Study: Antimicrobial Prescribing Practices During The 2009 Pandemic

Photo Credit – CDC

 

# 6479

 

One of the most common dilemmas that doctors face is whether or not to prescribe an antibiotic for a patient presenting with an FRI (Febrile Respiratory Illness) often defined as a fever > 38C accompanied by a cough, sore throat, or runny nose.

 

While these illnesses are often caused by a simple viral infection, there is always the possibility that the patient may have (or may subsequently develop) a bacterial infection.

 

Since there is little in a patients physical appearance that can help distinguish between a viral and a bacterial respiratory infection, many doctors will decide to err on the side of caution and prescribe an antibiotic, “just in case”.

 

The problem is that the over-prescribing of antibiotics is viewed as one of the main forces driving the continual growth of antibiotic resistance.  

 

Guidelines (created by the CDC in cooperation with other medical organizations) have been developed to assist the doctor in the prescribing of antibiotics for upper respiratory infections (Adult Treatment Guidelines, Pediatric Treatment Guidelines).

 

The CDC has also prepared patient education information on when antibiotics are appropriate (see the CDC’s GET SMART ABOUT ANTIBIOTICS website).

 

 

But in the end, it often comes down to the primary care provider’s gut feeling whether or not to prescribe an antibiotic. According to a study that appeared yesterday in the Annals of Internal Medicine, Epidemiological Context – not just patient appearance - can be one of the factors that influences this decision.

 

The study is called:

 

The Influence of Context on Antimicrobial Prescribing for Febrile Respiratory Illness: A Cohort Study

Courtney Hebert, MD; Jennifer Beaumont, MS; Gene Schwartz, MD; and Ari Robicsek, MD

 

The authors undertook a 5.5 year retrospective cohort study on the prescribing of antibiotics to patients seen by a network of Midwest primary care providers during influenza seasons between 2006 and 2011.

 

Their results, compiled from 28,301 patient encounters with signs of an FRI – seen by 69 physicians across 26 practices - is illuminating.

 

• They found that during the pandemic flu season (April to June 2009 - Sept 2009 to March 2010) antibiotic prescribing dropped significantly over that seen during non-pandemic flu seasons (39.2% versus 47.5%)
• Furthermore, they found the odds that a doctor would prescribe an antibiotic decreased as the number of FRI cases that they had seen in the previous week increased.

 

In other words, the more viral illness that a doctor perceives to be circulating in their community, the less likely that doctor is to prescribe an antibiotic.

 

Perhaps more surprising was the range of antibiotic script writing by doctors across this limited geographic region.

 

Overall, antibiotics were prescribed in just under half (45.2%) of all FRI cases, but among individual clinicians that number ranged from a low of 17.9% to a high of 83.7%.

 

While there may be other factors not readily apparent from these numbers, there does appear to be a surprising diversity of opinion among clinicians over the appropriateness of prescribing of antibiotics for FRIs.

 

Although limited in both size and scope, this study suggests that finding ways to keep doctors better informed on what illnesses are currently circulating in their community might help moderate the unnecessary prescribing of antibiotics.

 

You’ll also find an accompanying editorial in the same issue of Annals Of Internal Medicine, that stresses it is important to not only determine which external factors affect clinician’s decisions, “but how and why”.

 

The Context of Antibiotic Overuse

Sara Ackerman, PhD, MPH; and Ralph Gonzales, MD, MSPH

 

 

For more on the importance of proper antibiotic usage, you may wish to revisit these earlier blogs.

 

Chan: World Faces A `Post-Antibiotic Era’

Get Smart About Antibiotics Week

IDSA: Educational Guidelines Lower Antibiotic Use

 

 

And for a far more complete (and eye-opening) discussion of antimicrobial resistance issues, I can think of no better primer than Maryn McKenna’s book SUPERBUG: The Fatal Menace of MRSA.

 

And Maryn’s SUPERBUG Blog, part of Wired Science Blogs, continues to provide the best day-to-day coverage of these issues.

