted the assessment and application of data to an individual patient, was seen as the acme of professional practice. Now, health policy planners, and even some physicians, contend that clinical care should essentially be a matter of following operating manuals containing preset guidelines, like factory blueprints. Even more troubling, the authors suggest, is the impact of the new vocabulary on future doctors, nurses, therapists and social workers who care for patients. “Recasting their roles as providers who merely implement prefabricated practices diminishes their professionalism. Reconfiguring medicine in economic and industrial terms is unlikely to attract creative and independent thinkers.” When we are ill, we want someone to care about us as people, rather than as paying customers. Despite the lip service paid to ‘patient-centered care’ by the forces promulgating the new language of medicine, their discourse shifts the focus from the good of the individual to the exigencies of the system and its costs. Should we celebrate the doctors whose practices maximize profits or those who show genuine concern for their ‘customers’ or better still patients? Let us know what you think.

What’s Your Sleep Number?

Yesterday morning I was up at 3.15am to catch a flight, this morning it was 4.00am.  Tomorrow I have a 6.00am flight and on Friday I can look forward to another at 5.40am. Each of these early morning departures has, or will be, preceded by a late evening meeting.  All of which led me to thinking about sleep, or lack thereof.

A sleepless night can make us cranky and moody. So much so that sleep deprivation is sometimes used as a form of torture. So I was pleasantly surprised by new research that shows it can also bring on temporary euphoria.

Scientists at UC Berkeley and Harvard Medical School studied the brains of healthy young adults and found that their pleasure circuitry got a big boost after a missed night’s sleep. However that same neural pathway that stimulates feelings of euphoria, reward and motivation after a sleepless night may also lead to risky behavior.

When functioning correctly, the brain finds the sweet spot on the mood spectrum. But the sleep-deprived brain will swing to both extremes, neither of which is optimal for making wise decisions,” said Matthew Walker, associate professor of psychology and neuroscience at UC Berkeley and lead author of the study.

The findings, published in the Journal of Neuroscience, underscore the need for people in high-stakes professions and circumstances not to shortchange themselves on sleep.

Medical professionals, airline pilots and new parents take note.  “Based on this evidence, I’d be concerned by an emergency room doctor who’s been up for 20 hours straight making rational decisions about my health” added Walker.

So how much sleep do we need?

Most adults function best with 7 to 9 hours of sleep, although only about two-thirds of Americans regularly get it. Children fare better with 8 to 12 hours, while elderly people may need only 6 to 7.

One-third of Americans are sleep-deprived, regularly getting less than 7 hours a night, which puts them at higher risk of diabetes, obesity, high blood pressure and other health problems.

And then there are “short sleepers”.  It’s estimated that about 1% to 3% of the population, function well on less than 6 hours of sleep. Such people are both night owls and early birds, and tend to be unusually energetic and outgoing.  Not only are their circadian rhythms different from most people, so are their moods and their metabolism. They also seem to have a high tolerance for physical pain and psychological setbacks.

Who are these people?  Some short sleepers say their sleep patterns go back to childhood and some see the same patterns starting in their own kids, such as giving up naps by age 2. “As adults, they gravitate to different fields, but whatever they do, they do full bore,” says Christopher Jones, a University of Utah neurologist and sleep scientist

Typically, at the end of a long, structured phone interview, they will admit that they’ve been texting and surfing the Internet and doing the crossword puzzle at the same time, all on less than six hours of sleep,” says Dr. Jones. “There is some sort of psychological and physiological energy to them that we don’t understand.”

Benjamin Franklin, Thomas Jefferson, Leonardo da Vinci and Margaret Thatcher were too busy to sleep much, according to historical accounts. Winston Churchill and Thomas Edison came close but they were also fond of taking naps, which may disqualify them as true short sleepers.

Nowadays, some short sleepers gravitate to fields like blogging, and social media, where their sleep habits come in handy.

We can’t argue with that.  As many Word on Health readers have noted, ours is the first mail to hit their in-box every Monday, Wednesday and Friday.

Have any sleep stories to share?  We’d love to hear from you.