the personal views of a doctor in industry

Disease Management Programs

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I like to eat burgers. If I chose to eat a salad for lunch tomorrow instead of a burger, but then eat whatever I like thereafter, have I improved my health in the long term? Can the benefit of that one salad be quantified? What if I double my salad habit, taking one more salad the next day for lunch?


Like my appetite for lettuce, in the real world people do not take their chronic meds for very long either. So what good do these drugs really do if a patient takes them for only 3 to 6 months?


An article in the FT (The line from peddling pills to “disease management”) discusses the attempts being made to improve patient care and drug compliance using approaches outside of the traditional Dr-patient relationship. These strategies aim to address real problems: neither do patients take their medications as directed for long enough, nor do they curb their unhealthy lifestyles enough. The assumption is either that Drs are not inclined to provide this kind of support, or that they do not have the time. The solutions being looked at involve communicating with patients between their visits to the Dr. These may include reminders to take meds or advice on exercise and eating better. The hypothesis is that these interventions will improve drug compliance and have a positive effect on patient outcomes, ie patients will live longer healthier lives. By avoiding the expenses incurred by ill health, there may be financial benefits too for whoever would have been billed for them.


If we generously assume that these programs can double average compliance from 3 to 6 months, then for a 50 year old patient who will suffer an MI on his 65th birthday, this improved compliance would mean taking his medication for 3.3% of those 15 years, rather than an unassisted 1.6%. Intuitively, this does not look like a particularly impressive result.


I am a fanatical believer in drugs. But I know that even I am not very good at taking them. If we really want to shift the needle on our life expectancy then we will have to do more than take a statin for 3 months. It pains me to admit it, but we may need a more holistic approach.



Written by Pillhead

May 15, 2009 at 6:28 am

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