Drug Regimens

FOLLOW THE MONEY

By SCOTT HENSLEY


Insurers Help Patients Get
Their Drug Regimens Right


Evidence is building that the health-care system needs to do a better job of getting people's prescription-drug regimens right. Now, health insurers are starting to help patients deal with the problem.

A recent study highlights the issue. More than one in ten patients in ill health said they received either the wrong medicine or a mistaken dose during the past two years, according to the survey. The research, conducted in five English-speaking countries, including the U.S., focused on the experience of vulnerable patients with their health-care systems because they are sensitive indicators of quality. (Patients included those who rated their health as fair or poor, had a recent serious illness or injury or had been hospitalized for reasons other than a normal baby delivery. See the study.)

In the U.S., 12% of these sicker patients reported medication problems. Among patients taking four or more medicines regularly, the mistake rate was higher in all the surveyed countries and stood at 16% in the U.S. More than one third of the Americans surveyed took four or more drugs.

Researchers from Harvard University, the Commonwealth Fund in New York and Harris Interactive, a polling concern, conducted the survey, whose results appear in the current issue of policy journal Health Affairs. (The Online Journal conducts health-care polls with Harris Interactive.)

The findings are consistent with a growing body of medical research and common sense. Prescription-drug problems are widespread, and your chances of trouble are higher if you take more drugs.

Perhaps the most worrisome news is that 30% of U.S. patients surveyed (and even more elsewhere) say their main physician failed to review and discuss all the medications they were taking during the past two years.

Some insurers think they can help patients with this problem, and save themselves money in the process, by conducting prescription-drug review programs. Typically, a pharmacist for the insurer reviews a patient's prescriptions and medical record, looking for mistakenly prescribed medicines, potential interactions, drug duplications or signs of side effects. The pharmacist may also recommend adding a medicine for conditions that aren't adequately treated. The pharmacist usually talks with the patient's doctor about concerns or changes and then discusses the revised regimen with the patient.Ruth Yuil, a 64-year-old sales consultant at a Marshall Field's department store outside Detroit, is one of the beneficiaries of such an approach. Ms. Yuil's health insurer, Health Alliance Plan, identified her as vulnerable to medication problems because claims data showed she was taking eight prescription medicines.

Nearly three years ago, the health plan, owned by the Henry Ford Health System, began systematically reviewing the medicines of patients taking five or more drugs. Last year, Lesia Stebelski, a pharmacist working for HAP, checked Ms. Yuil's medicines and recommended switching her to osteoporosis fighter Fosamax from Evista and substituting Tylenol for Vioxx to reduce the water that Ms. Yuil was retaining.

Ms. Yuil suffers from heart failure, which means that even a small buildup of fluid could strain her weakened heart and send her to the hospital. Fluid build up is a side effect of Evista and Vioxx in some people. "I had no idea how much I was at risk," Ms. Yuil says.

After the changes, Ms. Yuil lost weight and felt better, except for nagging arthritis pain that flared when her Vioxx was stopped. (Recently, she began a trial prescription with Darvocet-N, another pain reliever.) She also stopped taking Allegra for her allergies, at Ms. Stebelski's suggestion, because it duplicated another allergy medicine, Rhinocort Aqua, already on her list. Thanks to the changes, Ms. Yuil is on track to save more than $700 in drug co-payments this year.

Barbara Zarowitz, vice president of pharmacy care at HAP and Henry Ford Hospital in Detroit, says her staff of pharmacists screens out drug duplications, dangerous combinations and incorrect doses. "Safety has been improved, and if you eliminate unnecessary drugs you're reducing costs," she says. Ms. Zarowitz estimates that, by the end of 2004, the health plan will have saved $4.5 million. More than 8,000 medication reviews were performed last year, and the number of patients on five or more medicines has fallen by half among those whose records have been checked.

Starting three years ago, Kaiser Permanente, the integrated health insurer and care provider, began aggressively assessing the prescription medicines being taken by new members to its plan in Colorado.

A Kaiser pharmacist talks with each new member about his or her medicines, usually calling the patient at home, where he or she can read labels on bottles in bathroom cabinets to make sure nothing is overlooked. The conversations about the patient's drug regimen can last as long as 45 minutes, says Kent Nelson, pharmacy services director for Kaiser's Colorado region.

Some 40,000 patients have had their medications reviewed this way. And the staff of pharmacists working on these intake exams and other drug-quality projects has grown to 10 from three in 2000.

"It's not uncommon for a new Medicare member to come in on 12 medications and leave on seven," Mr. Nelson says. While the prevention of bad outcomes is hard to document, Mr. Nelson is confident the attention is paying off. One measure he cites is positive feedback from members. "They say often that they've never understood why they take all the medicines that they do," he says.

Insurers can help themselves financially by eliminating drugs that patients don't need. But could HMOs go too far in their zeal and shortchange members?

"One can only hope that the patient's best interest is always being served," says Evelyn Hermes-DeSantis, a pharmacist and clinical associate professor of pharmacy at Rutgers University. "As long as a pharmacist acts in his or her professional capacity, then there shouldn't be a problem," she says. And doctors, of course, must approve any medication changes before they're made.

The bigger risk is sticking with the status quo. Prescription drugs are invaluable aids for healthier living. But, as with many tools, pills used carelessly can cause more harm than good.



Updated May 11, 2003 5:49 p.m. (WSJ 5/11/03 online)

Comments

It is advisable that the pharmacist consult the MD in charge of the patient, before changing any apsect of the patient's drug profile. If he/she doesn't, the pharmacist stands the chance of being sued for the practice of medicine without a license.

Darvocet is a good choice for pain relief, but not as a treatment for arthritis.( My opinion )