Medication Cost Information in a Computer-Based Patient Record System - Article Example

 Medication Cost Information in a Computer-Based Patient Record System One of the most important and relevant problems regarding medical care today is the price of the medications. To be more exact, medication costs today tend to be high, and sometimes even extremely high. Furthermore, it is known that "prescription medication expenditure accounts for nearly ten percent of the total healthcare expenditure in the United States" (Nyugen et al., 2006), and it "is anticipated to increase an average of 9.8%" in the next ten years (Ernst et al., 2000). This obviously poses a heavy financial burden on patients, who sometimes can't even afford the medications and may possibly not be medically insured, therefore not receiving any help or discounts in purchasing them. Even with the medical insurance, some medications prove to be more expensive than patients can afford. Due to the severity and importance of the situation, one must examine the possible solutions to this most serious problem. Many studies have been conducted, examining the efficiency of different ways to reduce the amounts patients have to pay for medications. I will examine three articles describing different studies regarding the issue of medication costs, and explain in detail the problem, the way of solution, and the quantitative method used in order to solve the problem. The first article I've chosen is named "Reduction in Prescription Medication Costs after Laparoscopic Gastric Bypass". It relates to specific medical problems caused by obesity, which require certain medication. The final conclusion of the study is the bypass operation can solve the obesity problem and drastically reduce the dosages and number of times the patients have to use to medications after the surgery. The aim of the study was to "examine the changes in monthly prescription medication costs in morbidly obese patients who underwent laparoscopic gastric bypass" (Nyugen et al., 2006). The study was carried out under the assumption that the bypass "would have significant improvement or resolution" of the comorbidities obese patients tend to have (such as hypertension, diabetes mellitus, hyperlipidemia and gastro esophageal reflux), and that this will result in a reduction in the dosage of medications patients would use and therefore would save the patients significant costs on medications (Nyugen et al., 2006). The study tested 77 obese patients with at least one of the four comorbidities which were previously described, who underwent the laparoscopic gastric bypass. Information for the database of the study was collected from the patients at the same time, and consisted clinical data about the patient characteristics, comorbidities, weight loss, medications and dosages prescribed for the treatment of the comorbidities. Changes in the use of the medications were recorded one month after the surgery, and then every three months. The patients' medical history was taken from the local clinic or hospital, and retail costs of the medications were taken from an online pharmacy website. 55 of the 77 patients were women, and the average age of the entire group was 45, and ranging between 17 and 65. Combined, the patients had 140 comorbidities, which led them to take an average of 2.4 medications before the operation. This cost them between 5$ and 2434$ a month. Results show that after the operation, more and more patients were able to discontinue their prescription medications, or at the very least use much less of it. As time went by, they needed less and less of the medications, until finally they were able to completely stop taking them. One year after the surgery, patients decreased from 2.4 medications per patient to only 0.2. This tremendously reduced the patients' costs on medications, which dropped from an average of 196$ to 54$. Overall, the average cost savings on medications in the first year after the surgery was 168$, meaning 86% savings. This meant that each patient saved about 2016$ per year. Moreover, the savings further improved in the second year after the surgery, and was 176$ per month, which was 90% of the costs. The overall cost savings for each patient were greater than the cost of the surgery by 7 seven after it. To conclude the data from this research, we can say that the gastric bypass done to obese patients substantially reduced their comorbidities, resulting in many of them not needing prescription medications any longer, since they've lost the excess weight. The reduction in the number and dosages of medications occurred almost immediately after surgery and continued during the two-year follow-up. This, of course, meant serious cost savings. These cost savings amounted to be thousands of dollars for each patient! It is important to mention that many other studies were made on the subject, and they all stated that after the gastric surgery, patients needed much less medications, and this resulted in a great reduction of costs on them. These other studies, as well as this one, validate the assumption that the gastric operation solves both the medical condition of the patients and the financial burden on them due to the need for medications. The second article I've chosen is named "Prescription Medication Costs", in which researchers wanted to determine how much do physicians know about and are