Unfilled Prescriptions 2

I visited the topic of Unfilled Prescriptions a few years ago.  It seems that the issues leading to not filling the prescriptions or what is sacrificed in order to fill them have not changed.

According to the report, "Patient Compliance, Disease Management and Consumer Outreach, " 20% of new prescriptions go unfilled, while up to 85% of prescriptions never get refilled.  The leading factor for non-compliance is believed to be a break-down in communication between patients and physicians.  Another contributing factor is the costs of the medication for those with and without medical insurance.

One way to cut down on the costs is to ask if there is a generic equivalent.  Be careful, there are some medications that are not exactly equivalent. Discuss this your medications and this your health care provider.



Karen Rowan, Managing Editor for MyHealthNewsDaily has put together some information regarding this topic as well. You can heck it out as well.

Unfilled Prescriptions

A study done by the Journal of General Internal Medicine shows that a significant number of prescriptions go unfilled. In this study, researchers found that among more than 75,000 Massachusetts patients given drug prescriptions over one year, 22 percent of the prescriptions were never filled. The rate was even higher -- 28 percent -- when the researchers looked only at first-time prescriptions.

Letting prescriptions go unfilled is called "non-adherence." Such "non-adherence," the study found, was common even among patients prescribed drugs for chronic conditions that can have serious health consequences.

The big question is why?  Exactly why many patients did not fill their prescriptions is unclear, but several reasons are possible.

1. The patient does not know why they are taking the medication
2. The patient's condition does not cause any symptoms
3. The patient cannot afford the medication(s)
4. The patient has concern about side effects
5. The patient doesn't want to take any medications

When health problems cause few or no symptoms -- as with high blood pressure or high cholesterol -- people may not see the need for a medication. Although there are many diagnoses that have no symptomotology, your disease is causing damage. When symptoms do occur, it will be more difficult to control and treat.

"If they do not fully understand the reason that they are being prescribed the medication, they may be less likely to take it," lead researcher Dr. Michael A. Fischer, of Brigham and Women's Hospital in Boston, told Reuters Health.  If you don't know why you are taking a medication, ask your doctor. It is our job to educate you about your diagnosis and advise you regarding all treatment options.

Cost could also be an issue, Fischer added -- particularly when people are unsure of why a drug is being prescribed.   All of the patients in the study had health insurance. But even with coverage, people may have high co-payments for medications or may be prescribed a drug not covered by their plan, Fischer and his colleagues note.

No matter what the reason, patients should not hesitate to talk with their physicians regarding their concerns. We especially need to know if you encounter side effects.

What's really scary about this study, though, is that these numbers reflect the behavior of people with health insurance (Massachusetts has a 97 percent insured rate). The numbers are undoubtedly higher among the uninsured.

Check out Trisha Torrey's blog as she takes the patients perspective. She gives the patient's responsibilty regarding prescriptions.

Back Pain in Kids and Teens

One of my kids has been complaining of back pain off and on. She did a search on the subject  and found that her problem probably began with band camp last summer (August 2009) and has been aggravated by her other activities throughout the school year (marching band, winter color guard). I read the article and it appears to go a great job of covering all the possibilities.  The article found on Healthcare South and written by Julian Huang, MD.  The article, Back Pain in Kids and Teens, is reproduced in its entirety below.

While back pain is very common for adults, kids are much more resilient and flexible and do not suffer the same types of back injuries to which adults are subject. In fact, medically significant back pain in children and teens is infrequently encountered, with even fewer cases in younger children.

Because children rarely suffer from back pain, any complaint by a child or teenager about acute or chronic back pain is taken very seriously by Pediatricians, and usually will result in a detailed consultation that will include a review of the child’s medical history and a physical exam.
Suspicious episodes of pain, or any concerning features of the pain, will result in radiological studies (such as an x-ray or MRI scan) and possibly a referral to a specialist for further examination and diagnostic tests.

The most common causes of back pain in children and teens tend to be somewhat age-dependent:
Younger children are less likely to be putting their spine under the same severe stresses as older children and adults. Thus, for the most part younger children do not have medically significant back pain and their discomfort tends to be short-lived. Also, younger children tend to self-limit their activity, choosing not to repeat painful activities, which aids in their recovery if an episode of back pain does occur.

At a young age, if a child has back pain there is greater concern for the possibility of a serious condition, such as a spinal tumor, growth, or an infection of the spine.
Therefore, if the pain persists in a younger child despite a lack of re-injury, or if there are other symptoms suggestive of a more insidious process (infection or tumor), the child’s condition will most likely be considered atypical, and therefore, further work-up and medical examination will be indicated.

Older children tend to be more aggressive in their activities and sports, thereby increasing the risk of injury to the bones, nerves and soft tissues in the spine. Teenagers are also more likely to test the limits of their bodies, often being exhorted by commercial advertising and/or peer pressure to push the envelope.

At this point, compression fractures are more commonplace, and we begin to see occasional disc injuries. Older pediatric patients also can injure the joints between vertebral bones, causing painful stress injuries. Only very rarely do the nerve roots become compromised.
lightly older children can be convinced to minimize their activity to speed up healing times, but then they frequently return to the same injurious behavior that caused the initial damage. Here, older kids may also find themselves the victims of their own intermittent inactivity and suffer overuse injuries, similar to an adult who is a “weekend warrior”. For most injuries, the treatment of choice is usually a short period of rest with an eye towards developing and maintaining physical conditioning.

Tumors and infection of the spine may occur in teens, but it is more common for back pain to be caused by sports injuries or overuse syndromes.

