Hi All,
Interesting study from the US - Wonder how close we are"
Elderly skip cholesterol and blood pressure drugs
Wed May 10, 2006 10:19 AM ET By Martha Kerr NEW YORK (Reuters Health) - A review of the medical records of a group of elderly patients shows that only 32.9 percent took the drugs prescribed to treat high blood pressure and high cholesterol.
"This study emphasizes the importance of considering adherence when caring for high-risk older patients," Dr. Richard H. Chapman commented to Reuters Health. "Despite the relatively high cardiovascular risk" of these patients, surprisingly few were adherent to prescribed medications.
Chapman of ValuMedics Research in Falls Church, Virginia, and colleagues conducted an analysis of data for 4,052 patients 65 years of age or older who were enrolled in the Protocare Sciences Managed Care Database. Drugs to lower high blood pressure and high cholesterol were initially prescribed within a 90-day period.
The researchers defined adherence as filling prescriptions to cover at least 80 percent of days of therapy to lower blood pressure and cholesterol. Adherence was evaluated at 3-month intervals, and the average follow-up was 19.5 months. The team reported the results at the American Heart Association's 7th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Diseases and Stroke, being held in Washington, D.C.
Chapman reported that adherence to both classes of drugs fell rapidly to 40.5 percent at the 3-month mark, then to 32.7 percent at 6 months, and stabilized at 32.9 percent at 1 year.
Patients tended to take more of one class of drug or the other, and the adherence rate to one drug at each time point was 27.8 percent to 35.0 percent higher than adherence to both. Adherence to blood pressure lowering drugs was generally higher than for cholesterol lowering drugs.
From the data in this study, it is not clear why adherence was lower with cholesterol-lowering drugs, Chapman said. The differences could be due to side effects or other factors. "For example, patients may believe that their high blood pressure is more of a problem than their high cholesterol." However, "we have no way to tell this for sure from this study."
The researchers also found that if both drugs were prescribed at the same time, adherence to both drugs was about 13 percent higher. Patients with pre-existing heart disease were also more motivated to take both medications as prescribed, and had an adherence rate that was about 27 percent higher than the other patients.
The factor associated with the lowest adherence to both drugs was having multiple prescriptions other additional medications.
Based on these findings, Chapman suggests that adherence could be improved by starting patients on high blood pressure and high cholesterol at the same time if possible. In addition, paying close attention to patients who are taking several drugs is a particularly important issue when the patient is elderly.
Cheers
David
---- Dr David G More MB, PhD, FACHI Phone +61-2-9438-2851 Fax +61-2-9906-7038 Skype Username : davidgmore E-mail: [EMAIL PROTECTED] On Thu, 11 May 2006 07:58:25 +0800, Richard Hosking wrote:
> I think there are several reasons for this
> Increased copayment
> Better GP prescribing behaviour - NPS and others are having an impact Public attitude to
> medication has changed - remember that consumers drive a lot of prescribing nowadays The Vioxx
> scandal was a sea change I reckon
>
> The proportion of these effects is probably impossible to measure - it depends on what political
> spin you want to put on it
> FWIW I think the public attitude change has been the biggest effect. This is why I would urge NPS
> to try a few "60 minutes" segments - I dont think they are brave enough though
>
> Richard
>
> David More wrote:
>
>>
>> /*Fall in scripts saves $260m*/
>> /Adam Cresswell, Health editor/
>> May 11, 2006
>> *SPENDING on the $6 billion-a-year Pharmaceutical Benefits Scheme is forecast to slide
>> $260million in the coming financial year due to a continued slump in the numbers of
>> prescriptions patients are getting filled.*
>> The budget papers said the reduction in 2006-07 - branded a "hidden cut" by Labor - was due to
>> "lower than expected growth" in certain drugs, such as entire classes of medicines used to
>> lower cholesterol and treat mental disorders.
>> The detail was highlighted yesterday by Labor health spokeswoman Julia Gillard, who said "in
>> plain English" what this meant was that "fewer sick Australians are filling prescriptions".
>> "Lower than expected growth in prescriptions for these medicines is not due to an outbreak of
>> wellness," she said. "Our simple point is that there's no evidence to suggest that the need for
>> these medicines has reduced. It means there's an affordability issue at the centre of it."
>> PBS figures last year showed there had been a slowdown in prescriptions after the federal
>> Government increased co-payments - the amounts patients have to pay for medicines at the
>> pharmacist's till - by about 20 per cent from January 1 last year.
>> In last year's budget the Government also increased the number of prescriptions patients needed
>> to rack up each year before they became eligible for the PBS safety net scheme, which picks up
>> most or all of further co-payment charges in the remainder of that year. Script numbers fell
>> from 15.4 million in December 2004 to 11.6 million in February last year. However, seasonal
>> factors were also at work as a similar pattern was evident in each of the three previous years.
>> Ms Gillard said she expected cutbacks to be applied to the PBS as part of a restructure later
>> this year.
>> Last month Peter Costello said the Government had to be "vigilant in relation to pharmaceutical
>> costs" and if they were not kept under tight rein "the system ... could well break". "We're not
>> stopping the rate of increase, we are restraining the rate of increase but it's still growing
>> far faster than the economy is growing," the Treasurer said at the time.
>> Labor's claims have been disputed by the federal Government. A spokeswoman for Health Minister
>> Tony Abbott said the PBS was demand-driven and "if people don't need their drugs, the cost of
>> it (the PBS) goes down".
>> She said the PBS grew 2.8 per cent from 2004-05 to 2005-06, but growth was expected to average
>> 7.6 per cent a year for the next four years. Catholic Health Australia chief executive Francis
>> Sullivan said other budget figures showed that reduction in PBS spending was hitting low-income
>> people hardest.
>> In last year's budget, the Government forecast it would spend $4.6 billion through the PBS for
>> concession-card holders, but yesterday's budget papers showed actual spending was only
>> $4.3billion -- a saving of $307 million.
>>
>>
>> ----
>> Dr David G More MB, PhD, FACHI
>> Phone +61-2-9438-2851 Fax +61-2-9906-7038
>> Skype Username : davidgmore
>> E-mail: [EMAIL PROTECTED]
>>
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