TELEPHONE PRESCRIPTION REQUESTS
- When you call, please clearly state your name, date of birth and your telephone number
- Always clearly pronounce or spell the name of the medication, the strength, instructions and the amount and number of refills needed.
- Always leave your pharmacy telephone number.
- Prescription refill requests will be authorized WITHIN 48 hours, so try not to wait until you are out of your medication. Please check with your pharmacy before you pick up the prescription to make certain it has been called in.
- One of the most frustrating problems we have to deal with is the need for "prior authorizations" or "overrides" from the various insurance companies. Before a brand name drug can be prescribed you have to have been tried on a generic. It is becoming a common practice for the companies to insist on a generic drug even if the patient has been successfully managed on a brand name medication for some time. These are not our rules. They are the rules of YOUR insurance company. Please do not take out your frustration on the office staff. Their jobs are tough enough.
- Covering physicians CANNOT authorize prescriptions for narcotics. If you do expect a non-narcotic medication to be called in for you by a covering physician after regular hours please have your pharmacy number available and be certain that the pharmacy is open.
- I strongly recommend that you keep a CURRENT list of your medications (with strengths and instructions) in your wallet or purse at ALL times, so as to avoid any confusion.We can give you a card specifically printed for this.....ask at your next visit.
- You must inform me about any drug allergies or side effects you've experienced.
- If you are experiencing side effects from a prescribed medication or you cannot afford a particular medication, please bring this to my attention BEFORE you decide to stop it.
The U.S. Agency for Healthcare Research and Quality recommends asking your doctor or pharmacist these questions when getting a new medication:
- What is the name of the medicine?
- What is it supposed to do?
- Is it OK to substitute a less-expensive generic drug for the name brand? Will it achieve the same effect?
- What is the dose of the medicine?
- Are there foods, drinks, other medicines, or activities I should avoid while taking this drug?
- What are the possible side effects? What should I do if they occur?
- How many refills of this prescription can I get?
- What should I do if I miss a dose?
- Is there written information I can take home?
- Keep a CURRENT list of your medications (with strengths and instructions) in your wallet or purse at ALL times.
- Keep your pharmacy telephone number handy
'Use Only as Directed' Isn't Easy
By Laura Landro : WSJ : April 26, 2011
A new push is under way to make prescription drug information clearer and stem the rise in emergency room visits and hospitalizations resulting from patients incorrectly taking their medicine.
As many as three in four Americans say they don't take prescription medicine as directed, according to the National Community Pharmacists Association.
Stephen Anzaldi Professor Michael Wolf, who researches drug labeling, holds up a seemingly contradictory warning on a prescription for Nexium given to his brother by a pharmacy in Washington, D.C.
The Food and Drug Administration is planning to test single-page consumer information sheets that would replace the multi-page package inserts and medication guides widely used in retail pharmacies. And the U.S. Pharmacopeial Convention, which sets quality standards enforced by the FDA for the quality, strength and purity of medicines, is developing a new national standard for prescription labels, which can vary widely from pharmacy to pharmacy and befuddle consumers. The standards, if adopted, would require clear instructions on dose and timing and state in simple terms the purpose of the drug—such as "for high blood pressure"—unless the patient prefers that it not appear.
Doctors and pharmacists are also being encouraged to counsel patients more effectively about their medications. About 100 industry and nonprofit groups are participating in a national awareness campaign about the importance of taking medication as directed, to be launched in May by the National Consumers League. The campaign includes a website for health professionals and a separate website where consumers can download tools such as work sheets to manage their medications. The group says more than a third of medication-related hospital admissions are linked to poor medication adherence.
With the growing complexity of medication regimens, especially for the elderly and those with multiple, chronic conditions, even highly educated consumers can fail to take their medications correctly, says Karen Weiss, program director of the FDA's Safe Use Initiative. "We need to create better awareness about the gamut of harm that can occur."
By the Numbers
Medication mishaps often happen in the hospital, due to clinician error and unexpected allergies or reactions. According to the Agency for Healthcare Research and Quality, the number of people treated in U.S. hospitals for illnesses and injuries from taking medications jumped 52% to 1.9 million between 2004 and 2008, the latest year available, including patients admitted from the emergency room. More than half of the increase was due to corticosteroids, blood thinners, and sedatives and hypnotics.
Another 838,000 patients were also treated and released from the ER with problems related to those and other medications, including painkillers, antibiotics, cardiovascular drugs, insulin and other hormones used to treat common diseases such as asthma, arthritis and ulcerative colitis. FDA officials say inadvertent errors made by patients who misunderstand information are causing significant harm. One reason cited is low literacy skills. A study in 2006 showed that of 70% of patients with low literacy who could correctly state the instructions "take two tablets by mouth twice daily," only 34% could then demonstrate the number to be taken daily.
