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Persistent antibiotic overprescribing, piloting a new model for end-of-life care, and proposals for fairness in drug pricing

July 30, 2015

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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Features:

 

A study published by the Centers for Disease Control and Prevention this month explores both consumer and provider attitudes toward antibiotic use and reports concerning findings. Some 54 percent of provider respondents perceived that their patients expect to be treated with an antibiotic when they present for a viral illness. 26 percent of all consumer respondents expect antibiotic treatment for a cough or cold. Given that a number of studies (also here and here) have found that provider perception of patient preferences vis-à-vis antibiotics predicts overprescribing, this new evidence that half of providers may be inclined to overprescribe points to the importance of culture change in physician training. According to writer Laura Colarusso, in The Boston Globe, “there is no specific, nationwide curriculum today that is required to teach safe and appropriate antibiotic use.” Colarusso discusses potential solutions to overprescribing apart from additional or more specialized instruction, for example, the implementation of “antimicrobial stewardship teams,” or top-down policy changes. This is not a newly recognized problem; its persistence is one more symptom that we need deep changes in education and the care delivery system.

 

At the end of life, many Medicare patients face continuing medical treatments or replacing them with hospice care. Now a new government policy may eliminate the necessity of choosing one or the other, as reported in The New York Times and The Wall Street Journal.  Soon patients can have both, if they choose. The pilot program, based on research showing patients who have access to both end up with a better quality of life and less intensive treatments, will affect the care of 150,000 patients over the next four years and involves more than 140 hospices. Some treatments, like those for cancer, change frequently and are confusing to patients, according to Jennifer Temel, MD, from Massachusetts General Hospital, an author of a randomized study of patients with lung cancer. “It’s harder for patients to decide that ‘I don’t want more chemotherapy.’ I think we need more of a gray zone where patients can get the benefits of hospice care but still receive chemotherapy to help them live longer,” she said. If the pilot is successful, the services may be extended to the entire Medicare population. Currently there is low utilization of hospice participation at the end of life; less than 45 percent of Medicare beneficiaries receive it. Health and Human Services representatives estimate the policy change might reduce overall costs or be cost neutral.

 

Every new cancer drug approved by the FDA last year cost more than $120,000 for a year’s treatment. Costs have always been a huge concern for patients undergoing treatment, but last week 100 oncologists, in Mayo Clinic Proceedings, blasted pharma and proposed policies that would require the FDA, in their reviews of new drugs, to include a mechanism for determining a fair price. “This raises the question of whether current pricing of cancer drugs is based on reasonable expectation of return on investment or whether it is based on what prices the market can bear,” the doctors wrote. Among the doctors’ other proposals are allowing Medicare to negotiate drug prices and permitting importation of cancer drugs from Canada, where costs are half of those in the U.S. According to a piece in The New York Times, some states are introducing pharmaceutical cost transparency bills in their legislatures, trying to force companies to explain their pricing. John Rother, a chief executive of the National Coalition on Health Care, hopes to introduce transparency legislation in Congress. “The industry has used R&D costs for the justification, but anyone who is reasonably sophisticated understands those are sunk costs and have little to do with pricing. The more important question is any calculation of value,” he said.

 

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More on antibiotic overprescribing

 

Overuse

 

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Evidence-based medicine

 

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COI

 

Pharma

 

End-of-life care

 

Public health

 

Social determinants

 

Compensation

 

Med ed

 

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RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.

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