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Put patient safety, comfort first when choosing therapeutics
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 Michael D. DePaolis |
It is no secret. For health care reform to succeed, it will require a concerted effort on everyone’s behalf – insurers, employers, patients and health care providers alike. As providers, this means we must help contain health care costs. It is a logical assumption, as we play a pivotal role in regulating health care consumption and cost.
For instance, spending an extra minute or two educating a patient on their diet, lifestyle, need for protective eye wear or other preventive strategies potentially improves health and indirectly lessens health care consumption. By managing acute conditions more efficiently and reducing the number of monitoring visits for certain chronic diseases, we further reduce expenditures. In addition, maybe the solution lies in opting for older, less expensive prescription drugs. However, is this strategy really in the patient’s best interest?
For instance, consider bacterial conjunctivitis. It is pretty safe to say that most cases are self limiting. They are clinical presentations that usually improve on their own in time. However, to someone suffering from bacterial conjunctivitis, it is anything but self-limiting. It causes discomfort and blurred vision, is contagious, requires time away from work or school and is an inconvenience – especially when using a drop requiring frequent dosing over an extended period of time. So, how should we manage bacterial conjunctivitis? Should we do so with an eye on saving health care dollars, or should we treat in the spirit of curing our patient as quickly as possible?
If your goal is cost containment, the best strategy is palliative care. Reassure patients and prescribe warm compresses and over-the-counter artificial tears. While this can be a viable option, it certainly does not resonate well with patients.
Given that we are inclined to proactively treat bacterial conjunctivitis, which approach should we take? Do we treat with older, generic antibiotics or newer, more effective brand agents? In short, do we write a prescription for a drug that costs less, but might not work optimally or for a more expensive drug with a broader spectrum of activity requiring fewer doses over a shorter period of time?
In this month’s “At Issue,” we posed this question to a well respected group of colleagues. While all indicated there are extenuating circumstances in which they will prescribe a less expensive (and potentially less effective) drug, there was an overwhelming consensus, with the message that patient safety and comfort always comes first. In short, prescribe the best antibiotic for the task at hand. It might cost a bit more, but it is a short-term expense and one easily justified for our patients’ peace of mind.