»» Read More

A Prescription For Any Disaster

Photo Credit – Wikipedia Commons

# 6323

 

With Hurricane season a little over two weeks away the time has come for those of us who live anywhere within the reach of these storms (and that can be hundreds of miles in from the coast) to begin our yearly storm preparations.

 

This year National Hurricane Preparedness Week  runs from May 27th through June 2nd, and I’ll have a good deal of coverage at that time. But today a preparedness step that could be life saving in any disaster situation.

 

As our population ages, more and more of us are dependent upon daily prescription medications. Blood pressure pills, cardiac drugs, and meds for a host of other conditions are taken by tens of millions of Americans every day.

 

As many people discovered after Hurricane Katrina devastated New Orleans in 2005, getting refills when you’ve had to evacuate, or your pharmacy is flooded, can be nearly impossible. 

 

Which makes maintaining an adequate supply of essential prescription medication in your emergency kit, along with copies of your prescriptions, a particularly important part of many individual’s and family’s preparedness plan.

 

Most doctors will gladly write an extra 14 or 30 day `disaster stash’ script for your most vital medications if you express your concern, and the AMA endorsed this idea several years ago (see AMA Now Supports Personal Rx Stockpiling For Disasters).

 

Depending upon your insurance coverage, you may have to pay for them out of pocket, but it certainly beats the alternative.

 

And if you do obtain a disaster stash, make sure to use and rotate those meds before they expire.

 

FEMA has long recommended that those with special needs make special preparations.

 

Considerations for people responsible for disabled individuals:

• For those on respirators or other electric-powered medical equipment, make prior arrangements with your physician or check with your oxygen supplier about emergency plans, and be sure to have electrical back-up for any medical equipment.
• Maintain a two-week supply of items such as dressings, nasal cannulas and suction catheters.
• Maintain a two-week supply of both prescription and non-prescription medications.
• Keep copies of your medical records.
• Keep copies of prescriptions for medical equipment, supplies and medications.
• Keep extra contact lenses and supplies, extra eyeglasses and extra batteries for hearing aids.
• Make plans now to have accessible transportation in case of evacuation.
• Shelters may be limited in accommodations to meet some of the needs of those with disabilities. Prepare ahead of time to ensure you will have what you need.

 

There are federal  programs designed to assist those in a federally declared disaster zone with their emergency prescription needs.  It is called EPAP or Emergency Prescription Assistance Program.

The goals of EPAP are to:

• Ensure access to covered prescription drugs and DME for eligible individuals who present at a pharmacy with a valid prescription, at no cost to the affected individual.
• Implement real-time point-of-sale eligibility checks and system edits for claims where the pharmacist has found no other coverage to limit dispensing of EPAP covered drugs and DME to eligible individuals.
• Facilitate legitimate pharmacy claims from new pharmacy locations and other out of network pharmacies on an as-needed basis.

 

But of course, you’ll need to be able to prove you are eligible and that you have a valid prescription (see Eligibility Information Sheet For Emergency Prescription Assistance Program (EPAP)).

 

And depending upon the size and scope of the disaster, there could be delays in getting your prescriptions processed. 

 

So having an extra supply on hand is still important.

 

As is knowing what to do if your prescriptions are damaged in a disaster.   Here, the FDA offers some advice.

 

Safe Drug Use After a Natural Disaster

The Center for Drug Evaluation and Research (CDER) at the FDA offers the following information on the use of drugs that have been potentially affected by fire, flooding or unsafe water and the use of temperature-sensitive drug products when refrigeration is temporarily unavailable.

(Continue . . . )

 

 

And on a related subject, everyone should have a readily available (preferably carried in your wallet or purse), EMERGENCY medical history.

 

I addressed that issue in a blog called Those Who Forget Their History . . . .   A few excerpts (but follow the link to read the whole thing):

 

Since you can’t always know, in advance, when you might need medical care it is important to carry with you some kind of medical history at all times.  It can tell doctors important information about your history, medications, and allergies when you can’t.

