Too Much and Too Little when it comes to prescriptions.
An article published this month in “Medscape” highlighted the epidemic of prescription errors occurring in hospitals when discharging older patients The article stated, “Potentially unsafe prescriptions are common at the time of discharge for older patients, according to a new study, with 83.8% of patients receiving at least one potentially inappropriate medication (PIM) and having a potential prescribing omissions (PPO).” The article goes on to state, “Patients with at least one PIM were significantly more likely to experience three or more readmissions, and those with at least one PPO were significantly more likely to die during the study follow-up.”
The shocking statistic that placed these errors at in-excess of 83% is evidence-based from the study. The increases in morbidity and mortality, as well as a marked decline in quality of life, can be traced to a senior citizen drug epidemic that may well have a comparable impact on the elderly as the opioid crisis is having on the rest of our society.
These statistics raise a profound question of how our healthcare professionals make judgments about the validity of the information they are receiving from older patients and how these professionals process that information in the best interest of their patient. I recall a personal incident a few years ago after I had a hip replacement operation. The visiting nurse came to my home and as she was checking my pulse she had a concerned look on her face. I asked her what the problem was and she said for my age my heart rate of 48 bpm was too low and highly unusual. I replied that I have a history of exercising almost 6 days a week for a number of decades. I also indicated that I don’t drink any caffeinated products. That would account for the low heart rate. However, she insisted on calling my PCP. When she reached him his response was, “Yes, Mark’s resting heart rate is always around 48 bpm as he has exercised aggressively for decades and doesn’t drink any coffee.” The reality of this story is twofold: first, the visiting nurse exercised caution which was highly commendable: second, she could not assimilate the same factual information from me (the patient) as I am a senior citizen.
This phenomenon affecting senior citizens repeats itself with great frequency in communities, particularly in the Sunbelt, that have a preponderance of older retirees. I’ve often thought about the fact that primary care physicians in non-senior environments see a cross-section of adults from age 20-100. Because of this, they view their patients as individuals. In retirement communities, these same physicians with comparable skills see a population predominately 70 and older. In this environment, the doctors can have a tendency to tune out their patient’s health care complaints as merely the musings of an aging person.
As we Americans are living longer and productive lives the medical care of our senior citizens is the essential component to the quality of their lives. As longevity increases it also has a very significant impact on the overall cost of healthcare delivery. We are becoming increasingly aware of the importance of physicians prescribing the necessary pharmaceuticals that will both extend life and sustain its quality. However, the possibility of overmedication is probably greater than the possibility of under medication. There is an increasingly important role to be played by the clinical pharmacist in preserving quality-of-life.
At Curus, our clinical pharmacist is an integral part of our team. His review of our member’s medical records is a critical part of the evaluative process. We too, often as patients, fail to ask our providers why they are prescribing a particular medication. That question should always be top of mind whether we are at our appointment with our primary care physician or inpatient at a hospital. For our senior citizens, family members, as their advocate on many occasions, should always feel comfortable asking the following question – “How is this prescription for my father/mother going to help them get better or improve the quality of their life?”
Medicine today is as much an art as a science. As such, as we age, we need to be discriminating consumers of the product we call healthcare. As the saying goes – too much of a good thing is sometimes as bad as too little.
Beyond the opioid crises, we have seen the pharmaceutical companies expand their advertising to push name brand products through the consumer to their physicians. At Curus, when our medical team and clinical pharmacist review our member’s Electronic Health Record, we pay very close attention to the correlation between the prescribed drug an our member’s general health. Our role as advisor/advocate/health navigator is an all-encompassing engagement with our members.