familiar with the costs of medications, and how much does it seem important to them to know the prices of the medications. The researchers surveyed 205 practicing faculty and resident physicians from seven medicine training programs in Iowa. All programs are community based, and in towns where there are between 30,000 and 190,000 people, meaning between 15,000 and 40,000 patient visits to the doctor per year. As preparation for the survey, a daily audit of written prescription was performed clinical pharmacist faculty members. Fifty drugs which were commonly prescribed in all clinics were chosen, out of 423 drugs and 3635 written prescriptions. For each medication on the survey, researchers tried to put another medication which was similar in its class of therapy, and was also on the fifty common ones. In the survey, the medications appeared in a random order and doctors were requested to guess the price of each one. The prices ranged between 0.01$ and 80$, and the doctors were tested to see if they would identify their price within 10$ intervals. Also, the doctors were asked to respond to four statements about the importance of medical cost information to their practice. The questions were the following: whether they believed they'd received enough information about the costs of the medications they prescribe, whether better accessibility of information about the costs would help them prescribe more cost-effectively, and whether the insurance of patients affect their choice of which medication to prescribe for patients. The results of the study showed that only 22.9% of the responses correctly identified the price of the medications, whereas 68.3% thought it was lower than it really was. There was also a difference between the doctors' identification of the prices of generic drugs, which are usually cheaper, and branded drugs, which are more expensive. The prices of the former type of drugs were overestimated by 90.2%, while the ones of the latter type were underestimated by 89.9%. In overview, 64.4% of the doctors felt that regular pricing information would help them prescribe drugs for patients more cost-effectively. Average scores weren't significantly different between those who states they'd received enough pricing information, and between those who didn't. 72% said that whether a patient has insurance affects their choice of which medication to prescribe. However, less than half of the doctors (47%) remember to ask patients about insurance. Another thing that was learned by the study was that there were no major differences in correct responses between veteran doctors and new ones in their first years of residency. This means that the familiarity of doctors with medication pricing doesn't increase in time, but stays stagnant. Hence, it is important to better incorporate this subject in the curricula of their residency training. Moreover, doctors underestimated prices of expensive drugs and overestimated prices of cheaper ones. This indicates that doctors view the pricing range as very narrow. This only enhances the fact that doctors must be better educated on the prices of drugs in order to better prescribe them for patients. The third article I've chosen is "Medication Cost Information in a Computer-Based Patient Record System". Its objective was to determine if cost information in computer-based patient record system (CPR) would have a positive impact on doctors prescribing medications. This was especially needed because a review from 1989 showed that traditional approaches to improving physician prescribing, such as mailing them educational materials, audits and group learning failed to achieve their goal and were ineffective. Therefore, it was thought that via computers, which can provide information in real time and in a simple way, it will be possible to improve physician prescribing (Ornstein, MacFarlane, Jenkins, Pan & Wager, 1999). More recent studies showed that audits with weekly reminders and academic detailing, along with a computer review of drug utilization can lower prescription drug costs (Ornstein et al., 1999). This led the researchers to believe that the computer is the ideal tool to provide doctors with the necessary information about medication prices. The clinical trial was conducted for a year at the Family Medicine Center, Department of Family Health, Medical University of South Carolina, Charleston. The trial was divided into two periods, the control period and the intervention period, in both the information about drug costs was collected through the CPR system. The difference between the two was that in contrast to the intervention period, in the control period doctors were not aware of the drug costs. Only in the intervention period were they given the information from the CPR system. This computerized system enables doctors to use many features and access a lot of information which was previously unavailable to them. For instance, they could access a list of drugs which is alphabetized and from which a doctor can choose what to prescribe. Also, the system recorded and displayed the wholesale price sold per total amount prescribed, the average price per unit and per amount prescribed and more. The cost information was updated every three months, so it remained as new as possible, under the limitations. One other feature which was very important was that when a doctor wanted to prescribe a