I’ve been telling my smoking patients for years that nothing I do for them is going to make an ounce of difference until they quit smoking for good. And the Italians are out to prove me right. The American Journal of Cardiology reported July 11th, 2011 on the Effect of Smoking Relapse On Outcome After Acute Coronary Syndrome.
In a study of just under 1,300 patients, Reuters reports that just over 1/2 the patients started smoking within 20 days of hospital discharge, despite in-hospital smoking cessation consultation for all patients. Researchers also found that resuming smoking increased death 3-fold compared with those that did not relapse and quitting smoking had a similar lifesaving effect as taking cholesterol and blood pressure medications. And I’m sure these folks all landed themselves back into the hospitals for a very expensive dying process.
That’s why billing the patient or their insurance for smoking cessation (CPT® 99406 and 99407) is so important. And that’s why I give many of my smoking patients my smoking lecture. You know how much Medicare pays for a ten minute consultation to help cardiac patients quit smoking right now? Read more »
*This blog post was originally published at The Happy Hospitalist*
Generic medications appear to be far more cost-effective than previously reported, concluded a team of Harvard professors. But, physicians and patients aren’t adopting them wholeheartedly.
Patents of 20 drugs with annual sales of more than $1 billion expired or will do so between 2010 and 2013, including Lipitor and Plavix, the highest- and second-highest revenue producing drugs in the U.S. While highly effective generics provide low-cost options for chronic disease management, they are not always factored into cost analyses, and are sometimes viewed with concerns about their safety and efficacy.
The Harvard team revisited a 2008 study that used brand-name medication costs in an analysis of the cost-effectiveness of strategies to prevent adverse outcomes associated with cardiovascular disease and diabetes. The study found that up to 244 million quality-adjusted life-years could be gained over 30 years with appropriate preventive care. But, the study authors wrote, that “most prevention activities are expensive when considering direct medical costs.”
The Harvard team recalculated figures from the 2008 research, Read more »
*This blog post was originally published at ACP Internist*
When the medical press seizes a story, it can become an obsession. Any physician who is reading any journal is aware of the reported interaction between clopidrogel (Plavix) and proton pump inhibitor (PPI) drugs, including Prilosec and her cousins. PPI medicines are not exotic elixirs known only to medical professionals. They are known to any person with a working TV set or who still reads a newspaper, since ads for these drugs are omnipresent. Just google ‘purple pill’ and begin your entrance into the PPI Chamber of Advertising.
PPI medicines are highly effective for peptic ulcers and gastroesophageal reflux, although I suspect that most patients on these medications do not have any true indication for them. (Disclosure: I’ve pulled the PPI trigger too quickly on many patients who do clearly require acid blocking medicines.) PPI medicines are prescribed to hospitalized patients almost by reflex, and are often administered by the intravenous route, even when patients can swallow pills adequately.
Medical studies in 2009 reported that PPI medications appeared to make Plavix less effective. Since thousands of patients are on both of these medicines, this drug interaction could affect a large cohort of patients. Plavix serves to keep coronary stents open and to prevent heart attacks and strokes. Clearly, any force that could diminish Plavix’s potency could have serious ramifications for patients. But, is it really true? Read more »
*This blog post was originally published at MD Whistleblower*