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Your treatment choices can help contain drug costs
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If your community is anything like ours, health care costs are again in the news. It appears as though health insurance premiums are heading for another double-digit jump in 2001. As politicians, employers and insurers search for answers, drug costs continue to come under scrutiny.
Indeed, the pharmaceutical industry has been blamed for much of our escalating health care costs in recent years. It seems as though nobody wants to acknowledge the millions of dollars spent in research, development, clinical trials and liability premiums associated with bringing a new drug to the market. Instead, critics like to focus on consumer drug costs and pharmaceutical profits. Apparently, it’s OK for computer, telecommunications and even health insurance companies to post healthy profits. Just not drug makers. Sometimes it just doesn’t seem fair.
Of course, as health care providers, we’re right in the thick of things. Primary care physicians are being “encouraged” to avoid antibiotics as a first-line treatment for sinusitis. Pediatricians are facing the same mandate with respect to otitis media with effusion. As eye care providers, we face these pressures as insurance formularies impose limits on drug choices while endorsing generics.
It’s certainly not an easy position to be in. On one hand, we want to do our share in containing health care costs by not over-prescribing. On the other hand, ocular infections can be devastating. In certain cases the potential for corneal scarring with vision loss warrants prompt and aggressive treatment. Additionally, contemporary ophthalmic surgery’s exceptional safety record is due — in part — to antibiotic prophylaxis. In these scenarios, limiting antibiotic use is in nobody’s best interest. So, how do we balance what is best for our patients while practicing fiscally sound medicine?
Take fundamental steps
While the perfect solution has eluded clinicians and health care planners around the world for years, there are a few fundamental things we can – and should – do. First, and foremost, we must understand the condition we are treating. While differential diagnoses can be daunting at times, they are essential. For instance, topical antibiotic eye drops do very little to expedite the treatment of adenoviral keratoconjunctivitis. For these folks, education and palliative therapy makes more sense clinically and fiscally.
Next, we must prioritize our treatment options. While we all worry about fluoroquinolone utilization, the reality is that fluoroquinolones are the most appropriate drugs for the majority of what we’re treating. Prioritizing fluoroquinolones as a first-line therapy can avoid the embarrassment (and cost) of a patient returning to the office unresponsive to a course of a lesser drug.
Finally, we must prescribe with authority. Whether we’re using antibiotics for perioperative prophylaxis or for treating a bacterial corneal ulcer, we should prescribe aggressively and succinctly. Using the maximum dosing strategy for the appropriate interval is more clinically appropriate and cost effective than “dabbling” with a suboptimal dose over a prolonged period of time.