All posts by Dr. Lee

Happy New Year!

Happy New Year!  The new year comes with a host of challenges and opportunities.  I would like to cover just a few.

New Insurance

Many will have new insurance with new deductibles and new pharmacy benefit managers.  Likewise, networks and deductibles may have changed as well.  We encourage you to bring your new insurance cards to your first visit of the new year.  It is also important to be ready to pay for your visit with cash or credit because many deductibles reset in the new year.  It is also helpful to bring in your formulary so we can prescribe to most cost-effective medications.  Many insurances have contracted with different pharmacies which means you may need new prescriptions sent to new pharmacies.

Influenza

No, it is not too late to have an influenza vaccine.  Despite reports questioning the efficacy of our current vaccine, it is still the best way to prevent influenza and avoid life threatening complications like pneumonia.  The CDC is reporting a sharp uptick in the incidence of influenza and influenza like illness.

Influenza A represents about 86.7% of illness, with Influenza B accounting for the remaining 13.3%.  Of the strains of Influenza A, the more virulent H3 strain predominates over the H1 strain by a ratio of 10:1.

Tamiflu is still the drug of choice for confirmed illness.   It works best when started within 48 to 72 hours of the onset of symptoms.  The CDC is not recommending prophylactic treatment of household contacts.  A flu vaccine is still the preferred management for the flu season, especially given to cost of Tamiflu and potential drug shortages too.

Wellness

Increasingly, insurance companies are upping the ante to encourage full participation in all recommended wellness screening.   This includes Annual Physicals, attention to obesity, smoking cessation, and regular screening for specific disease states, like colonoscopy for colon cancer, mammograms for breast cancer, bone density testing for osteoporosis, and blood work to screen for high cholesterol and diabetes.  Failure to abide by these screens in some cases may trigger letters from insurance companies.  Make plans now to have your Annual Physical, or for those in Medicare, an Annual Medicare Wellness exam.

In future blogs we will talk about new innovations in many areas of medicine and how Unifour Family Practice is working on your behalf to bring you the “state of the art” in primary care.

Our wish for you is to have a happy, healthy, and very blessed new year.

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Minimizing Adverse Drug Events in Older Patients

We live in a very therapeutic society, meaning, a lot of people are taking a lot of medications. Inevitably, there is concern about drug interactions, side-effects of medications, and even compliance with medications.
As you age, you body’s ability to metabolize and clear drugs changes. The two main routes of excretion of medicines are either through breakdown in the liver or clearance through the kidneys. Any disease process that affects your kidney or liver function can have an impact on how long medications stay in your system, which can lead to unwanted side-effects. Likewise, two drugs can compete for the same metabolic pathway, which can cause slower metabolism and longer effective duration of action, again leading to side-effects.
Studies show that once your total number of medications rises above 5 per day, the likelihood of an adverse drug event rises significantly. This is particularly concerning for the elderly, especially when using medications for anxiety, sleep and bladder control that can cross the blood-brain barrier and lead to an increase risk of falls, fractures and delirium.
Insurance companies are quick to encourage physicians to prescribe with the Beers Criteria in mind. The Beers Criteria is a compilation of medications that have the potential to lead to significant safety concerns in the elderly, such a falls and delirium as mentioned above. For this reason, we are encouraged to avoid several classes of medications in the elderly, like sedating anti-histamines, certain types of sleep aides, like zolpidem, benzodiazepines like valium, lorazepam and temazepam, and certain classes of bladder control medications that can lead to confusion and falls. Insurance companies my refuse to pay for medications on the Beers list, or require a PA (Prior Authorization) so they can be assured of the medical necessity of these medicine.
With any medication, we want the risk/benefit ratio to tilt decidedly toward benefit, but we also have to be vigilant for any problems. At each office visit, we will ask how you are tolerating your medicines, and take special care to use the Drug-Interaction software in our electronic health record to alert us to any potential drug interactions. We will try to prescribe with the Beers Criteria in mind too.
We want you to be fully informed about all aspects of your health including the name, purpose, and potential side-effects of all our medicines. You can help the process by bringing all your medicines to each office visit, even if they are prescribed by other specialists in the community.
As always, your health is our number one priority.

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