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Do we take the medication that doctors prescribe for us?

Ignacio Aznar Lou, Parc Sanitari Sant Joan de Déu; María Rubio Valera, Parc Sanitari Sant Joan de Déu
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Non-initiation of courses of treatment prescribed by general practitioners has an economic impact of up to 44.5 million euros a year in Catalonia alone. In a study of 1.6 million patients and 2.9 million prescriptions, it was found that 17.6% of the medication prescribed for the first time was never collected. The results show that patients who do not start treatment spend less on medication, but their economic impact on society is higher due to longer periods of sick leave and increased use of emergency healthcare services.
Key points
  • 1
       The study found that non-initiation was more frequent among young men, people from the Americas and people starting symptomatic or acute treatment.
  • 2
       One in five prescriptions for painkillers was not collected. This percentage was noticeably lower in the case of drugs used to treat hypertension or heart failure, as patients regard these as serious conditions.
  • 3
       The most alarming figures are related to drugs for treating chronic conditions such as diabetes and depression. One in ten prescriptions for insulin or antidepressants is never collected from the pharmacy.
  • 4
       The patient’s decision is also largely dependent on their relationship with and level of trust in their doctor. Seeing a practitioner other than their own GP or at a health clinic where resident doctors are trained increases the likelihood that a patient will not begin their course of treatment.
How much do courses of treatment that are never begun cost the public health system? On average, €165 per patient
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According to the results, patients who do not begin their course of treatment save on drugs, make fewer visits to their health clinic and undergo fewer medical tests. Consequently, they generate lower healthcare spending. However, their overall economic impact is higher due, for example, to longer periods of sick leaves (an average difference of 2.5 days) and to home visits by doctors or nurses. These figures indicate a worsening of the patient’s state of health, which may ultimately lead to longer courses of treatment that will probably result in the consumption of more medical resources and longer sick leave.

It has not been possible to evaluate the impact of chronic diseases such as hypertension, as complications in this type of illness do not appear until later, within a period of between five and ten years. This explains why only insignificant differences are found when estimating the impact on costs of non-initiation of treatment for chronic conditions.

The impact is probably higher

Costs related to the inability to work, borne by companies, mutual societies, the Social Security System and others, must be added to the economic losses to the healthcare system occasioned by the use of more expensive services. This study was unable to assess the use of hospital services such as inpatient admissions, treatments and visits to accident and emergency departments. If these figures were taken into account, the financial cost of patients’ decisions not to begin their course of medication could be higher still. The calculated impact could also be higher if data were available on the effect of non-initiation of treatment among the population without job contracts, including the many self-employed people, as well as the population engaged in not-for-profit activities, such as students and pensioners.

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