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Posted by Ishani Ganguli July 23, 2013 11:00 AM
A 90-year-old woman comes to the hospital, like so many others, after a fall that leaves her skin bruised and her tailbone broken. The best thing we can do for her, besides managing her pain and getting her through physical therapy? Scrutinize her medication list.
Polypharmacy - literally, many medications - is a diagnosis that disproportionately affects elderly patients. They are particularly susceptible to the mind-altering and dizzying effects of drugs like zolpidem (better known as Ambien, used for sleep), diphenhydramine (or Benadryl, an anti-histamine and sleep agent), and too-high doses of blood pressure medicines - with the consequence of dangerous, sometimes deadly falls. I spent my last week working with geriatricians as part of a primary care elective and found that the focus of most visits was, if not glamorous, then at least resoundingly consistent: reviewing medication lists and paring off such worrisome drugs.
It is on doctors to prescribe high-risk medications cautiously, if at all, for their elderly patients. And until recently, these practices had been largely opaque to the detriment of these patients and their families as well as of doctors.
After months of effort, reporters at ProPublica, a non-profit group that produces investigative journalism in the public interest, unleashed the power of the Freedom of Information Act to access the prescribing patterns of doctors seeing patients insured by Medicare - the public program covering seniors and the disabled. They published an easy-to-peruse database of what these doctors prescribed in the year 2010 under Medicare’s prescription drug program.
The reporters found that each patient had 40 prescriptions on average that year. Some of the most popular medications were no surprise, including simvastatin (the cholesterol-lowering agent thought to have a host of other, not-quite-understood benefits) and lisinopril (the blood pressure drug that can protect the kidneys from damage). The third most popular, at a whopping 28 million prescriptions, was less reassuring: hydrocodone plus acetaminophen - the potent opioid otherwise known as Vicodin and known to be problematic for the elderly and to some extent, all patients. The reporters also discovered that only 3% percent of prescribers were responsible for half of all medications prescribed - raising a red flag that they have already started to chase down.
As a patient and as the daughter, wife, and sister of patients, I value the chance to gauge the cost and safety of the drugs our doctors prescribe. As a physician, I appreciate knowing how I compare to peers in my prescribing practices and better understanding national trends. More of this information should be publicly available, and I’m grateful to ProPublica for getting us started.
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