 

Many hospitals and pharmacies provide – either free, or for a very nominal sum – folding wallet medical history forms with a plastic sleeve to protect them.

 

I’ve scanned the one offered by one of our local hospitals below. It is rudimentary, but covers the basics.

In a medical emergency, minutes can make the difference between life and death.  And even in less urgent cases, having all of this information can go a long ways towards speeding your treatment.

 

 

While disasters like hurricanes, floods, and earthquakes are never pleasant experiences, the things we do in advance can make the difference between being inconvenienced and uncomfortable, and being irreparably harmed.

 

Those with special medical needs are all the more vulnerable during a disaster, and so extra preparations are warranted.

»» Read More

Turn In Your Old Rx Drugs Today

 

 

# 6301

 

Millions of medicine cabinets around the country are filled with unused, expired, and potentially dangerous prescription drugs that – for a variety of reasons – never get taken by the person for whom they were intended.

 

Often a doctor changes a prescription, or a patient doesn’t finish their meds.  Sometimes a patient dies with a medicine cabinet full of pills.

 

Whatever the reason, these drugs pose a serious threat, both to people, and to the environment. 

 

 

Too often, they end up flushed down the drain, or tossed into the trash, only to end up in rivers and streams. Or worse, they can end up in the hands of the wrong persons, and are used recreationally – particularly by teenagers.

 

For many, the dilemma is how to properly dispose of these pills. To this end, the National Take Back Initiative was created by the DEA, in conjunction local law enforcement agencies, to provide a safe – no question’s asked - place to take these drugs.

 

Today (April 28th), there will be thousands of drop-off points set up around the country where you can take these drugs.

 

 

You’ll find handy links for a search engine that will provide you with local drop off locations around the country.

 

NATIONAL TAKE-BACK INITIATIVE

April 28, 2012
10:00 AM - 2:00 PM

The Drug Enforcement Administration (DEA) has scheduled another National Prescription Drug Take-Back Day which will take place on Saturday, April 28, 2012, from 10:00 a.m. to 2:00 p.m.  This is a great opportunity for those who missed the previous events, or who have subsequently accumulated unwanted, unused prescription drugs, to safely dispose of those medications.

Americans that participated in the DEA’s third National Prescription Drug Take-Back Day on October 29, 2011, turned in more than 377,086 pounds (188.5 tons) of unwanted or expired medications for safe and proper disposal at the 5,327 take-back sites that were available in all 50 states and U.S. territories. When the results of the three prior Take-Back Days are combined, the DEA, and its state, local, and tribal law-enforcement and community partners have removed 995,185 pounds (498.5 tons) of medication from circulation in the past 13 months.

“The amount of prescription drugs turned in by the American public during the past three Take-Back Day events speaks volumes about the need to develop a convenient way to rid homes of unwanted or expired prescription drugs,” said DEA Administrator Michele M. Leonhart. “DEA remains hard at work to establish just such a drug disposal process, and will continue to offer take-back opportunities until the proper regulations are in place.”

“With the continued support and hard work of our more than 3,945 state, local, and tribal law enforcement and community partners, these three events have dramatically reduced the risk of prescription drug diversion and abuse, and increased awareness of this critical public health issue,” said Leonhart.

Collection Site Locator:

Find a collection site near you. Check back frequently as collection sites are continuously being added.

»» Read More

A Prescription For Disasters

 

 

 

# 5787

 

 

Photo Credit – Wikipedia Commons

 

I’ve written before of my visit to New Orleans five weeks after Katrina struck to help my twin brother retrieve what belongings we could from his French Quarter apartment.  

 

While we were in town one of his planned tasks was to get refills on his prescriptions from his local pharmacy.  But 5 weeks after the storm, his Mom & Pop pharmacy was still shuttered and vacant.

 

Like thousands of others post-Katrina, he was in a bind.

 

He had no way of contacting his doctor, no way to prove he had refills left at his pharmacy, and would be forced to find a new doctor and schedule an appointment in order to get new prescriptions.

