“The use of medications in older patients is arguably the single most important health care intervention in the industrialized world,” Dr. Jerry Avorn asserts in a concise analysis called Medication Use in Older Patients in the October 13, 2010, issue of the Journal of the American Medical Association (JAMA).
Since the population over 65 is the biggest consumer of health care services (and thus, driver of costs), and continues to grow, the segment commands the attention of health system stakeholders: policymakers, payers, medical schools, and pharmaceutical drug researchers. Medicare Part D, which covers payment for seniors’ drug costs, put the Federal government in the #1 position of prescription drug purchaser. This means that U.S. taxpayers are also key stakeholders in the challenge of medication use in older people.
Dr. Avorn points out that many aspects of the U.S. health system mitigate against sound medication management in older patients:
- Medical schools don’t generally address the special issue of pharmacotherapeutics in older people;
- Clinical trials for prescription medications don’t enroll sufficient numbers of people over 80;
- The continuity of care in health delivery in the U.S. continues to compromise health outcomes for people with complex, multiple morbidities which require people to take many prescription drugs (causing drug-drug interactions and medical errors) – what Dr. Avorn terms, “pharmacological chaos;” and,
- Policymakers who have avoided dealing with comprehensive Medicare reform that puts the patient-senior at the center.
Dr. Avorn concludes that there’s a treasure trove of data that can be mined through the adoption of electronic health records which will allow analysts to identify best practices; the FDA to measure outcomes in the new Sentinel program; and, provide doctors at the point-of-prescribing alerts that will help the prescriber optimize drug choices for individual patients. Even where EHRs are not adopted, “academic detailing” programs (which counter pharmaceutical companies’ direct-to-physician promotional activities) can provide doctors with evidence-based drug information.
Health Populi’s Hot Points: Ultimately, Dr. Avorn mentions the concept of patient-centered medical homes which are included in pilot program provisions in the Affordable Care Act. While seniors on Medicare identify with specific physicians for primary care (such as internists, general practitioners, and family practitioners), the above-listed barriers work against older peoples’ best health outcomes — especially when it comes to their consumption of prescription drugs. Reforming Medicare reimbursement based on patient outcomes, coupled with training medical students for geriatric populations on complex drug regimens, will realign the physician workforce toward putting older patients at the center of care. This objective also reinforces the strategic importance of doctors’ adoption of electronic health records, spurred by the HITECH incentives between 2011-2014. There’s an argument for expanding these incentives to long-term care and home care organizations, as well, to bolster continuity-of-care for older Americans.