Data Stream
A Big Pill to Swallow
Over the last 13 years, the number of people in the United States taking
prescription medications – and the number of prescription medications per
person – have increased steadily.
According to an analysis of data from the National Health and Nutrition
Examination Survey from 1999 to 2012, which included 37,959 participants:
51%
Chipping Away at Choosing Unwisely
59%
An analysis of seven treatment and testing services listed by the Choosing
Wisely® campaign shows some decline in unnecessary procedures, but highlights the amount of work still to be done in reducing wasteful and needless
medical treatments and testing procedures.
The study, published in JAMA Internal Medicine, analyzed medical and
pharmacy claims data from 2010 to 2013 to examine trends of use of these
7 low-value services, finding little or no change in test and drug ordering by
clinicians:
of U.S. adults
reported use of any
prescription drugs
within a 30-day
period in 1999
of U.S. adults
reported use of any
prescription drugs
within a 30-day
period in 2012
In that same time period, the number of people using 5 or more prescription
drugs also increased, from 8.2% to 15%.
1.5%
• imaging tests for uncomplicated headache......................................
The increase in prescription use may be driven in part by the rise in obesity,
the authors noted: the drug classes with the greatest increase in prescriptions over time were anti-hyperlipidemic agents, followed by antidepressants, prescription proton-pump inhibitors, and muscle relaxants.
1.1%
• cardiac imaging without history of cardiac conditions...................
Source: Kantor ED, Rehm CD, Haas JS, et al. Trends in prescription drug use among adults in the
United States from 1999-2012. JAMA. 2015;314:1818-30.
• low back pain imaging without red-flag conditions........................
STABLE
• preoperative chest x-rays with unremarkable history
0.2%
and physical examination results......................................................
• human papillomavirus testing for women younger
1.2%
than 30 years........................................................................................
• use of antibiotics for acute sinusitis.................................................
0.8%
• use of prescription nonsteroidal anti-inflammatory
drugs for people with hypertension, heart failure,
1.8%
or chronic kidney disease....................................................................
“Population-level analysis showed both desirable and undesirable modest
trends in use of low-value services,” the study authors wrote. “The relatively
small use changes suggest that additional interventions are necessary for
wider implementation of Choosing Wisely recommendations in general practice.” Their suggestions include: data feedback, physician communication
training, systems interventions (e.g., clinical decision support in electronic
medical records), clinician scorecards, patient-focused strategies, and financial incentives.
Source: Rosenberg A, Agiro A, Gottlieb M, et al. Early trends among seven recommendations from
the Choosing Wisely Campaign. JAMA Intern Med. 2015 October 12. [Epub ahead of print]
Drug Ad Nauseaum
A vast majority of Americans believe that the U.S. Food and Drug Administration (FDA) should practice greater oversight over how medications are
marketed to consumers and doctors, according to results from the Kaiser
Family Foundation.
Of the 1,203 people polled:
82% reported seeing or hearing prescription drug ads
51% said they believed prescription drug advertising was generally a good idea
28% said they had talked with a doctor about a specific medicine as a result
of an ad
However, 89% of respondents favored requiring the FDA to review
prescription drugs ads for accuracy and clarity before they can be aired to
the public – something it currently does not do.
Source: Kaiser Family Foundation, “Kaiser Health Tracking Poll: October 2015,” October 28, 2015.
38
ASH Clinical News
December 2015