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The Costs, And Maybe Cost Savings, Of Medication Non-Adherence

A Cat Playing Whack-A-Mole

Medication non-adherence is a hot button topic in healthcare. Physicians lament patient “non-compliance” with their medical advice, and policy wonks tell us that more than half of patients do not take their medications as directed. Missed opportunities to control chronic illnesses such as diabetes, heart disease, and cancer surely do cost us untold billions of dollars and millions of quality life years lost annually in the U.S. But there is a flip side to the equation that no one is talking about. The costs of polypharmacy (over medication).

In my opinion, many Americans, especially those over 65, are taking far too many medicines. The unwanted side effects and medication interactions (both known and unknown) can be devastating. In my line of work (inpatient rehabilitation) I receive a steady stream of patients who have fallen and injured themselves or have been involved in serious accidents. An astonishing number of these incidents are related to drug side effects.

Take, for example, the elderly woman who had mild hypertension. Unbeknownst to her physicians, she was not compliant with the diuretics she had been prescribed. Each successive visit it was presumed that she was taking her medicines as directed, and that they were not sufficient to control her blood pressure. So the dosing was increased. Her husband dutifully picked up the new prescriptions from the pharmacy, and she collected them (unopened) in her desk drawer.

One day this spirited lady caught pneumonia and required a couple of days of inpatient monitoring and antibiotics at the local hospital. Her son decided to assist with her transition back home and stayed with her for a week, taking on both cooking and medication administration duty from his dad. He found all of her pills in her desk drawer and began to give them to her as directed.

Several days later the distraught son told me that his mother’s health had taken a nose-dive, and that she was hallucinating and acting uncharacteristically hostile. He took her to a more distant specialty hospital, where their initial impression was that she had advanced dementia, which had probably gone unnoticed by a son who hadn’t lived nearby for years. She would benefit from hospice placement.

The reality was, of course, that this poor woman was as dehydrated as a raisin and was becoming delirious from excessive diuretic use. Once I figured out that her son’s sudden, and very well-intentioned, medication adherence program was to blame, we stopped the blood pressure medications, gave her some water and she returned to her usual self within 24 hours.

On another occasion, I admitted a closed-head injury patient who had lost her front teeth after fainting and falling head first onto the asphalt in a grocery store parking lot. This was her third head injury in 6 months. A review of her medications revealed no less than six medications (that she was dutifully taking for various diseases and conditions) that carried a known side-effect of “dizziness.” We were able to discontinue all of them, and to this day I have not heard of another fall.

Just last week a wise, elderly patient of mine declined to take her blood pressure medicine. I explained to her that her blood pressure was higher than we’d like and that I wanted to protect her from strokes with the medicines. She smiled kindly at me and said, “I know my body, and I get dizzy when my blood pressure is at the levels you doctors like. The risk of my falling and hurting myself when I’m dizzy is greater than the benefit of avoiding a stroke. I’ve been running at this blood pressure for 80 years. Let’s leave it be.”

What I’ve learned is that although there are costs to not taking medicines, there are costs to taking them too. It is hard to say how many injuries are accidentally prevented by patient non-adherence. But we all need to take a closer look at what’s in our desk drawers, and pare down the prescriptions to the bare minimum required. I consider it a great victory each time I reduce the number of medications my patients use, and I would urge my peers to join me in the pharmaceutical whack-a-mole game that is so sorely needed in this country.


The American Geriatrics Society provides a helpful list of medications that should be avoided whenever possible in older individuals.

Holiday Decoration-Related ER Visits: Are These Statistics Sending The Wrong Message?

Yesterday’s ACEP Member Communication email (entitled Emergency Medicine Today, in affiliation with BulletinHealthcare) had this as its top story: Injuries Linked to Holiday Decorating on the Rise, from a website called HealthDay News. The reported cites a US Consumer Product Safety Commission press release, crafted with help from Underwriter Laboratories (the wire engineers). They claim:

In November and December 2010, more than 13,000 people were treated in U.S. emergency departments for injuries involving holiday decorations, up from 10,000 in 2007, and 12,000 in 2008 and 2009, according to the U.S. Consumer Product Safety Commission (CPSC).

“A well-watered tree, carefully placed candles, and carefully checked holiday light sets will help prevent the joy of the holidays from turning into a trip to the emergency room or the loss of your home,” said CPSC chairman Inez Tenenbaum in an agency news release.

Good advice. Though it’s been said many times, many ways. So when it came time for CPSC and UL to raise the topic, did we need the very questionable statistics to justify it? Read more »

*This blog post was originally published at Blogborygmi*

Remembrance And Rules For Cyclists And Motorists

This third installment of “Cycling Wednesdays” comes as a guest post from Rachel Fagerburg. Rachel is a dear friend, mother of two young children, fellow cyclist, and wife of a teammate. She is famous in this area for her talent as a race announcer. I am grateful for her words:

On May 19, my husband and I joined thousands across the globe to honor cyclists who have been injured or killed while cycling on public roadways. With 1,000 participants at the first ride in 2003, the Ride of Silence has grown to a worldwide event raising awareness of the tragedies that can occur between motorists and cyclists. My husband and I rode in honor of two people we were privileged to call “friend.” Read more »

*This blog post was originally published at Dr John M*

The Prius And Accelerator Problems: Don’t Believe The Hype

I have a confession: I’ve been risking my life.

Yes, still driving a Prius.

I do buy that accelerator pedals can be mechanically jammed by a floor mat (though there’s clips on my car to hold it in place), but this unintended acceleration ‘panic’ is just that.  (If for no other reason that there’s now a flurry of cases of this, and none before it was the freak-out du jour). Read more »

*This blog post was originally published at GruntDoc*

New Year’s Resolution: Don’t Multi-Task

I’ve been fighting pretty hard to avoid the temptation to multitask. I plan to do so again this year. People who claim to multitask are viewed with awe. Attaining the skill is a badge of honor. In a society that is increasingly 24 /7 where demands from work, family, and friends seems endless and the opportunities to be connected are more, how can a person survive if they simply do one task at a time?

Simple. Research suggests that the person who single tasks actually does better work, focuses better, and is productive.

Oh and it might save your life. Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

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