Health News Updates - Information from the World Chiropractic Alliance and The Chiropractic Journal

Thousands of patients prescribed high-risk drugs

July 20, 2011 TerryARondberg No comments

According to research published at BMJ.com, GPs prescribed high-risk medications for thousands of patients in Scotland who are especially vulnerable to adverse drug events (ADEs), exposing them to potential harm.

A number of medications or scenarios previously flagged as high risk included non-steroidal anti-inflammatory drugs for certain patients, prescribing a new drug to a patient on the blood-thinning medication warfarin, prescribing drugs when patients have heart failure, and prescribing antipsychotic drugs for patients with dementia.

Prof. Bruce Guthrie from Dundee University and colleagues expanded this list, developing 15 indicators to examine how often patients susceptible to ADEs were prescribed high-risk, potentially harmful drugs.

They used the indicators to review data from 315 Scottish General Practices with 1.76 million patients, of which 139,404 (7.9%) were identified as being particularly vulnerable to ADEs.

The results showed that 19,308 (13.9%) who were in the vulnerable group were prescribed one or more high-risk medications.

Some prescribing will be appropriate, as prescribers and patients balance risks and benefits when there may be no clearly “correct” course of action, but the study also uncovered significant variation in the prescribing practices between the GPs’ surgeries surveyed. Since the variation couldn’t be explained by the patient case mix, the researchers say it suggests there’s considerable scope to improve those prescribing practices.

Led by Prof. Guthrie, the authors point out how prior studies showed GP prescribing can cause considerable harm, and they highlight that “adverse drug events (ADEs) account for 6.5% of all hospital admissions, over half of which are judged to be preventable.”

Patients might be vulnerable to high-risk drugs due to their age, other existing illnesses, or because of other prescription medications they may be on. The authors caution that GPs need to be alert to these risk factors, and be careful about the drugs they prescribe to these patients.

SOURCE: “High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice” BMJ, June 22, 2011 ABSTRACT

Fewer drug prescriptions would save lives and money

July 14, 2011 TerryARondberg No comments

Lives and money would be saved if a more cautious approach were taken by medical professionals who prescribe drugs, according to a new study from the University of Illinois at Chicago College of Pharmacy.

The study appears in the online edition of the Archives of Internal Medicine as part of the journal’s “Less is More” series.

According to Bruce Lambert, co-author of the paper and UIC professor of pharmacy administration, several studies over the past decade have concluded that the use of many new and frequently prescribed medications was either harmful or not beneficial to patients.

Using the prior research as a guide, 24 principles were developed that can help prescribers avoid excessive and harmful prescribing, said Lambert, director of UIC’s Center for Education and Research on Therapeutics.

“None of these principles are particularly novel, nor should they be terribly controversial,” he pointed out. “But taken together they represent a radical shift in the way clinicians think about and prescribe drugs.”

The radical shift is known as “conservative prescribing,” and if adopted by every prescriber, could save many lives and dollars, Lambert said.

Physicians need to move away from the mindset that leads them to heavily prescribe the “latest and greatest” new drugs, to “fewer and more time tested is best,” stated Dr. Gordon Schiff, associate professor of medicine at Harvard University, who co-authored the report. Medical and pharmacy schools should not solely teach the pharmacology of drugs, but principles that would make practitioners better and more cautious prescribers and users of drugs, he said.

Some principles of conservative prescribing:

Think beyond drugs. Consider non-drug therapies such as diet, exercise or physical therapy; look for and treat underlying causes rather than just mask symptoms with drugs; emphasize prevention rather than treatment.

Practice strategic prescribing. Defer drug treatment if drugs can be safely started after a trial of non-drug therapy. Avoid frequent drug switching; be circumspect about unproven drug uses; start treatment with only one new drug at a time.

Watch for adverse effects. Suspect drug reactions when patients report problems; be aware of withdrawal syndromes; educate patients about side effects so they can anticipate and report reactions.

Exercise caution regarding new drugs: Seek out unbiased information sources; wait until drugs have proven safe on the market; be skeptical of markers such as improved laboratory test values rather than true clinical benefits; avoid stretching to include patients or diseases different from those in the clinical trials; avoid seduction by molecular studies that have no proven outcome benefits; beware of reporting that highlights positive trials and hides those that fail to show benefit.

Work with patients for a shared agenda. Don’t automatically yield to patient requests for drugs; consider non-adherence before adding additional drugs; avoid restarting previously unsuccessful treatments; discontinue any medications that are not needed or not working; and respect patients’ own reservations about drugs.

Consider long-term, broader impacts. Weigh short-term benefits against long-term outcomes and ecologic impacts. Recognize that improved prescribing and better monitoring may outweigh marginal benefits of new drugs.

The UIC Center for Education and Research on Therapeutics is one of 14 such centers in the United States to study how consumers and clinicians make critical treatment decisions about therapeutic products and interventions. The program is funded by the Agency for Healthcare Research and Quality (AHRQ), part of the US Health and Human Services department.

Other co-authors on the study were Dr. William Galanter, associate professor of clinical medicine; Amy Lodolce, clinical pharmacist, pharmacy practice; and Michael Koronkowski, clinical assistant professor, pharmacy practice, all of UIC.

SOURCE: “Principles of Conservative Prescribing” by Gordon D. Schiff, MD, et.al. Archives of Internal Medicine. Published online June 13, 2011. ABSTRACT

Rare accident reminds DCs of the need for safety precautions

July 6, 2011 TerryARondberg No comments

Having a supervised play area for children can prevent accidents

It was one of the rarest accidents ever recorded in a chiropractic practice and one of the saddest as well. An 18-month-old boy apparently crawled under an electric powered therapy table at a chiropractic office in Shoreview, Minn., last month.

