Highlighting the jumbled U.S. landscape of drug therapy

By LEE BOWMAN
Scripps Howard News Service
Wednesday, June 27, 2007

Medication errors in U.S. hospitals kill an estimated 7,000 people a year, injure or delay the recovery of tens of thousands more and cost at least $2 billion in lost income and additional medical costs.

But prescriptions written for less effective drugs, or policies that shift the cost of front-line drugs to the patient and thus discourage use, all in the name of economy, may result in even greater losses in the long run.

Two reports released Wednesday, and a new campaign to promote value over cost control in health care, illustrate the jumbled landscape of drug therapy in the United States.

A new review of a dozen past studies comparing handwritten and computerized prescribing systems found that U.S. hospitals had a 66 percent reduction in prescription errors by switching to procedures where physicians personally enter their prescriptions into computers.

Nearly a quarter of all hospital patients experienced medication errors, a rate that's increased from 5 percent in 1992, according to the study published in the journal Health Services Research.

"These medication errors are very painful for doctors as well as patients. Nobody wants to make a mistake," said Tatyana Shamliyan, lead author of the review and a research associate at the University of Minnesota's School of Public Health.

Illegible handwriting and transcription errors were responsible for as much as 61 percent of medication errors in hospitals. Errors could be as severe as prescribing the wrong drug or the wrong dose, or having the drug administered at the wrong time or not at all.

Only about 9 percent of hospitals in this country now use computerized prescribing systems. The rest don't, both because they're costly to set up and because it's tough to get doctors to accept and use them.

Yet doctors have grudgingly come to accept insurance restrictions on what they can and can't do or prescribe for patients -- even if those rules leave people partially treated.

A second study, released by the nonprofit Integrated Benefits Institute, found that company health-insurance policies that imposed even moderately high co-payments for arthritis drugs resulted in more than half of workers with rheumatoid arthritis not taking doctor-prescribed medications.

As a result, the 17 companies in the study lost some $17.2 million in worker productivity -- about 26 percent more than they would have spent if the workers had taken the drugs.

The study underscored the point of a new campaign launched Wednesday by Dr. Louis Sullivan, the Health and Human Services secretary in the first Bush administration and president emeritus of the Morehouse School of Medicine in Atlanta.

"Concern over cost has overwhelmed the other elements of our health-care delivery system," Sullivan said at a Washington news conference. "I see the best way of addressing health costs is by improving health outcomes, and value for the individual patient."

Sullivan decried the shifting of more drug costs to patients through higher co-pays and deductibles as well as "therapeutic substitution" policies by health plans and pharmacy benefit managers that encourage or require doctors to prescribe only select drugs from a pre-approved list.

"This is much different from prescribing generic drugs, which have the same active ingredients. This leads to giving patients drugs that do not fully cure them, or that can even leave them worse off."

Sullivan -- whose efforts are partially underwritten by drug companies but also supported by patient-advocacy and medical-specialty groups -- insisted that he's not against the use of "evidence-based" medicine to help guide doctors in choosing the best drugs and other therapies.

"But too much of this has been used to justify one-size-fits-all treatment approaches that seem to save money in the short run, but wind up costing the patient and society more in the long run. Cost should always be part of our concern, but not the number one priority. We want to facilitate a national dialogue on the need for a balanced, symphonic approach to health-care delivery."

On the Net: http://www.drlouissullivan.com

(Contact Lee Bowman at bowmanl(at)shns.com.)