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Top 5 Most Expensive Classes Of Prescription Drugs

The top five therapeutic classes ranked by total expense are metabolic, central nervous system, cardiovascular, gastrointestinal, and psychotherapeutic, altogether totaling $155.7 billion, or two-thirds of prescription drug expenses by U.S. adults in 2008.

Two-thirds of American adults use a prescription drug, totaling the $232.6 billion in expenses. The Agency for Healthcare Research and Quality compiled a statistical brief showing that drug classes varied widely in how they made the top five list. While 46 percent of adults with a prescribed drug expense bought a central nervous system agent, they are relatively cheaper on average. Gastrointestinal agents had the highest average expense per prescription ($133), or more than three times the average expense of the cheapest class, which was cardiovascular agents ($39). But 46 percent of adults who take a prescription drug use a central nervous system agent, while 17.7 percent take a gastroenterological one.

Metabolic agents had the highest total expenses ($52.2 billion), or more than one-fifth of all prescription drug expenses. The rest of the list by total expenditures were central nervous system agents ($35.1 billion), cardiovascular agents ($28.6 billion), gastrointestinal agents ($20.2 billion), and psychotherapeutic agents ($19.6 billion).

The estimates presented are derived from the Household and Pharmacy Components of the 2008 Medical Expenditure Panel Survey (MEPS). Expenditures include payments from all sources including out of pocket, private and public insurance sources for outpatient prescription drug purchases during 2008. Over-the-counter medicines are excluded, as are prescription medicines administered in an inpatient setting, clinic, or physician’s office.

*This blog post was originally published at ACP Internist*

A Thank You A Day…

This is a guest post by Dr. John Schumann.

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I just read the book “365 Thank Yous” by John Kralik. I heard an interview with the author on NPR and it caught my attention.

Kralik had been down on his luck in 2007: Divorced twice, overweight, with a struggling law firm that he’d started, he was also failing in a new romantic relationship. He was worried about losing his seven-year-old daughter, too, in a custody dispute.

He made a momentous decision: Instead of feeling sorry for himself (easy to do given his predicaments), he decided to be grateful for what he had. To show it, he vowed to write a thank-you note every day for the next year. What do you think happened?

His life changed for the better. His relationship improved. His clients started paying their bills and his firm’s financial footing solidified. His health improved. He eventually achieved his lifelong dream of becoming a judge. To top it off, he turned his personal quest into a writing project. Within minutes of writing a book proposal, he received responses from agents who hoped to shepherd his project. Every writer’s dream.

I’ll grant you that it sounds hokey. But there are a couple of things the book demonstrated to me. Read more »

*This blog post was originally published at ACP Internist*

More Physician Temps Needed For Doctor Shortage

The use of temporary physicians is rising, filling in until permanent physicians can be hired amid the ongoing shortage of doctors nationwide, a locum tenens firm has found. The company estimates between 30,000 and 40,000 physicians worked on a locum tenens basis in 2010.

The survey, by Staff Care, polled hospital and medical group managers about their use of locum tenens. Eighty-five percent said their facilities had used temporary physicians sometime in 2010, up from 72 percent in 2009.

Psychiatrists and other behavioral health specialists were the most sought-after specialty (22 percent of all requests), followed by primary care physicians, defined as family physicians, general internists and pediatricians (20 percent) and internal medicine subspecialists (12 percent). Hospitalists were 9 percent.

According to the survey, the primary reason cited by 63 percent of healthcare facilities was to fill a position until a permanent physician could be found. Forty-six percent of healthcare facilities now use locum tenens physicians to fill in for physicians who have left the area, compared to 22 percent in 2009. Fourteen percent use locum tenens doctors to either help meet rising patient demand for medical services or to fill in during peak times, such as flu season. Fifty-three percent use locum tenens physicians to fill in for physicians who are on vacation, ill or for other absences.

Most locum tenens physicians plan to stick with temporary practice in the short-term, the company noted. Sixty percent said they plan to practice on a locum tenens basis for more than three years, 28 percent for one to three years and 12 percent for less than a year.

Freedom trumps pay, the company noted, as 82 percent cited flexibility as a benefit, compared to 16 percent who identified pay as a benefit. Other reasons cited for working as a locum tenens include absence of medical politics (48 percent), travel (44 percent), professional development (21 percent) and searching for permanent practice (20 percent).

The locum tenens option is important to maintaining physician supply, the company concluded, because during a time of physician shortages it allows doctors who might be considering full retirement to remain active in medicine.

*This blog post was originally published at ACP Internist*

Adult Vaccines: Most Doctors Don’t Stock All Of Them

Less than one in three primary care practices offer all 10 recommended adult vaccines, citing a variety of financial and logistical reasons.

Researchers sponsored by the Centers for Disease Control and Prevention sampled 993 family physicians and 997 general internists. Of the respondents, 27 percent (31 percent of family practitioners and 20 percent of internists) stocked all 10. Results appear in the Feb. 17 issue of the journal Vaccine.

The 10 vaccines were hepatitis A; hepatitis B; human papillomavirus vaccine (HPV); combined measles, mumps, and rubella (MMR); meningococcal conjugate vaccine (MCV4); pneumococcal polysaccharide (PPSV23); tetanus diphtheria (Td); combined tetanus, diphtheria, and pertussis (Tdap); varicella; and zoster.

Of the responding practices, two percent plan to stop vaccine purchases, 12 percent plan to increase them and the rest had no plans to change their vaccination stocking habits. But physicians who identified themselves as their respective practices’ decision makers for stocking vaccines were more likely to decrease the number of different vaccines stocked for adults (11 percent vs. three percent; P=.0001).

The National Vaccine Advisory Committee, a group that advises the various federal agencies involved in vaccines and immunizations, arrived at even bleaker figures in 2009, reported the April 2009 issue of ACP Internist. For example, 62 percent of decision makers in practices said they had delayed purchase of a vaccine at some time in the prior three years due to financial concerns. And in the prior year, 16 percent of practice decision makers had seriously considered stopping vaccinations for privately-insured patients due to the cost and reimbursement issues. Read more »

*This blog post was originally published at ACP Internist*

The Cost Of Treating Kidney Disease

Medical spending to treat kidney disease totaled on average $25.3 billion annually from 2003 to 2007 (in 2007 dollars). Almost half of the expenditures ($12.7 billion) were spent on ambulatory visits.

On average, 3.7 million adults (1.7 percent of the population) annually reported getting treatment for kidney disease, reports a statistical brief from the Agency for Healthcare Research and Quality. During 2003-2007, for those ages 18 to 64, more than half of the total kidney disease expenditures were from ambulatory visits (53.1 percent) compared with about one third (30.3 percent) from inpatient visits. Among those age 65 and older, ambulatory visits accounted for 46 percent of the total kidney disease expenditures and hospital stays were 43 percent.

Similar amounts were spent on prescription medicines ($1.4 billion) and emergency room visits ($1.5 billion). Hospital stays amounted to $9.1 billion. Medicare paid 40 percent of the total expenditures to treat kidney disease.

*This blog post was originally published at ACP Internist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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