Fall of 2013 was the season of updated guidelines. Organizations and expert panels such as the American Heart Association and the American College of Cardiology, the Eighth Joint National Committee, and the American Diabetes Association all announced new guidelines providing evidence-based strategies to improve and standardize the management of different diseases.
Unfortunately, there are still many physicians not using or adhering to these evidence-based guidelines. Obviously, patient treatment should be patient-specific, but data shows there are significant differences depending on where you live.
A CBS news article highlights recent findings from the Dartmouth Atlas project findings that show significant differences related to prescribing medications for seniors around the country.
The study used the 2010 data from 37 million patients on the Medicare Part D drug plan. Here are some of its surprising findings:
- 1 in 4 patients are still prescribed long-deemed high-risk medications, and some regional areas show higher percentage than others (e.g., Alexandria, Louisiana vs. Rochester, Minnesota).
- People living in the South fill prescriptions for riskier medications and are less likely to be ordered standard treatments for heart and bone conditions. They also use antibiotics more than those in the West or Midwest without a difference in disease rate.
- In Ogden, Utah, 91% of seniors who survived MI were prescribed cholesterol-lowering statins. In Abilene, Texas, that number was only 44%.
- The overall average of month-long prescriptions (new or refills) per patient was 49. The highest area was Miami, Florida (63). The lowest was Grand Junction, Colorado (39).
So how does this affect us as clinicians?
In order to best care for our patients, we must stay up-to-date on current guidelines and evidence-based medications. We must also be sure to perform complete medication reconciliation, which includes looking for appropriate medications for diseases.
Communicate with the patient’s primary care physician on the following:
- Ask if the patient was supposed to be on a particular medication classification (e.g., ACEI or ARB).
- Assess for unresolved signs and symptoms with current medications.
- Ask if the patient missed a prescription or did not fill it.
- Find out why the patient is not on a specific medication (e.g., ASA), and document it clearly in the home health record.
And remember, many times the PCP does not see the patient in the hospital, and chronic illness medications are not resumed.
Last but certainly not least, educate your patients on their disease(s) and types of medications usually prescribed. Encourage them to ask questions when visiting their doctor.