The Article in Brief
Linda M. Hunt , and colleagues
Background This study of management of type 2 diabetes and hypertension examines clinicians' treatment strategies, factors influencing treatment decisions, and patient understandings and experiences in managing these illnesses.
What This Study Found With 11 percent of the US population and 40 percent of people older than 60 years taking 5 or more medications, this study examines the underlying influence and unintended outcomes of the dramatic rise in polypharmacy in patients with diabetes, hypertension, or both. The authors suggest that heavy use of pharmaceuticals is caused by a number of factors, most notably (1) increasingly stringent diagnostic and treatment thresholds for common chronic conditions, (2) clinician auditing and reward systems, and (3) a prescribing cascade whereby more medications are prescribed to control the effects of already prescribed medications. The authors identify several challenges to patient well-being resulting from a heavy reliance on pharmaceuticals, including financial costs and adverse drug effects. They present a conceptual model, the inverse benefit law, to provide insight into the impact of pharmaceutical marketing efforts on the observed trends.
Implications
- The authors call for (1) policies that will exclude individuals or organizations with financial conflicts of interest from involvement with guideline-writing panels, (2) physicians to be discouraged from seeing drug representatives, and (3) the monitoring of pay-for-performance plans for evidence of unintended negative effects on patients.