 

For my brother, it wasn’t a life or death situation.  But for many others, daily medications are literally a matter of survival. 

 

Maintaining an adequate supply of essential prescription medication in your emergency kit, along with copies of your prescriptions, is an important part of individual and family preparedness.

 

Most doctors will gladly write an extra 14 or 30 day `disaster stash’ script for your most vital medications if you express your concern, and the AMA endorsed this idea several years ago (see AMA Now Supports Personal Rx Stockpiling For Disasters).

 

Depending upon your insurance coverage, you may have to pay for them out of pocket, but it certainly beats the alternative.

 

And if you do obtain a disaster stash, make sure to use and rotate those meds before they expire.

 

FEMA has long recommended that those with special needs make special preparations.

 

Considerations for people responsible for disabled individuals:

• For those on respirators or other electric-powered medical equipment, make prior arrangements with your physician or check with your oxygen supplier about emergency plans, and be sure to have electrical back-up for any medical equipment.
• Maintain a two-week supply of items such as dressings, nasal cannulas and suction catheters.
• Maintain a two-week supply of both prescription and non-prescription medications.
• Keep copies of your medical records.
• Keep copies of prescriptions for medical equipment, supplies and medications.
• Keep extra contact lenses and supplies, extra eyeglasses and extra batteries for hearing aids.
• Make plans now to have accessible transportation in case of evacuation.
• Shelters may be limited in accommodations to meet some of the needs of those with disabilities. Prepare ahead of time to ensure you will have what you need.

 

There are federal  programs designed to assist those in a federally declared disaster zone with their emergency prescription needs.  It is called EPAP or Emergency Prescription Assistance Program.

The goals of EPAP are to:

• Ensure access to covered prescription drugs and DME for eligible individuals who present at a pharmacy with a valid prescription, at no cost to the affected individual.
• Implement real-time point-of-sale eligibility checks and system edits for claims where the pharmacist has found no other coverage to limit dispensing of EPAP covered drugs and DME to eligible individuals.
• Facilitate legitimate pharmacy claims from new pharmacy locations and other out of network pharmacies on an as-needed basis.

 

But of course, you’ll need to be able to prove you are eligible and that you have a valid prescription (see Eligibility Information Sheet For Emergency Prescription Assistance Program (EPAP)).

 

And depending upon the size and scope of the disaster, there could be delays in getting your prescriptions processed. 

 

So having an extra supply on hand is still important.

 

As is knowing what to do if your prescriptions are damaged in a disaster.   Here, the FDA offers some advice.

 

Safe Drug Use After a Natural Disaster

The Center for Drug Evaluation and Research (CDER) at the FDA offers the following information on the use of drugs that have been potentially affected by fire, flooding or unsafe water and the use of temperature-sensitive drug products when refrigeration is temporarily unavailable.

(Continue . . . )

 

 

And on a related subject, everyone should have a readily available (preferably carried in your wallet or purse), EMERGENCY medical history.

 

I addressed that issue in a blog called Those Who Forget Their History . . . .   A few excerpts (but follow the link to read the whole thing):

 

Since you can’t always know, in advance, when you might need medical care it is important to carry with you some kind of medical history at all times.  It can tell doctors important information about your history, medications, and allergies when you can’t.

 

Many hospitals and pharmacies provide – either free, or for a very nominal sum – folding wallet medical history forms with a plastic sleeve to protect them.

 

I’ve scanned the one offered by one of our local hospitals below. It is rudimentary, but covers the basics.

In a medical emergency, minutes can make the difference between life and death.  And even in less urgent cases, having all of this information can go a long ways towards speeding your treatment.

 

 

While disasters like hurricanes, floods, and earthquakes are never pleasant experiences, the things we do in advance of them can make the difference between being inconvenienced and uncomfortable, and being irreparably harmed.

 

Those with special medical needs are all the more vulnerable during a disaster, and so extra preparations are warranted.

»» Read More