Saturday, August 13, 2016

Impact of a physician-led point of care medication delivery system on medication adherence.

Impact of a physician-led point of care medication delivery system on medication adherence.
Authors: Palacio A, Chen J, Tamariz L, Garay SD, Li H, Carrasquillo O
A physician lead point-of-care medication delivery system helped improve adherence to medications among elderly minority patients with diabetes, without increasing pharmacy costs.

Am J Manag Care. 2016;22(7):e264-e269

Saturday, December 6, 2014

Generic Drug Prices are Rapidly Increasing

Generic medication prices are escalating in part due to fewer companies manufacturing the generic products, decreasing competition. Read More

Saturday, November 15, 2014

Do Pharmaceutical Reps Change Prescribing Habits by Doctors in a Bad Way?

QUESTION: it is known that sales reps change behavior. In the case a doctors and pharmaceutical industry sales reps, does the change in behavior lead to worse prescribing habits by the doctor?

METHODS: an online survey was performed. Response rate was 11.5%

RESULTS: attending industry sponsored continuing medical education courses was associated with a higher rate of prescribing patent-branded (non-generic) medications. Acceptance of office stationary was associated with higher daily doses.

of industry-sponsored CME is associated with more rational prescribing

COMMENT: the authors do not address their low response rate. As such, the conclusion from this study can only be considered an unconfirmed hypothesis.

PLoS One. 2014; 9(10): e110130.

Saturday, October 25, 2014

What happens when physicians refuse pharmaceutical samples?

This family medicine clinic in rural Oregon found that after instituting a policy of not accepting pharmaceutical detail rep samples, that:

a) clinic operations were enhanced after eliminating interruptions from pharmaceutical representatives

b) there was a positive response from the public, and

c) there were reduced diversion of samples for personal use.

Clinicians interviewed agreed that

a) brand pharmaceutical samples were of questionable benefit

b) information obtained from industry reps was incomplete or of questionable objectivity, and

c) that it was helpful to substitute other educational activities to replace former industry

One practice's experiment in refusing detail rep... [J Fam Pract. 2011] - PubMed - NCBI

Wednesday, January 1, 2014

Top Prescription Medications: 1 - 10

Top Prescription Medications: 1 - 10 

Consult a doctor if you have a medical concern. The following is editorial opinion only and not intended for use in medical diagnosis or treatment.
  1. HYDROCODONE - an opioid agonist used for pain and sedation. Usually combined with acetaminophen, so care must be taken to limit total daily dose of acetaminophen. May cause respiratory depression. Monitor Cr, LFTs at baseline and periodically. Currently Schedule 3.
  2. LEVOTHYROXINE - thyroid hormone replacement. Avoid use for obesity or weight loss. May cause heart problems including arrhythmias and failure. Monitor ECG.
  3. LISINOPRIL - ACE inhibitor for hypertension, congestive heart failure, and after an acute myocardial infarction. Avoid use during pregnancy. May cause angioedema, hyperkalemia, SIADH. Monitor renal function, BP, WBC.
  4. SIMVASTATIN - HMG CoA inhibitor (statin) used for lipid disorders. Avoid use during pregnancy. May cause myopathy, rhabdomyolysis, hepatotoxicity. Monitor Cr, CK, LFTs.
  5. AMOXICILLIN - a penicillin bactericidal antibiotic. May be used for pharyngitis, otitis, sinusitis,  dental infections. Avoid use in patients with mononucleosis. Can lower seizure threshold, result in yeast infection or GI upset. Monitor Cr, CBC, LFTs for prolonged treatment.
  6. AZITHROMYCIN - a macrolide antibiotic. May be used for pharyngitis, COPD, sinusitis (2nd line), pneumonia, chlamydia. May prolong QT interval, cause diarrhea.
  7. ATORVASTATIN - HMG CoA inhibitor (statin) used for lipid disorders. Avoid use during pregnancy. May cause myopathy, rhabdomyolysis, hepatotoxicity. Monitor Cr, CK, LFTs.
  8. METFORMIN - biguanide that decreases hepatic glucose production, decreases intestinal glucose absorption, and increases insulin sensitivity. Used for diabetes type 2 and polycystic ovary syndrome. Watch for lactic acidosis. Use with care in renal disease. Monitor Cr, Hct, HgbA1c, vitamin B-12.
  9. HCTZ - thiazide diuretic that inhibits distal tubule sodium and chloride resorption. Used for hypertension, edema. Watch for hyperglycemia, electrolyte disorders, hypotension. Monitor electrolytes looking for hypokalemia, hyponatremia, hypochloremia, hypomagnesemia, hypercalcemia.
  10. ALPRAZOLAM - benzodiazepine that enhances GABA effects. Used for anxiety and panic. Avoid abrupt withdrawal. Watch for CNS depression. Avoid in pregnancy. Monitor LFTs.

Friday, July 10, 2009

Pharmaceutical Sampling: the Good and the Bad

It is common for pharmaceutical companies to provide physicians with samples of their new products to give to patients. This can help patients without the means to pay for the pharmaceutical, or can be used to try out a new medication to see if the patient responds to it as expected.

The downside of pharmaceutical sampling is that only the expensive, latest pharmaceuticals are handed out as samples. This can be problematic, because once a patient is on a new medication, and they seem to be doing well, then it is unlikely that the physician or the patient will want to then switch to a different, generic pharmaceutical.

By promoting the sampling of generic medications, patients are started out on the less expensive medications. The pharmaceuticals that have been tested and proven safe over a long period of time. Patients are more likely to end up on a less expensive, generic medication. Antibiotic resistance is less likely to occur.

Join the effort to promote best practices in pharmaceutical sampling. You can blog for and also support the effort by participating in the Internet Medical Association.