Geographical Variation in Prescribing Dangerous Drugs
The following is from a recent study published in The New England Journal of Medicine:
- The hospital-referral region with the largest proportion of elderly beneficiaries taking [potentially dangerous] high-risk drugs is Alexandria, Louisiana, where 44% of elderly beneficiaries received them — four times the 11% who received them in the Bronx, New York, the best-performing hospital-referral region on this measure.
- Regions in which beneficiaries were more likely to be given prescriptions for potentially harmful or high-risk drugs did not necessarily spend more on drugs overall than regions in which beneficiaries were less likely to use such drugs.
- The regions in which nondrug medical spending per beneficiary was higher were also the regions in which beneficiaries were more likely to be given prescriptions for potentially harmful or high-risk drugs — a finding that does not support the premise that higher medical spending leads to higher-quality prescription use.
Public health advocates tend to blame doctors for regional variation in Medicare treatments and prescription drug utilization. However, another place to look is patients. Some patients are more demanding; while others are too compliant. Patients may see numerous physicians and never inform their doctors all the medications patients are on. Some Medicare enrollees never ask about medications or discuss whether they still need a drug or if there is a non-drug alternative.
Given the huge geographical variation in personal tastes and preferences, it appears the practice of medicine must also be subject to personal taste.
Alexandria, Lousiana is the location of the Central Lousiana State Hospital. It provides acute and long-term mental health treatment. One of the high risk drugs tracked in the paper is used to treat schizophrenia. Maybe there is a reason for the geographical variation after all.
Thanks, Linda. we can always count on your watchful eye to keep these guys honest.