## Wednesday, May 18, 2011

### Much Medicine Might Mean More Misery

Welcome to the Excel Math blog for today. How are you feeling? Healthy, I hope?

Let's see how we can use our elementary math skills to read and comprehend some numerical data about our US medical situation. Don't worry, it's not about the COST of it!

A team of researchers (Niteesh Choudhry, Michael Fischer, Jerry Avorn, Joshua Liberman, Sebastian Schneeweiss, Juliana Pakes, Troyen Brennan & William Shrank) studied prescription data obtained from CVS Caremark in Rhode Island, a company that manages medication for 50 million people in the United States. They have published this study online.

Test subjects had all been prescribed a statin drug (1.8 million people) or alternative heart medication (1.5 million) during a one-year period beginning in mid-2006. The mean age was 63 years and the subjects were 49% male, 51% female. All had insurance and their average household income was over \$50,000.

The research team counted each patient's medications, prescribing doctors, pharmacies, visits, and refills. They focused on a "complexity period" of 90 days.

The average patient was given 11.4 total prescriptions by 2 different doctors, for 6.3 different medications, from 5 different classes of drugs, which required at least 5 visits to the pharmacy in the 3-month period!

Here's some of the data in chart form. [Click the charts for a larger view]

Are you sitting down?

One-tenth of patients had prescriptions for 23 or more medications, from 11 different drug classes, from 4 or more doctors, which were filled at 2 or more pharmacies, requiring 11 or more pharmacy visits in 90 days!

About 2/3 of patients took their medication as prescribed and 1/3 did not. When patients needed to make a separate pharmacy visit for each drug, 8.4% fewer took the medication correctly compared to those who got all refills in one visit from one pharmacy. Subjects with the best consolidation of prescriptions and refills took their medication at a rate 14% higher than the worst group.

Many barriers keep us from taking medication: cost, side effects, difficulty of managing multiple prescriptions, our (in)ability to navigate the health care system, cognitive impairment or dementia, cultural and belief systems, and the feeling that we're not sick.

In this case, the researchers concluded, “Because non-adherence is associated with excess morbidity and mortality, our findings suggest therapeutic complexity may undermine the goals of chronic disease management .. these results highlight an essential aspect of the therapeutic cascade that may be particularly burdensome and which few clinicians likely consider when making prescribing decisions.

Or to put it in plain English, If you don't take your medicine you're more likely be sicker or die earlier. But the more drugs you are given, the harder it will be to get and take them as prescribed, which doctors don't seem to consider.

Here are some of the 19 medications prescribed
for one of my relatives to take every day!

Are you still feeling okay?

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