medication of a certain classification, a pop-up would appear listing the other medication of the same classification and their prices. However, the computerized system had some disadvantages, the most obvious of which was that the cost information about a certain medication would only appear if the medication name and dose in the prescription were identical with the ones on the CPR dictionary. In total, 22,883 prescriptions were written during the year period, but 13% of them (2,985 prescription) were excluded of the analyses. Some were written less than 5 times, some had incomplete information or one-time injections or treatments, and others included equipment, devices or exercise regiments. The remaining prescriptions represented 600 discrete medications prescribed at 30,461 patient contacts. The results show that there are no meaningful differences between the control and intervention periods neither in terms of cost per prescription nor in cost per contact. Costs did decrease in certain types of drugs during the intervention period, but in other types there was an increase in costs. Therefore, this data doesn't determine the efficiency of the CPR system. These results contradict what has been previously proven- that academic detailing, such as the one of the CPR system, can reduce costs. As a result of this and the disappointing results, the researchers assume that doctors may be insensitive to medication costs, and consider other factors, like anticipated efficacy, side effects, patient compliance and peer recommendations, more than the costs (Ornstein et al., 1999). Generally speaking, the problem in all three articles is identical- the high prices of medications, which pose a heavy financial burden on patients. But even though the problem is the same, there are different techniques offered in order to solve the problem, which are alternative approaches to the problem. The first article suggests using a medical procedure that will eliminate or substantially decrease the need for medications, while the other two articles focus on making sure doctors know more about the prices of medications, in order for them to be able to prescribe medication more cost-effectively. The assumptions in the articles are also different. While in the first one it is presumed that the surgery will replace the need for medications to solve the comorbidities caused by obesity, the other two articles speculate that informing doctors about prices of medications, whether it is through a computerized system or by incorporating pricing information in their curricula, can help them prescribe medications which are relatively cheaper than others but still as effective. In order to see if the assumptions made in the articles are correct, a quantitative method is used. The quantitative method used in all of the articles is planning. The articles describe different plans hatched in order to solve the problem of the high costs of medications patients use. Planning for a problem definitely provides a guideline on how to solve the problem, and is very useful in the application of the solution. Nevertheless, there are limitations to it. Although there are different plans offered in the articles as to how to solve the problem of high prices of medications, not all of them work. For instance, the third article concludes that a computerized system detailing prices of medications does not make a real difference and fails to solve the problem. It is susceptible to bugs and system failures, and does not always work properly. Therefore, while in theory it's a good plan, it is actually ineffective. Also, in the second article it is proven that doctors' familiarity with medication pricing does not increase in time, and only if they're taught about it while studying for their medical degree, will they really know it. It can be concluded that the limitations of planning are inherent, as can be seen in the analyses of the articles. Planning for a problem has to be reinforced with studies which determine if the plans will be effective or not. Every plan is good in theory, but it has to be tested in order to see if it truly works. That is also why the limitation can't be overcome with more sophisticated methods- theories must be supported with data obtained from researches. Despite the limitations, planning is a good way of solving problematic situations. It specifies the way to reach the solution in an organized way, providing with steps needed to achieve the solution. This is the advantage of planning- it specifically details how to solve the problem, rather than trying to do so without it, in a chaotic, disorganized way. In fact, planning is so useful that with proper thinking, nearly every problem can be solved by it. However, proper research must be made as well as the use of preexisting data and theories in order to try and determine if the plan suggested will be successful in achieving its goal. References 1) Nyugen, Ninh T. et al. Reduction in Prescription Medication Costs after Laparoscopic Gastric Bypass. American Surgeon; Oct2006, Vol. 72 Issue 10, p853-856, 4p. 2) Ornstein, Steven M. et al. Medication Cost Information in a Computer-Based Patient Record System. 8 December 2006. < http://archfami.ama-assn.org/cgi/reprint/8/2/118.pdf > 3) Ernst, Michael E. "Prescription Medication Costs". 8 December 2006. < http://archfami.ama-assn.org/cgi/reprint/9/10/1002 > Read More