German children and seniors swallow too many pills
The Barmer GEK published the 2013 Medicines Report 2013, which evaluates data from 2.1 million insured persons over a period of 65 years. “We have found many reasonable care structures. We have also found the use of many sensible and safe-acting medicinal products, but we have also found excessive and incorrect care, ”summarizes health care researcher Prof. Gerd Glaeske, summarizing the findings of the investigation. The biggest problems in the German pharmaceutical landscape are, on the one hand, the polypharmacy of older insured persons and, on the other hand, the increased number of prescriptions for antipsychiotics in children and adolescents.
Older people suffer from polypharmacy Polypharmacy is mentioned when more than five active pharmaceutical ingredients are used every day. According to the 2013 drug report, this problem affects a third of all insured. Half of the elderly aged between 80 and 94 are affected. "On average, men over 65 years of age take 7.3 active substances a day, for women in this age group it is 7.2", writes the Barmer GEK. Glaeske emphasizes: "In pharmacology we speak of the fact that one can tolerate three to four active ingredients relatively well."
The reason for this oversupply is the fact that over 65-year-olds have an average of four doctors: a general practitioner, an ophthalmologist, an orthopedic surgeon, and a gynecologist in women and a urologist in men. They would prescribe multiple medications each. The polypharmacy is "an indication that there is a regular lack of coordination between the doctors," explains Glaeske.
According to Rolf-Ulrich Schlenker, deputy chairman of the board of the Barmer GEK, the risky multi-medication could be prevented by electronic means. He emphasizes: “We urgently need the electronic insurance card. We urgently need the electronic prescription. And we also need the electronic patient card as a matter of urgency. ”His criticism hereby applies in particular to medical officials who have been resisting its introduction for years. They should finally give up their negative attitude, said Schlenker. "It must finally end with the blockade policy of well-known medical officials against a modern telematics infrastructure," writes the Barmer GEK. She recommends that older people “have their medication checked for interactions in the pharmacy”.
Use of antipsychiotics in children increases dramatically The development of prescription numbers of antipsychiotics in children and adolescents appears just as dramatic. They rose by 41 percent between 2005 and 2011, according to the 2013 drug report. "The growth is mainly caused by newer drugs (+ 129 percent)", while the prescription figures for older drugs are slightly down. A closer look at the affected age groups shows a clear picture: “In toddlers up to four years of age, doctors hardly prescribe antipsychotics. For all others, the number of prescriptions increases, especially among the 10 to 14 year olds, ”said the Barmer GEK. This increase is particularly problematic because, according to Glaeske, no medical explanation can be derived. The Barmer GEK explains: "Studies have neither shown an increase in psychiatric disorders in children and adolescents, nor have the relevant therapy recommendations changed."
"And if that doesn't work with retalins and similar medicines on their own, then you suddenly seem to be adding very strong sedatives," Glaeske tries to explain. In this way, the children apparently wanted to adapt to the social framework in which they live. The problem is that antipsychiotics sometimes have serious side effects. According to Glaeske, this includes headaches, insomnia and weight gain. In addition to psychopharmaceuticals, a third of the children are also given anti-ADHD drugs, despite the fact that the diagnoses are not serious - an unexplained problem for the researchers involved.
Pharmaceutical companies refer to PRISCUS list and FORTA classification The association of research-based pharmaceutical companies calmly countered these allegations. The increasing risk of diseases such as high blood pressure, stroke or osteoporosis with age causes the greater number of drug treatments, according to a statement. "It is a blessing for patients that one can now treat these diseases with medication or prevent them." However, the pharmaceutical association also points out that particularly great care is required in older people. "The simultaneous use of several medications must be carefully planned so that there are no avoidable interactions between preparations that lead to the therapy not working sufficiently or being poorly tolerated."
Possible interactions can often be derived from the "active principles and degradation processes of the medication", as a further measure these would be tested in clinical studies. In addition, the interactions that occur are generally known interactions, only “rarely are they still unknown effects in medicine”. In order to support doctors in the treatment of older patients, physicians had also created aids such as the PRISCUS list and the FORTA classification. "Both guidelines are designed to ensure that older patients receive good treatment and avoid unnecessary risks." The pharmaceutical association hopes that these aids will be used more in the future. (lb)
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