Bad Reactions
How drugs can cause harm if taken incorrectly
In another study, his team filled 100 prescriptions across the country and found that important warnings often were not included on labels. For example, only half the time did prescription labels for Fosamax, an osteoporosis drug, carry the warning that patients should not lie down for 30 minutes after taking the drug; doing so can lead to irritation and erosion of the lining of the esophagus.
The FDA is working with the Brookings Institution on the one-page guides that could eventually replace other materials, says Denise Hinton, a senior program manager with the FDA. A pilot test is awaiting funding from the Office of Management and Budget. It could take five to six years for a final rule to go into effect.
There is some concern that a one-page summary printed on only one side isn't adequate, especially for more complex drugs. The Institute for Safe Medication Practices (ISMP), a nonprofit safety group that investigates medication errors, is working with the Agency for Healthcare Research and Quality on a series of medication brochures printed on two sides of a single page for medications with the potential to cause the most harm, such as the cancer drug methotrexate, which has caused deaths when mistakenly taken daily instead of once or twice a week. ISMP President Michael Cohen says the free brochures will be tested in pharmacies this year.
The American Society of Health-System Pharmacists, which creates medication instructions used by the federal National Library of Medicine, cautions that it will be difficult to boil down instructions to a single page without compromising patient safety, says Gerald McEvoy, assistant vice president of the group.
Kaiser Permanente, the large managed-care organization, has started a training program for pharmacists that includes confirming the directions for use and stressing the importance of taking medication as prescribed. "As reluctant as many pharmacists and consumers are to take the extra time, it is worth one last extra check to make sure nothing will go wrong," says Michael Negrete, chief executive of the Pharmacy Foundation of California.
Side Effects? These Drugs Have a Few
By Gina Kolata : NY Times : June 4, 2011
Dr. Jon Duke of Indiana University was trying to figure out why his patient’s blood platelets were abnormal. Could it be a side effect of one of the dozen drugs the man was taking, a number that is not uncommon among elderly people?
He began reading the label of each and every drug. “I was just overwhelmed,” Dr. Duke said. The lists of possible adverse reactions went on and on.
Now he knows why. In a new paper in the Archives of Internal Medicine, Dr. Duke and two colleagues report that the average drug label lists 70 possible side effects and some drugs list more than 500. “This was beyond even what I’d expected,” he said.
For anyone who has ever had to watch an entire Flomax commercial, the listing of a drug’s side effects is almost a joke. But the question is, why does the list continue to grow?
It’s not as if the problem hasn’t been addressed. In 2006, troubled by the ever-expanding lists of side effects, Dr. Jerry Avorn and Dr. William Shrank of Harvard Medical School wrote a paper in The New England Journal of Medicine calling it “linguistic toxicity.”
That same year, the Food and Drug Administration suggested making labels clearer with a new format and advised drug makers: “Exhaustive lists of every reported adverse event, including those that are infrequent and minor, commonly observed in the absence of drug therapy or not plausibly related to drug therapy should be avoided.”
But, Dr. Duke found, instead of decreasing in the years after the agency issued guidelines, the average number of side effects rose to 94, as compared to 67 for those whose labels predated the new format. Some potential complications are weird, like “compulsive gambling.” Others, like “nausea” are so common — it’s listed on 75 percent of drug labels — that they almost seem like a universal issue.
Some were adverse reactions that showed up in clinical trials before a drug was marketed. Others were conditions patients reported when they were taking the drugs that may — or may not — have been caused by the drugs. Often there is no way to know why or how a side effect got reported.
Listing every inkling of an adverse reaction can help drug companies in lawsuits, Dr. Duke said. If someone sues about a side effect that is listed in the drug’s package insert, the company can say patients had been warned.
The Pharmaceutical Research and Manufacturers Association says the companies are just complying with the F.D.A.’s requirement that they reveal all of a drug’s risks, “even if a clear causal connection between the medicine and the observed adverse event cannot be fully established,” a spokesperson for the group wrote in an e-mail.
But, said Dr. Christine Cheng, a doctor of pharmacy at the University of California in San Francisco, what is happening is a case of “information overload.” Dr. Cheng wrote an invited commentary to accompany Dr. Duke’s paper.
And the F.D.A., in an e-mail, said “extensive lists of rare and minor adverse events for which there are no data to support a causal relationship” are not useful.
Patients agree.
Jim Murrell, a 54-year-old telecommunications consultant who lives in the Atlanta suburbs, says he wants to know all about adverse drug reactions but he has decided the labels are not helpful; he looks for better sources on the Internet.
“I took a medication that had the side effect of drowsiness,” he said. “I read a little further and saw it had another side effect. Insomnia. One medication had diarrhea as a side effect and it also had constipation.”
