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Way Too Many Doctors Are Prescribing Antibiotics In Error, Study Says

By Karen Kaplan, Los Angeles Times

About 7 in 10 patients who go to a doctor seeking treatment for acute bronchitis wind up leaving their appointment with a prescription for an antibiotic, according to a new study in the Journal of the American Medical Association. That’s a problem, the study authors say, because the ideal prescription rate should be 0 percent.

That’s right, a big fat zero. Zip. Nada. Zilch.

More than 40 years of clinical trials have demonstrated that antibiotics do not help patients with acute bronchitis. On top of that, the Centers for Disease Control and Prevention have been emphasizing this fact for the last 15 years, as has the Healthcare Effectiveness Data and Information Set for nearly 10 years, the JAMA report says.

But it doesn’t seem that the message has gotten through to doctors. Not only are physicians continuing to write prescriptions for the medications, but they also did it more frequently in 2010 than they did in 1996, the study authors found.

Researchers from Brigham and Women’s Hospital in Boston analyzed data from two national surveys that track patients who are seen in medical clinics (including pediatric practices) or in hospital emergency departments. Records between 1996 and 2010 identified 3,153 patients whose only medical complaint was acute bronchitis, a respiratory disease that makes people cough and is over in less than three weeks. (Patients who also had other problems, including chronic pulmonary disease or infectious diseases, were excluded from the analysis.)

During the entire study period, 36 percent of those patients got a prescription for an extended macrolide, a group that includes such workhorses as azithromycin and erythromycin. Another 35 percent got an Rx for a broad-spectrum antibiotic, including fluoroquinolones, aminopenicillins and cephalosporins. Altogether, the antibiotic prescription rate was 71 percent, the researchers found.

Use of the broad-spectrum drugs fell slightly during the study period, though the difference wasn’t large enough to be statistically significant, the researchers reported. However, there was a distinct rise in the use of extended macrolides, with the prescription rate increasing from 25 percent between 1996 and 1998 to 41 percent between 2008 and 2010, according to the study.

Over the 14 years of the study, 72 percent of doctors in primary care practices gave their patients some kind of antibiotic for acute bronchitis. So did 69 percent of the doctors treating patients in hospital emergency departments. Both groups of physicians seemed to lay off the drugs a little bit between 1999 and 2001, but that trend didn’t last.

The study authors sounded somewhat exasperated about the fact that a figure that should be 0 percent was actually 71 percent. “Avoidance of antibiotic overuse for acute bronchitis should be a cornerstone of quality health care,” they wrote.

The CDC and other health groups are concerned that the overuse of antibiotics is helping to fuel the rise in drug-resistant pathogens, including strains of tuberculosis, Staphylococcus aureus and E. coli. This month, one of the World Health Organization’s top officials for health security warned that “the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.”

“Effective antibiotics have been one of the pillars allowing us to live longer, live healthier and benefit from modern medicine,” said Dr. Keiji Fukuda, who led a report on the state of antimicrobial resistance around the world. “Unless we take significant actions … the implications will be devastating.”

Photo via Flickr

More U.S. Consumers Are Seeking Medical Care, Report Shows

By Chad Terhune, Los Angeles Times

A historic slowdown in U.S. health care spending in recent years may be drawing to a close.

An industry report published this week and health care experts point to a steady rise in medical care being sought by consumers seeing specialists, getting more prescriptions filled and visiting the hospital. Other factors such as millions of newly insured Americans seeking treatment for the first time and higher prices from health care consolidation could also help drive up costs.

Experts aren’t predicting an immediate return to double-digit increases in medical spending. But the emerging trend underscores how difficult it will be for policymakers, employers and health plans to control health care costs going forward.

“2013 was a rebound year for health care,” said Murray Aitken, executive director of the IMS Institute for Healthcare Informatics, an industry research firm that released Tuesday’s report. “We saw health care usage overall up for the first time in three years. We think that is reflective of a strong economy, more patients with insurance and also some pent-up demand for services that may have been delayed or deferred since the economic downturn.”

David Gruber, director of health care research at Alvarez & Marsal, said he’s expecting a similar trend of higher demand coupled with consolidation among hospitals and large physician groups pushing up prices. He said the demand for services is being driven by an influx of Obamacare enrollees, aging baby boomers and people with chronic conditions who can no longer delay care.

“At some point you can’t defer anymore,” Gruber said. Health spending “isn’t going up by double digits, but it could spike to 6 percent or 7 percent.”

There are other forces at play that could serve as an effective counterweight and bear watching. The growing use of narrow provider networks by employers and health insurance companies and a shift away from conventional fee-for-service reimbursement for medical providers can be potent cost-containment tools, Gruber said.

On Monday, the Congressional Budget Office cited the prevalence of narrow networks as one reason premiums for Obamacare coverage in government-run exchanges will be lower in the next few years than previously expected.

David Axene, a fellow at the Society of Actuaries, estimates that rates for individual consumers under the health law may rise, on average, 6 percent to 8.5 percent next year. He cautions that rates will vary across the country, and some health insurers such as industry giant WellPoint Inc. have already warned about double-digit rate hikes in some markets.

“Many exchange health plans got better discounts than anticipated from providers, but there is really a strong pushback now from hospitals and physicians who are concerned about having enough money to cover their costs,” said Axene, an actuary in Murrieta, Calif. “I hope we can stay south of double digits, but there’s no guarantee we will.”

From 2009 to 2012, U.S. health care spending grew annually at less than 4 percent, according to federal data. That’s been the lowest rate of growth in half a century, and has sparked considerable debate about the underlying reasons.

Many health economists and industry officials have attributed the slowdown primarily to lingering effects of the Great Recession, when millions of Americans cut back on medical care. But the Obama administration and other experts have pointed to fundamental changes in health care reimbursement and the delivery of care spurred by the Affordable Care Act.

The IMS Health report found that total U.S. spending on pharmaceutical drugs grew 3.2 percent last year to $329.2 billion. That came after a 1 percent drop in 2012 — the first decline since IMS began tracking the data in 1957.

Patent protections expiring on major drugs and cheaper generic substitutes flooding the market helped drive that previous decrease. Aitken said patent expirations had less impact last year and there was greater use of health care in general.

IMS Health also found that the number of physician office visits, hospitalizations and prescriptions filled all rose last year.

At the doctor’s office, visits to primary care physicians fell less than 1 percent, but trips to specialists jumped 5 percent. The number of hospital visits also grew last year, primarily among commercially insured patients who received outpatient treatment.

Any upswing in medical costs could further squeeze workers. Their health insurance premiums keep taking a bigger bite of their paychecks, as employers shift more health care costs to employees.

There was some good news for consumers. The IMS report found that 57 percent of all retail prescriptions filled last year cost consumers $5 or less. But patients often bear a growing share of the cost for high-priced specialty medications for cancer, rheumatoid arthritis and other chronic conditions.

Will O’Neill via Flickr