Drug Use In The Health Care System

Spending on drugs, as a percentage of what was spent on health care in total, increased from 5.8% to 8.5% from 2005 to 2006. This amounts to a percentage increase of 47% in 1 year. Drivers for this significant increase include increasing available technologies, increasing numbers of patients and prescriptions per patient, and an increasing number of seniors taking advantage of the Medicare Part D Drug Benefit. Generic drug use accounts for over 50% of prescriptions filled in the United States, but, as a percentage of expenditures on drugs in total, remains less than 30%. Brand-name drug purchases fuel the increase in spending on drugs as evidenced by the 2006 data.

There are significant numbers of medications used daily in the United States. Over one decade (from 1997 to 2007) prescriptions purchased zoomed from 2.2 billion to 3.8 billion. The average number of prescriptions per capita in the United States rose from 8.9 in 1997 to 12.6 in 2007. Problems occurring with the use of drugs can include:

• Medication errors

• Suboptimal drug, dose, regimen, dosage form, and duration of use

• Unnecessary drug therapy

• Therapeutic duplication

• Drug-drug, drug-disease, drug-food, or drug-nutrient interactions

• Drug allergies

• Adverse drug effects, some of which are preventable

Clinicians are often called upon to identify, resolve, and prevent problems that occur due to undertreatment, overtreatment, or inappropriate treatment. Individuals can purchase medications through numerous outlets. Over-the-counter (OTC) medications can be purchased in pharmacies, supermarkets, convenience stores, via the Internet, and through any number of additional outlets. OTCs are widely used by all age groups. Prescription medications can be purchased through traditional channels (community chain and independent pharmacies), from mail-order pharmacies, through the Internet, from physicians, from health care institutions, and elsewhere. Herbal remedies are marketed and sold in numerous outlets. The monitoring of the positive and negative outcomes of the use of these drugs, both prescription and OTC, can be disjointed and incomplete. Clinicians and health professions students need to take ownership of these problems and improve patient outcomes resulting from drug use.

It is important to realize that, although clinicians are the gatekeepers for patients to obtain prescription drugs, patients can obtain prescription medications from numerous sources. Patients may also borrow from friends, relatives, or even casual acquaintances. In addition, patients obtain OTC medications from physicians through prescriptions, on advice from pharmacists and other health professionals, through self-selection, or through the recommendations of friends or acquaintances. Through all of this, it must be recognized that there are both formal (structural) and informal (word-of-mouth) components at play. Health professionals may or may not be consulted regarding the use of medications, and in some cases are unaware of the drugs patients are taking. In addition, herbal remedies or health supplements may be taken without the knowledge or input of a health professional.

External variables may greatly influence patients and their drug-taking behaviors. Coverage for prescribed drugs allows those with coverage to obtain medications with varying cost sharing requirements. However, many do not have insurance coverage for drugs or other health-related needs. With the advent of Medicare Part D coverage for outpatient prescription medications, we have seen more of the elderly with access to needed therapy—more than ever before.4


Self-medication can be broadly defined as a decision made by a patient to consume a drug with or without the approval or direction of a health professional. The self-medication activities of patients have increased dramatically in the late 20th and early 21st centuries. Many factors affecting patients have continued to fuel this increase in self-medication. There are ever increasing ways to purchase OTC medications. There have been many prescription items switched to OTC classification in the last 50 years, which is dramatically and significantly fueling the rapid expansion of OTC drug usage. In addition, patients are increasingly becoming comfortable with self-diagnosing and self-selection of OTC remedies. In many studies,5 self-medication with nonpre-scribed therapies exceeds the use of prescription medications in the patient groups assessed.

Patients' use of self-selected products has the potential to provide enormous benefits.6 Through the rational use of drugs, patients may avoid more costly therapies or expenditures for other professional services. Self-limiting conditions, and even some chronic health conditions (e.g., allergies and dermatologic conditions), if appropriately treated through patient self-medication, allow the patient to have a degree of autonomy in health care decisions.

Compliance Issues

Patient noncompliance with prescription regimens is one of the most understated problems in the health care system. The effects of noncompliance have enormous ramifications for patients, caregivers, and health professionals. Noncompliance is a multifaceted problem with a need for interprofessional, multidisciplinary solutions. Interventions that are organizational (how clinics are structured), educational (patient counseling, supportive approach), and behavioral (impacting health beliefs and expectations) are necessary. Noncompliance leads to lack of control of hypertension and a high discrepancy in how patients respond to therapies. Helping to identify psychosocial interventions, which engage patients to self-manage their therapies, has proven efficacy. Acknowledging the barriers that people perceive in complying helps to identify how to assist patients to overcome these distracters. Compliant behavior can be enhanced through your actions with the patients for whom you provide care. Many times what is necessary is referral to specific clinicians for individualized treatment and monitoring to enhance compliance. The case histories provided in this text will allow you to follow what others have done in similar situations to optimally help patients succeed in improving compliance rates and subsequent positive health outcomes.

Drug Use by the Elderly

Various components of drug use in the elderly are worth noting. Problems with health literacy (i.e., the understanding of medical terminology and directions from providers) are more common among the elderly.8 The burgeoning population of the elderly, coupled with their lack of health literacy, means that this issue will become even more problematic in the future.9

Over the next decade, seniors will spend $1.8 trillion on prescription medications. Medicare proposals to provide a drug benefit for seniors have been suggested to cost $400 billion over a 10-year period. Thus, the most elaborate of the current drug programs will pay only 22% of seniors' drug costs. Enhanced use of pharmacoeconomic tenets to select appropriate therapy, while considering cost and therapeutic benefits for seniors and others, will become even more crucial for clinicians in the future.

Unnecessary drug therapy and over medication are problems with drug use in the elderly. A joint effort by health professionals working together is the best approach to aiding seniors in achieving optimal drug therapy. Evaluation of all medications taken by seniors at each patient visit can help prevent polypharmacy from occurring.10

Herbal Healing For Everyone

Herbal Healing For Everyone

Disease isn't complicated it's really very easy and the application of good sense techniques may defeat any disease. All microbes and viruses are weak and may be defeated easily with cleaning and nutrition.

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