“It makes no sense,” Mr. Murrell said.
“What I need to know is probably buried somewhere in there,” he added. “But what I don’t need is all the information that is probably in there because, I don’t know, maybe there’s a lawsuit somewhere.”
By Laura Landro : WSJ : April 26, 2011
A new push is under way to make prescription drug information clearer and stem the rise in emergency room visits and hospitalizations resulting from patients incorrectly taking their medicine.
As many as three in four Americans say they don't take prescription medicine as directed, according to the National Community Pharmacists Association.
Stephen Anzaldi Professor Michael Wolf, who researches drug labeling, holds up a seemingly contradictory warning on a prescription for Nexium given to his brother by a pharmacy in Washington, D.C.
The Food and Drug Administration is planning to test single-page consumer information sheets that would replace the multi-page package inserts and medication guides widely used in retail pharmacies. And the U.S. Pharmacopeial Convention, which sets quality standards enforced by the FDA for the quality, strength and purity of medicines, is developing a new national standard for prescription labels, which can vary widely from pharmacy to pharmacy and befuddle consumers. The standards, if adopted, would require clear instructions on dose and timing and state in simple terms the purpose of the drug—such as "for high blood pressure"—unless the patient prefers that it not appear.
Doctors and pharmacists are also being encouraged to counsel patients more effectively about their medications. About 100 industry and nonprofit groups are participating in a national awareness campaign about the importance of taking medication as directed, to be launched in May by the National Consumers League. The campaign includes a website for health professionals and a separate website where consumers can download tools such as work sheets to manage their medications. The group says more than a third of medication-related hospital admissions are linked to poor medication adherence.
With the growing complexity of medication regimens, especially for the elderly and those with multiple, chronic conditions, even highly educated consumers can fail to take their medications correctly, says Karen Weiss, program director of the FDA's Safe Use Initiative. "We need to create better awareness about the gamut of harm that can occur."
By the Numbers
- Nearly 1.9 million people were treated in hospitals for illnesses and injuries from taking medicines, a 52% increase from 2004 to 2008.
- Another 838,000 people were treated and released from emergency rooms due to harm from medications in 2008.
- Almost 36% of treat-and-release emergency room visits were patients ages 18 to 44, and 18% were elderly.
Medication mishaps often happen in the hospital, due to clinician error and unexpected allergies or reactions. According to the Agency for Healthcare Research and Quality, the number of people treated in U.S. hospitals for illnesses and injuries from taking medications jumped 52% to 1.9 million between 2004 and 2008, the latest year available, including patients admitted from the emergency room. More than half of the increase was due to corticosteroids, blood thinners, and sedatives and hypnotics.
Another 838,000 patients were also treated and released from the ER with problems related to those and other medications, including painkillers, antibiotics, cardiovascular drugs, insulin and other hormones used to treat common diseases such as asthma, arthritis and ulcerative colitis. FDA officials say inadvertent errors made by patients who misunderstand information are causing significant harm. One reason cited is low literacy skills. A study in 2006 showed that of 70% of patients with low literacy who could correctly state the instructions "take two tablets by mouth twice daily," only 34% could then demonstrate the number to be taken daily.
Bad Reactions
How drugs can cause harm if taken incorrectly
- Painkillers: Taking with alcohol or other painkillers or sedatives can cause breathing problems or death. Over-the-counter products containing acetaminophen can injure the liver if taken with opioid-acetaminophen combination drugs.
- Antibiotics: Can cause allergic reaction or fail to fight infection; sun exposure while taking can cause extreme burn.
- Corticosteroids (for arthritis, asthma, ulcerative colitis, immunosupression in transplant patients): Can worsen high blood pressure, diabetes, bloodsugar problems or ulcers. Suddenly stopping use can cause withdrawal symptoms.
- Antidepressants/ tranquilizers: Can lead to suicidal actions, panic attacks.
- Blood-pressure drugs: Insufficient dose can cause spike in blood pressure; overdose can cause dizziness, chest pain, shortness of breath, coma or an unusually slow or fast heartbeat; stopping use too quickly can cause serious heart problems.
- Cancer drugs: Can exacerbate fatigue, confusion. Can cause fever, shortness of breath, nausea and vomiting, diarrhea, overdose can cause death.
- Insulin: Can increase or reduce blood-sugar levels and lead to shock and other complications
- Blood thinners: Too high a dose can cause excessive bleeding, bruising; too low a dose can cause blood clots. Interactions with many medications can reduce effectiveness or cause bleeding.
In another study, his team filled 100 prescriptions across the country and found that important warnings often were not included on labels. For example, only half the time did prescription labels for Fosamax, an osteoporosis drug, carry the warning that patients should not lie down for 30 minutes after taking the drug; doing so can lead to irritation and erosion of the lining of the esophagus.
