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Prescription drug pricing vs. value, substance abuse treatment gains, and the arc of health literacy

August 13, 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.

Join the conversation: Post your comments in our section at the bottom of this page.

 

Features:

 

The high cost of prescription drugs continues to dominate American health news. But often their price does not correlate with their efficacy, says Vikas Saini, MD, president of the Lown Institute, who this week appeared on New England Cable Network’s Broadside program. Last week, on OnPoint, Leonard Saltz, MD, debated outrageous cancer drug costs with a representative from a pharmaceutical trade group, who defended them. Prescription drugs and other medical costs are bankrupting patients like Holly Davis, who writes in KevinMD  “…I am running through my savings paying for my health, instead of my retirement. I’m trying to find some balance between spending to enjoy what time I have left and scrimping, just in case I get to stay awhile.” Meanwhile, physicians from the giant CVS Health, in a JAMA piece, raise questions regarding the use of less expensive cholesterol-lowering statins versus costly PCSK9 inhibitors, which are coming to market.

 

While opioid use and overdose in the United States have been on a startling upward trend over the past decade, policy and treatment options have been slow to keep up. Now progress looms. Recently in Massachusetts, as reported in the Boston Globe, Governor Charlie Baker has vowed to combat this epidemic by treating addiction as a disease rather than a crime. Current state policy dictates that individuals struggling with substance abuse can be involuntarily committed for treatment. Unfortunately when committed, many end up in medium-security prisons (without any conviction) due to lack of treatment beds. In addition to expanding availability of treatment, harm reduction centers are a promising tool in the fight against substance abuse and its sequelae. A recent report shows they can also be highly effective in helping hospitals provide care to vulnerable patients and ultimately reduce hospital readmissions. As reported in Kaiser Health News, harm reduction enters like BOOM!Health in New York City, through their experience caring for sex workers and drug users, are uniquely positioned to deliver integrated care.

 

Howard K, Koh, MD, MPH, and Rima E. Rudd, ScD, MSPH, of the Harvard T.H. Chan School of Public Health, in JAMA last week, wrote about the challenge of addressing health literacy at the many levels of the healthcare system. A small minority (about 12%) of U.S. adults possesses a proficient level of health literacy. Low health literacy has been linked to negative health outcomes and early mortality. Why are so many Americans so health illiterate? Partly because a wide gulf remains between common medical jargon many clinicians use to speak to their patients and the patient’s ability to comprehend. This has long been recognized by researchers, patients, and clinicians involved in the shared decision making movement. (See for example work by the Informed Medical Decisions Foundation, the Mayo Clinic, and Ottawa Hospital.) Strategies to bridge this gap often target the individual, often placing the onus of responsibility on someone who may already be burdened by disease or other factors. The authors discuss strategies that may be used by clinicians, institutions, and systems to create more of a shared responsibility. For example, instead of saying to a patient, “Do you understand?” clinicians might say, “Help me see if I left anything out.” Institutions could devote resources to rigorous research in developing critical texts—and in doing so, potentially improve patient safety. And systems (e.g. ACOs) can leverage health literacy strategies to improve quality and satisfaction. In a related article, The New York Times Haider Javed Warraich, MD, calls attention to the importance of language and communication in the context of caring for patients at the end of life. There are many ways to bridge the divide between what doctors and nurses say and what patients hear, and doing so has many benefits. The only question left is what will get medical schools and hospitals to make it so?

 

Announcements:

 

  • The 10th Annual Mid-Atlantic Hospital Medicine Symposium, Mastering the Care of the Hospitalized Patient, presented by the Icahn School of Medicine at Mount Sinai, will be held on Friday and Saturday, October 23, 24. Keynote speaker is Vikas Saini, MD, president of the Lown Institute. Harry Cho, MD, a Lown Young Innovator grantee, will also participate at one of the workshops. For details and to register, click here.

 

  • Do you want an idea for RightCare Action Week? Here’s one posted by a medical student on the Action Forum on RightCareActionWeek.org:  Take very detailed social histories, strip them of patient identifiers, and post them to highlight the importance of social determinants of health. Want to learn more? Have your own idea for RCAW? Get involved on the Forum today.

 

 

Headlines:

 

Overuse

 

Practice

 

FDA

 

Treatment guidelines

 

Tech/innovation

 

Social determinants

 

Communication

 

Cost of care

 

Conflict of interest/transparency

 

Safety

 

Patient experience

 

Alternative medicine 

 

Practice models

 

Health insurance

 

Public health

 

Patient engagement

 

Med ed

 

Cost effectiveness

 

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