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NHS Scotland created a comprehensive site regarding medication management which they refer to as polypharmacy guidance. http://www.polypharmacy.scot.nhs.uk/7-steps/
An example of their content follows. They even have an app for smartphones.
Step1: Identify aims and objectives of drug therapy
Review diagnoses and identify therapeutic objectives with respect to:
- Management of existing health problems.
- Prevention of future health problems.
The National Academies of Sciences, Engineering, and Medicine released the report “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.”
Here’s the link.
Despite a lot of rhetoric, current research supports value for three conditions as noted in the following quote.
“There is conclusive or substantial evidence that cannabis or cannabinoids are effective:
- For the treatment for chronic pain in adults (cannabis) (4-1)
- Antiemetics in the treatment of chemotherapy-induced nausea and vomiting (oral cannabinoids) (4-3)
- For improving patient-reported multiple sclerosis spasticity symptoms (oral cannabinoids) (4-7a)”
It’s been my experience that sending written information to prescribers had a greater impact than trying to meet with them face-to-face. This article from Lancet doesn’t compare the two but did show a limited impact of written information.
Here’re the findings from the abstract:
“Between Sept 8 and Sept 26, 2014, we recruited and assigned 1581 GP practices to feedback intervention (n=791) or control (n=790) groups. Letters were sent to 3227 GPs in the intervention group. Between October, 2014, and March, 2015, the rate of antibiotic items dispensed per 1000 population was 126·98 (95% CI 125·68–128·27) in the feedback intervention group and 131·25 (130·33–132·16) in the control group, a difference of 4·27 (3·3%; incidence rate ratio [IRR] 0·967 [95% CI 0·957–0·977]; p<0·0001), representing an estimated 73 406 fewer antibiotic items dispensed. In December, 2014, GP practices were re-assigned to patient-focused intervention (n=777) or control (n=804) groups. The patient-focused intervention did not significantly affect the primary outcome measure between December, 2014, and March, 2015 (antibiotic items dispensed per 1000 population: 135·00 [95% CI 133·77–136·22] in the patient-focused intervention group and 133·98 [133·06–134·90] in the control group; IRR for difference between groups 1·01, 95% CI 1·00–1·02; p=0·105).”
The Healthcare Economist posted some very useful information on this topic. One of the estimates placed the range between $109,000 and $297,000 per year of added life.
No real surprises.
From the abstract:
“Results indicate an increase in overall use of prescription drugs among US adults between 1999-2000 and 2011-2012 with an estimated 51% of US adults reporting use of any prescription drugs in 1999-2000 and an estimated 59% reporting use of any prescription drugs in 2011-2012 (difference, 8% [95% CI, 3.8%-12%]; P for trend <.001). The prevalence of polypharmacy (use of ≥5 prescription drugs) increased from an estimated 8.2% in 1999-2000 to 15% in 2011-2012 (difference, 6.6% [95% CI, 4.4%-8.2%]; P for trend <.001). These trends remained statistically significant with age adjustment. Among the 18 drug classes used by more than 2.5% of the population at any point over the study period, the prevalence of use increased in 11 drug classes including antihyperlipidemic agents, antidepressants, prescription proton-pump inhibitors, and muscle relaxants”
You may have seen the news on the WHO report condemning red meat.
Number of deaths attributable to eating processed meat, according to the World Health Organization (WHO): 34,000
That’s an annual risk of approximately 1 in 200,000
Number of people struck by lightning annually: 240,000
It’s important to have a point of reference when evaluating numbers like these.