This Christmas Give The Gift of Deprescribing

dr-jim-amos santalandIt’s Christmas Eve and I’m wondering how many doctors out there would like to give their patients, especially the older ones, a great Christmas gift.

It’s called “deprescribing.”

At first glance, it looks like you’d be taking something away, not giving a gift. I think it could be reframed in that, at least in my business as a psychiatric consultant in the general hospital, giving opioids and benzodiazepines to some patients could be a lethal “gift.”

Now the patient satisfaction ratings may worry you, but I worry more about patient mortality increasing being correlated with higher patient satisfaction. “The most satisfied patients also had statistically significantly greater mortality risk compared with the least satisfied patients” [1].

Almost every day, I see the disasters from prescribing benzodiazepines to patients who are also getting opioid analgesics. Delirium is the usual outcome and the ones who suffer the most are the elderly:

Hey, it’s Christmas. Give the gift of deprescribing for patients’ sake.

Have a happy holiday!

Reference:

1. Fenton, J. J., et al. (2012). “The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality.” Arch Intern Med 172(5): 405-411.
BACKGROUND: Patient satisfaction is a widely used health care quality metric. However, the relationship between patient satisfaction and health care utilization, expenditures, and outcomes remains ill defined. METHODS: We conducted a prospective cohort study of adult respondents (N = 51,946) to the 2000 through 2007 national Medical Expenditure Panel Survey, including 2 years of panel data for each patient and mortality follow-up data through December 31, 2006, for the 2000 through 2005 subsample (n = 36,428). Year 1 patient satisfaction was assessed using 5 items from the Consumer Assessment of Health Plans Survey. We estimated the adjusted associations between year 1 patient satisfaction and year 2 health care utilization (any emergency department visits and any inpatient admissions), year 2 health care expenditures (total and for prescription drugs), and mortality during a mean follow-up duration of 3.9 years. RESULTS: Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had lower odds of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI, 1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53). CONCLUSION: In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.

 

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