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Monday, September 24, 2007

More on the Polypharmacy Conundrum

Chapter 8

While we are on the topic of polypharmacy, let’s visit the question of how we got into this situation (mess). The fact that all of these elements we have been discussing have become part of our “system” of how we, the people provide for our elderly citizens is really quite disturbing! Polypharmacy is only one of these very disturbing factors.

Most nursing home administrators “contract” for certain services at their facility. Common things that are “contracted out” include pharmacy services, therapy services, and billing services. There may be other less common services contracted out – but the ones just mentioned are the ones that can make the most difference to patients in nursing homes.

Busy nursing home administrators fall into the trap of thinking that once these services are “contracted out” that the administrator’s problems are over. The administrator no longer focuses on the contracted services, instead thinking that now the problems belong to someone else. In that process, a loophole is created and accountability is lost. In the case of polypharmacy, the pharmaceutical company who has been contracted gains too much power over how much medication is administered via “recommendations” to the nursing staff and physicians.

The administrator certainly has a choice over which subcontractor they will use and that should establish a foundation for accountability, however, the administrator has so many problems on his/her plate, some of which we have already discussed, that they are simply grateful for the help. So because they are desperate for help, and the pharmaceutical company is more than happy to “take over” this responsibility, a system is established that does not benefit patients and costs we, the people billions.

The resulting conundrum, the use of medications is largely in the hands of the people who make money when patients take medications, is very low on the priority list of problems to be solved because on the face of it – the collective administrators believe it is solved.

Busy physicians who have to order the medications often respond to nurses or pharmacists phoned requests or recommendations that the patient “needs something” without examining the patient. The pharmacist or the pharmaceutical company who is contracted to provide these services makes money for every pill, injection, IV or topical medication that the patient receives. We, the people should not object to this if the medications are indeed benefiting the individual they are given to. Hopefully, we, the people will object strongly that often the benefit is for the staff rather than the patient.

There are estimates published by AARP on their website that indicate that 50% of the medications given to our elderly citizens in nursing homes may be unnecessary. That is huge! Not only subjecting a person to the risks and potential side effects of these medications, but also the cost to we, the people for providing them.

The average number of medications each nursing home patient is given in a day is 12 to 15. There are 16,000 nursing homes nationwide and on average each nursing home has 123 beds equaling 1.9 million nursing home beds. These beds are, on average, 85% occupied meaning that there are 1.6 million nursing home patients on any given day. On an average day, 25 million medications are given nationwide at a cost to we, the people of $300 million each day for an astonishing $109 billion each year. And half of that may be unnecessary!

Should we, the people balk at that? Not if the medication is required for the patient’s benefit. However, when the medication is given to the patient for the convenience of the staff; or, to overcome the staff’s feeling of helplessness. we, the people should protest. We, the people should ask for greater accountability. We, the people should insist that our legislators fix these systemic problems.

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