Question 2
Why do you think there was not a significant difference in pharmaceutical costs but there was a significant difference in medical care costs?
posted by Anonymous @ 7:14 PM
9 comments
ISU Dietetic Internship Journal Club
Objective: To become familiar with current scientific literature on a variety of nutrition topics and to gain experience in gathering, organizing, critically evaluating, presenting and facilitating group discussion of the literature and the implications to practice.
9 Comments:
This could be due to increase doctor/hospital visits due to complications of obesity/overweight that can be treated without medications, such as increased inpatient care (which seemed to have the most significant difference between groups in Table 3) and procedures.
I think that many obese patients seek medical “care” for conditions, rather than being put on medications. They may be put on medications after the care, but this is most likely to occur after a pricey trip to the emergency room or hospital. Those expensive trips often include physician and hospital services, as well as diagnostic tests. These kinds of interventions would add up significantly compared to a patient being put on a prescription medication.
The article did mention that this might be somewhat biased due to the fact that obesity and diabetes are related to many comobidities. It could have been coincidental that there were more hospital visits. Also, I think that even though patients are participating in a lifestyle program compared to the usual program, drug treatment is not likely to change dramatically. Often times drugs provide the quickest, best results and it is not likely that a short term program would immediately reduce the amount of pharmaceuticals used.
Annie-
You had a good point in that a lifestyle program may not necessarily change or reduce the long-term use of pharmaceuticals. It would most likely take a much larger and longer program and lifestyle modification to affect something as stable as prescriptions for certain medications that these patients may have been on for a very long time
I think that the pharmaceutical costs did not significantly change because the subjects were already on the medications that they needed for their conditions. Significant changes in medications are not made quickly but rather over time and may not be visible by the short study. However, medical costs increased due to seeking more medical attention that may have been brought about by the scrutiny of the study or the fact that the subjects were getting more medical attention then they had before the study. Also, as people continue to live with diabetes and obesity more medical costs come about as conditions usually worsen or even more medical costs for prevention.
I agree with you Steph, in how you observed that often it is a long process to change the pharmaceutical needs of patients and the length of this study as well as small number of participants made this a difficult thing to measure. So it is possible that over time those patients in the RD lifestyle program would have seen a greater reduction in their drug needs but more research is necessary to determine.
Since obesity/diabetes is something that can primarily be taken care of through diet and exercise, it is really no surprise that although medical costs are high, pharmaceutical costs are not increasing. I believe that insulin and other meds (antihypertensive drugs, cholesterol controlling drugs, etc) are probably already being consumed by many of the these clients, so when they have problems, they go to the doctor and have tests performed. Many of the problems of obesity cannot be taken care of with medications and many medical care professionals are becoming hesitant to prescribe weight loss drugs because they are seeing the side effects.
I agree with Steph and Annie. I think that because most of the individuals were already on prescription medications, the medications did not show an increase. Medicare increased more due to the fees of seeking treatment for the weight loss/diabetes. (i.e. consultations, hospital care, tests).
When a patient is on medications for the management of their Type 2 DM it would not be advisable for that patient to lower or discontinue their dosage until their is evidence that the prescription may be unnecessary. When a patient begins an exercise/nutrition regimen it may take quite some time for a person to make enough of a change in their condition to be advised to lower/discontinue their medication routine. Since this study was only done over a year's time, I would have thought that some patients would have started weaning their medication usage at the tail end of the study, but not much sooner than that. For this reason, the difference in pharmaceutical costs between the two groups may not have been large enough at the end of the study to have shown up as a statistically significant difference.
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