Investigators guess that he somehow hit a button on the foot pedal, which lowered the 315-pound table onto him. His mother was strapped onto the table at the time and didn’t see him until the table descended.

Despite frantic attempts by the staff members of the office to raise the table off the boy, the mechanism wouldn’t work. They even tried lifting it off him by hand, but to no avail.

Finally, after several failed attempts, the motor engaged and the table lifted. But it was too late – the child died of traumatic head injuries shortly after arriving at the local hospital.

The table was a Triton DTS TRT-600 traction system with no known reported problems prior to this accident.

The table’s user guide warns that the system “should be kept out of the reach of children” and states that doctors should “not allow any unsupervised patient access to the traction table.” A danger section also warns to “not allow any person, object or device to be under the table while the table is in operation.”

The case is a tragic reminder that dangers exist whenever there are heavy, powerful pieces of equipment like this. We must be constantly vigilant, especially where children are involved. When parents are undergoing treatment, they cannot properly supervise their children, so that task falls to the office staff.

Having a separate “kid’s play area” – with proper supervision under the watchful eye of a staff member – is one way to ensure no child is put at risk in your office.

The child’s family has set up a memorial fund at www.newtonfamilyfund.com for anyone who wishes to make a donation.

1 in 5 young adults may have high blood pressure

June 29, 2011 TerryARondberg No comments

Young adulthood is supposed to be a generally healthy and carefree time of life. Yet, according to a new study by researchers at the University of North Carolina at Chapel Hill, that’s not the reality today. In fact, studies are indicating that as many as one fifth of all young adults in their 20s and early 30s have elevated blood pressure.

Researchers analyzed data on more than 14,000 men and women between the ages of 24 and 32 in 2008 from the National Longitudinal Study of Adolescent Health – known as Add Health – funded by the National Institutes of Health. They found 19% had hypertension, which has been directly linked to poor diet and stress.

Although hypertension can have serious long-term effects, only about half of the participants with elevated blood pressure had been alerted to that fact by their health care provider.

“The findings are significant because they indicate that many young adults are at risk of developing heart disease, but are unaware that they have hypertension,” said Quynh Nguyen, a doctoral student at UNC’s Gillings School of Global Public Health and the study’s lead author. Hypertension is a strong risk factor for stroke and coronary heart disease, the leading cause of death for adults in the U.S.

The findings were published in the journal Epidemiology.

Dr. Kathleen Harris, the study’s co-author, stated that the high rate of hypertension among the Add Health study participants was surprising. Another widely cited and reputable study – the National Health and Nutrition Examination Survey, or NHANES – reported a much lower rate of hypertension (4%) for a similar age group around the same time period (2007-2008). Both studies use the same definition of hypertension: a blood pressure reading of 140/90 mmHg (millimeters of mercury) or more.

“Our respective findings may differ, but the message is clear,” said Dr. Harris. “Young adults and the medical professionals they visit shouldn’t assume they’re not old enough to have high blood pressure. This is a condition that leads to chronic illness, premature death and costly medical treatment.

“Our results show that the processes that trigger these problems begin early in life, but they are preventable,” she emphasized, “so it’s important to check for hypertension now and head it off at the pass, in order to avoid these health and societal costs later on.”

Several research studies have shown that chiropractic may be effective in controlling or reducing high blood pressure. An article published in the Journal of Human Hypertension, found that restoration of Atlas alignment is associated with marked and sustained reductions in blood pressure. In fact, the result was about the same as using a common two-drug combination therapy, but with no adverse effects.

SOURCES: “Discordance in National Estimates of Hypertension Among Young Adults” Epidemiology: July 2011 – Volume 22 – Issue 4 – pp 532-541 Abstract

“Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study” Journal of Human Hypertension (2007) Abstract

Almost all US women experience “complications” during delivery

June 8, 2011 TerryARondberg No comments

While US families spend billions of dollars on pre-natal care, the vast majority of women have what the medical industry labels “complications” during their deliveries – costing them another $17.4 billion each year.

Those were the findings of a study reported by the Agency for Healthcare Research and Quality (AHRQ), which reported that more than nine out of every ten women giving birth in the United States had some complication in 2008.

According to data from the federal agency, 94% of women hospitalized for pregnancy and delivery had complications such as: premature labor, urinary infection, anemia, diabetes, vomiting, bleeding, laceration of the area between the vagina and anus during delivery, abnormal fetal heart rate, advanced maternal age (over 35 years), and hypertension and eclampsia (a condition associated with high blood pressure which can involve swelling and seizures).

Although the AHRQ didn’t speculate as to why the “complication” rate was so high, it did provide a few clues about one probable reason: economics.

Without complications, a woman either delivers outside a hospital setting (in home, birth center, etc.) or stays only an average of 1.9 days in the hospital. However, when diagnosed with a complication, she’s in the hospital nearly three days on average, and the cost jumps nearly 50% ($4,100 as opposed to $2,600).

In fact, the AHRQ reported that pregnancy and delivery-related complications accounted for $17.4 billion, or nearly five percent of total US hospital costs.

This offers a huge incentive to label many situations as “complications” (including being over age 35) and treat pregnancy as an illness or “condition” in need of medical treatment. In countries where the economic incentive is removed, the frequency of complications plummets.

British general practitioner Susan Jarvis says: “For the majority of women, labour is a positive, uncomplicated and rewarding experience. About 85 per cent of women having their first baby will experience a normal delivery, and that rate rises to about 95 per cent if you have had a normal delivery before.” (from “Complications during labour,” netdoctor.co.uk. )

This AHRQ News and Numbers summary is based on data from Statistical Brief #113: “Complicating Conditions of Pregnancy and Childbirth, 2008” . The report uses data from the agency’s 2008 Nationwide Inpatient Sample.

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