The Nine Forces Converging On Primary Care: #4 The Pharmaceutical Revolution

Throughout the history of medicine and particularly in the past two decades, innovative drug treatments offer a remarkable record of improved health outcomes and quality of life. At the same time, however, prescription drug expenditures are a significant component of total health care expenditures. In fairness, a large part of the expenditures are related to increased utilization. But overall costs are increasing nonetheless. These increases, coupled with higher co-pays and other forms of increased cost sharing on the part of patients, are associated with decreased adherence to treatment regimens and even the discontinuation of needed medications.

For the primary care physician, poor compliance (or adverse reactions even when compliance is perfect) can mean additional office visits, often paid through a reduced Medicare reimbursement.  So for that already overburdened practitioner the cycle continues.

A recent article in Medical News Today estimates that the number of drug prescriptions written each year in America comes out to the nice round number of four billion, roughly 13 prescriptions for every American.

Digging a little deeper, the administration of prescriptions goes far beyond the act of simply writing the script and handing it to a patient. A systematic approach advocated by the World Health Organization illustrates just how detailed and complicated the process has become. Their eight-step approach checklist includes:

• Evaluate and clearly define the patient’s problem

• Specify the therapeutic objective

• Select the appropriate drug therapy

• Initiate therapy with appropriate details and consider non-pharmacologic therapies

• Give information, instructions, and warnings

• Evaluate therapy regularly (e.g. monitor treatment results, consider discontinuation of the drug)

• Consider drug cost when prescribing

• Use an electronic medical record or other computer-based tools to reduce prescribing errors

With only very minor exception the pharmaceutical revolution, has benefited all of us through its ability to provide some of the greatest medical innovations with regard to better health over longer lifetimes.

But when administering prescriptions and managing related care become so labor intensive, and when keeping up on the expanding literature associated with these new pharmaceuticals proves to be a separate skill set, there’s no question that the continuing expansion of pharmaceutical options creates a major strain on the primary care physician’s ability to effectively treat growing numbers of patients.