How a drug company pays doctors to treat the ‘worst of the worst’
MEDICINE BUDDHA, NC — It is a common practice for medical professionals to provide medication to patients for free in an effort to avoid the cost of dispensing the drug to the public.
But for doctors who treat a high number of patients, the practice is fraught with risks, especially in a world where pharmaceutical companies are increasingly taking a hard line against generic drugs.
The practice is known as dispensing antibiotics at home for free, and according to the American College of Emergency Physicians, this practice is a growing problem in the US, where doctors are prescribing more antibiotics to patients than ever before.
In 2015, for example, more than 5.7 million prescriptions were filled for antibiotic-resistant pathogens, including MRSA, C. difficile, Escherichia coli, and Pseudomonas aeruginosa, according to an analysis by the Center for Disease Control and Prevention.
In some states, a large number of prescriptions were dispensed at home.
The new guidelines, published Thursday in the Journal of Emergency Medicine, advise doctors to only dispense antibiotic drugs to patients who have tested positive for MRSA and who are also on the federal government’s list of “high risk” patients.
They also recommend that doctors do not prescribe antibiotics to people who are on the government’s “no-fly” list, and for patients who are deemed at high risk of developing the bacteria.
Doctors can also dispense antibiotics for free if the patient is in an emergency, or if the doctor believes they have a reasonable opportunity to avoid a potentially life-threatening complication, such as infection.
“We know that prescribing antibiotics for these patients is a costly and risky practice, especially if the prescribing physician is unfamiliar with the patient’s condition or has not been trained to handle such patients,” said Dr. Richard R. Breen, an emergency medicine physician at St. Elizabeths Hospital in New York.
“It is not uncommon for doctors to dispense medications for free to patients with chronic medical conditions or when they have no choice but to do so.”
The new advice comes on the heels of a new federal policy, adopted in June, that requires hospitals to provide free antibiotic therapy to patients in critical need.
The move by hospitals and emergency medical services providers came in the wake of the discovery that at least 2,000 patients have died of MRSA infections in recent years in the United States.
And the new guidelines say hospitals and health departments should “not prescribe antibiotics for patients with a high risk” of developing MRSA or other STDs.
“Our guidelines call on hospitals and healthcare providers to prescribe antibiotics only for patients in urgent need of urgent care and for whom there is a reasonable chance of survival, including patients with an infection or suspected infection,” the authors write.
“When these conditions are considered in isolation, physicians should prescribe antibiotics in a medically appropriate way for all patients.”
The guidelines also suggest that healthcare providers do not take patients off antibiotics “unless it is clinically indicated” or if they are experiencing a severe and life-saving complication, including anaphylaxis, pneumonia, or kidney failure.
“In these situations, healthcare providers should be mindful of their medical judgment, take the time to understand the patient and their symptoms, and determine how they might benefit from antibiotic treatment,” they write.
The guidelines are part of the American Emergency Medical Association’s efforts to promote patient-centered care and prevent the unnecessary use of antibiotics.
“The AMA believes that the best way to reduce the burden of infection is to reduce unnecessary antibiotic use,” said AMA President Jeffrey A. Schauffman in a statement.
“In this effort, the AMA has created new guidelines that encourage hospitals and other healthcare providers not to prescribe or administer antibiotics for the purpose of treating a patient with MRSA infection or to treat a patient for other serious health conditions, including for non-infectious COVID-19-related complications, such a pneumonia or hemolytic uremic syndrome.”
The AMA has urged healthcare providers and other health professionals to recognize that they must take a proactive approach to controlling infection.
In the past year, the federal Centers for Disease Prevention and Control (CDC) has reported that the U.S. death toll from COVID has surpassed 1.3 million.
That has prompted calls for more research and more aggressive efforts by healthcare providers.
“With the increased use of COVID drugs, more patients are dying every day,” said Robert K. LeBlanc, president and CEO of the National Healthcare Federation.
“These guidelines are the first step toward increasing awareness about the importance of antibiotic stewardship for healthcare professionals and patients.”
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