Scoliosis
While scoliosis (curvature of the spine) is not an uncommon diagnosis among teenagers, it is very rare that scoliosis will cause back pain. Teens with scoliosis may develop back pain, just as other teenagers, but it has not been found that people with adolescent idiopathic scoliosis are any more likely to develop back pain than the rest of the population.

Potential causes of back pain in children and teens
While adults can have vertebral disc injuries involving rupture, protrusion or slipping, and compression, these problems are uncommon in children. However, as kids age and their bodies mature, it becomes more likely that an injury to the spinal discs may occur and cause pain.

Causes of back pain that tends to occur older children
Spondylolysis
As kids’ sporting events become more competitive and the activities more specialized, certain types of injuries tend to arise. Spondylosis, a defect of the joint between vertebral bones, is commonly found in those who tend to hyperextend their backs (bend backwards), such as gymnasts. This injury may actually represent a stress fracture and the period of rest and recuperation may be extensive – up to 4 to 6 weeks.

Spondylolisthesis
Occasionally, further injury can be found as spondylolisthesis, a “slipping” of one vertebra upon another. This condition can progress through adolescence, and if it results in instability and pain it may require spinal fusion surgery at a later point.

Disc Injuries and vertebral fractures
Teens who tend to punish their spines through gymnastics or extreme sports (such as skateboarding, in-line skating, and vert biking) will frequently land very hard on their feet or buttocks. Either way, the force is transmitted to their vertebrae, which can result in a vertebral fracture and/or damage to the intervertebral discs.

If the disc material is extruded out or herniated, the spinal cord nerve roots leaving the cord can be compressed. This causes the sensation of pain along the path of that nerve. A well-known version of this is sciatica, which presents as buttock pain radiating down the back of a leg. Conservative measures are usually the first line of treatment for this type of pain (such as physical therapy, medications, osteopathic or chiropractic manipulation). If these treatments do not provide sufficient pain relief, patients may require surgery (e.g. a microdiscectomy or discectomy) to relieve pressure on the nerve.

Causes of back pain that may occur in younger or older children:
Infection
Of constant concern to physicians is the diagnosis of infection of the spine (discitis) in children. An infection of the spine is of great consequence and requires prompt diagnosis. Diagnosis of an infection is usually made with the assistance of a good physical exam and laboratory data. Signs of inflammation may be present (e.g. redness, swelling) even to the level of the skin. Radiographic studies are frequently normal. Treatment may consist of antibiotics if bacteria are found to be the cause of the infection. Again, prolonged rest is the primary treatment.

Tumor
Another major concern for pediatricians is potential for a tumor in the spine in children. Luckily, this is a very rare occurrence. As with infection of the spine, the diagnosis hinges on obtaining a good medical history, physical exam, and the suspicious nature of physicians when they cannot get an otherwise satisfactory diagnosis to explain the child’s symptoms. Treatment once again depends upon the final diagnosis and the skills of several subspecialties.

Backpacks

Importantly, pediatricians are starting to see a new form of injury in school-age children and teens become more common: overuse injuries and back strain caused by carrying back packs that are too heavy.

Often, backpacks may equal 20% to 40% of the child’s own body weight (equivalent to a 150-pound adult carrying a 30 to 60-pound back pack around 5 days a week). This amount of weight understandably creates a great deal of strain on the child’s spine. Additional strain is caused when children and teens carry the backpack over one shoulder, causing an uneven load on the spine.

Summary
As you may have noted, rest and careful monitoring of symptoms seems to be the answer for most diagnoses. This is because the vast majority of back pain problems in children are related to soft tissue damage (such as muscles, ligaments and tendons), which is often caused by overuse or strain.

Surgery for back pain in children is very rare, and is usually only considered for the more severe cases. If the child’s pain is severe, and he or she is having difficulty functioning, then surgery may be considered.

Most importantly, a careful process of elimination of medically more significant causes of back pain (such as tumor, infection, fracture) should always precede any therapeutic plan.

Julian Huang, MD
July 10, 2002

The Little Pink Pill - Part 2

Since my initial blog article (The Little Pink Pill), the US Food and Drug Administration's (FDA) Reproductive Health Drugs Advisory Committee voted 10 to 1 on June 18 that flibanserin, 100 mg (Girosa; Boehringer Ingelheim), was not significantly better than placebo for hypoactive sexual desire disorder (HSDD); they also voted unanimously that the benefits did not compensate for its adverse effects, which may include loss of consciousness and depression.

Even before the advisory committee’s meeting debate was triggered whether this is a long sought step toward equality for women or is it the pharmaceutical industry’s fabrication of a questionable “disorder” (see below) in order to sell unnecessary and potentially dangerous drugs?

The disorder is Female Dysfunctional Syndrome (FDS) also called Hypoactive Sexual Desire Disorder (HSDD).  It is a deficiency or absence of sexual fantasies and desire for sexual activity, as defined by the American Psychiatric Association (APA). The women are not averse to sex. They just they don’t care about it and stop thinking about it.  They have problems with sexual desire, arousal, or orgasm and unexplained loss of sexual thoughts, fantasies and desire. They also have a low sex drive and a slow response to stimulation. Some complain of an inability to experience an orgasm. Researchers suggest that approximately 10% of women suffer from this disorder.

Because the definition is vague and there are significant differences in sexual interest levels and in sexual functioning among women; the question is what is normal?  Another question may be what led to this change? Many say that a decreased sex drive in a woman may be a normal part of aging, a dysfunctional relationship (i.e., an abusive partner), stress, a lack of exercise, diet or other medical problems.

Is this a real syndrome and if so does it need to be treated with medication? Many say that the pharmaceutical industry has played a central role in defining FSD/HSDD as an official psychiatric disorder and has exaggerated its scope by funding key research.

What do you think?