The FDA is working with the Brookings Institution on the one-page guides that could eventually replace other materials, says Denise Hinton, a senior program manager with the FDA. A pilot test is awaiting funding from the Office of Management and Budget. It could take five to six years for a final rule to go into effect.
There is some concern that a one-page summary printed on only one side isn't adequate, especially for more complex drugs. The Institute for Safe Medication Practices (ISMP), a nonprofit safety group that investigates medication errors, is working with the Agency for Healthcare Research and Quality on a series of medication brochures printed on two sides of a single page for medications with the potential to cause the most harm, such as the cancer drug methotrexate, which has caused deaths when mistakenly taken daily instead of once or twice a week. ISMP President Michael Cohen says the free brochures will be tested in pharmacies this year.
The American Society of Health-System Pharmacists, which creates medication instructions used by the federal National Library of Medicine, cautions that it will be difficult to boil down instructions to a single page without compromising patient safety, says Gerald McEvoy, assistant vice president of the group.
Kaiser Permanente, the large managed-care organization, has started a training program for pharmacists that includes confirming the directions for use and stressing the importance of taking medication as prescribed. "As reluctant as many pharmacists and consumers are to take the extra time, it is worth one last extra check to make sure nothing will go wrong," says Michael Negrete, chief executive of the Pharmacy Foundation of California.
Side Effects? These Drugs Have a Few
By Gina Kolata : NY Times : June 4, 2011
Dr. Jon Duke of Indiana University was trying to figure out why his patient’s blood platelets were abnormal. Could it be a side effect of one of the dozen drugs the man was taking, a number that is not uncommon among elderly people?
He began reading the label of each and every drug. “I was just overwhelmed,” Dr. Duke said. The lists of possible adverse reactions went on and on.
Now he knows why. In a new paper in the Archives of Internal Medicine, Dr. Duke and two colleagues report that the average drug label lists 70 possible side effects and some drugs list more than 500. “This was beyond even what I’d expected,” he said.
For anyone who has ever had to watch an entire Flomax commercial, the listing of a drug’s side effects is almost a joke. But the question is, why does the list continue to grow?
It’s not as if the problem hasn’t been addressed. In 2006, troubled by the ever-expanding lists of side effects, Dr. Jerry Avorn and Dr. William Shrank of Harvard Medical School wrote a paper in The New England Journal of Medicine calling it “linguistic toxicity.”
That same year, the Food and Drug Administration suggested making labels clearer with a new format and advised drug makers: “Exhaustive lists of every reported adverse event, including those that are infrequent and minor, commonly observed in the absence of drug therapy or not plausibly related to drug therapy should be avoided.”
But, Dr. Duke found, instead of decreasing in the years after the agency issued guidelines, the average number of side effects rose to 94, as compared to 67 for those whose labels predated the new format. Some potential complications are weird, like “compulsive gambling.” Others, like “nausea” are so common — it’s listed on 75 percent of drug labels — that they almost seem like a universal issue.
Some were adverse reactions that showed up in clinical trials before a drug was marketed. Others were conditions patients reported when they were taking the drugs that may — or may not — have been caused by the drugs. Often there is no way to know why or how a side effect got reported.
Listing every inkling of an adverse reaction can help drug companies in lawsuits, Dr. Duke said. If someone sues about a side effect that is listed in the drug’s package insert, the company can say patients had been warned.
The Pharmaceutical Research and Manufacturers Association says the companies are just complying with the F.D.A.’s requirement that they reveal all of a drug’s risks, “even if a clear causal connection between the medicine and the observed adverse event cannot be fully established,” a spokesperson for the group wrote in an e-mail.
But, said Dr. Christine Cheng, a doctor of pharmacy at the University of California in San Francisco, what is happening is a case of “information overload.” Dr. Cheng wrote an invited commentary to accompany Dr. Duke’s paper.
And the F.D.A., in an e-mail, said “extensive lists of rare and minor adverse events for which there are no data to support a causal relationship” are not useful.
Patients agree.
Jim Murrell, a 54-year-old telecommunications consultant who lives in the Atlanta suburbs, says he wants to know all about adverse drug reactions but he has decided the labels are not helpful; he looks for better sources on the Internet.
“I took a medication that had the side effect of drowsiness,” he said. “I read a little further and saw it had another side effect. Insomnia. One medication had diarrhea as a side effect and it also had constipation.”
“It makes no sense,” Mr. Murrell said.
“What I need to know is probably buried somewhere in there,” he added. “But what I don’t need is all the information that is probably in there because, I don’t know, maybe there’s a lawsuit somewhere.”
'Drug Store' by Edward Hopper
