[Congressional Record (Bound Edition), Volume 145 (1999), Part 8]
[Extensions of Remarks]
[Page 12028]
[From the U.S. Government Publishing Office, www.gpo.gov]



      ANOTHER REASON WE NEED A RX BENEFIT FOR EVERYONE IN MEDICARE

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                         Tuesday, June 8, 1999

  Mr. STARK. Mr. Speaker, a number of us have introduced H.R. 1495, a 
bill to provide a prescription drug for everyone in Medicare. A 
provision in that bill requires a system to prevent drug errors and the 
use of contraindicated drugs.
  Over-prescription and reactions among multiple prescriptions costs 
Americans billions of dollars a year in illness--and thousands of 
deaths. If we can reduce those errors, the total health care system can 
make enormous savings.
  A new article in the May/June 1999 issue of the Journal of the 
American Pharmaceutical Association provides another example of why we 
should improve the quality of drug use among all Medicare 
beneficiaries. Following is the abstract of Rajender Aparasu's study 
entitled. ``Visits to Office-Based Physicians in the United States for 
Medication-Related Morbidity.''

       Objective: To examine the prevalence, nature, demographics, 
     and resource use associated with visits to office-based 
     physicians in the United States during 1995 for medication-
     related morbidity.
       Design: A nationwide cross-sectional survey of ambulatory 
     care visits to physician offices, based on data from the 
     National Center for Health Statistics' 1995 National 
     Ambulatory Medical Care Survey.
       Setting: Physician office-based settings in the United 
     States.
       Patients: Patients visiting office-based physicians for 
     principal diagnoses of adverse effect of medications (ICD-9-
     CM E-code 930.00-947.9).
       Main Outcome Measures: Weighted measures of prevalence, 
     nature, demographics, and resource use associated with visits 
     related to adverse effects of medications.
       Results: An estimated 2.01 million (95% confidence 
     interval, 1.69 to 2.34 million) visits for medication-related 
     morbidity were made to office-based physicians in the United 
     States during 1995, representing an annual rate of 7.70 
     visits per 1,000 persons. Medication-related visit rates were 
     greater in women, in patients between 65 to 74 years of age, 
     and in the Midwest. The most frequently cited reasons for 
     medication-related visits were skin rash, nausea, and 
     shortness of breath. The therapeutic agents responsible for 
     medication-related visits were most often hormone and 
     synthetic substitutes (13.32%), antibiotics (11.55%), and 
     cardiovascular drugs (9.30%). Medication-related visits most 
     often involved diagnostic services and medication therapy. 
     The majority included instructions for a scheduled follow-up, 
     and fewer than 1% resulted in hospital admission.
       Conclusion: Medication-related ambulatory care utilization 
     can pose a significant burden on health care resources unless 
     specific strategies are initiated to control medication-
     related problems. The provision of pharmaceutical care can 
     play an important role in reducing medication-related 
     problems and associated health care costs.





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