Antipsycotics and foster care, continued

OK, I actually found this thread to be INCREDIBLY INTERESTING when I was ignoring the paper bag comments. I would like it if we could continue to discuss it, and make it a TROLL FREE zone by not responding to derailing comments. Mods, if this is inappropriate, I apologize, and please feel free to lock. It's just that there is so much potential in this discussion, it would be a shame not to have it.

I was especially interested in some of the solutions people were brainstorming to fix the problem of inappropriate prescribing of antipsychotics, especially to those who don't have as much say in their medical/mental health care. So far the two suggestions that seemed key were having more education on these drugs for GP's, since seeing a specialist is often out of the question for many people, and increasing the pay and training of staff in group and nursing homes drastically in order to avoid mass-prescriptions of drugs which may make things worse.

What do you see as a solution to the problem? What are your ideal vs pragmatic solutions? Are there other countries that handle this issue better, and why do you think that is? Would their system work in our country?

And seriously, if someone says something amazingly stupid or off topic, just DON'T RESPOND. Let's see what a thread looks like when only intelligent, honest, on-topic posts are addressed.

Thank you!
I would also love to have the opportunity to see people's ideas on solutions. This is heartbreaking.

I agree. But when it comes to kids, especially, how can this research be done in an ethical way? This is what it always comes down to. I honestly wonder if these foster kids/kids on medicaid ARE the guinea pigs.

Yeah, sort of. Doctors get their info on new drugs from drug reps. Pharmacists have to do continuing education throughout their entire career. In my experience, doctors are terrifyingly underinformed on medications, their correct uses, dosages and side effects. Want to get the real scoop on a drug? Talk to your pharmacist. I am not even allowed to talk to patients about side effects, recommendations, etc and I still have to do CE.
Case in point: pretty much every day, we get a prescription handed in that is written for a drug that doesn't exist. Seriously

yep, we call the doctor's nurse and say, "sooo...there's no such thing. didja mean something else? like something real?"

I think that's a really great point. I hope that such drugs will be available soon.

How do you feel we should deal with issues like over-prescribing and mis-prescribing of such meds?

I feel like part of the job of being a doctor is to keep yourself up to date on such issues. Not having a ton of time with your family is part of the package. It sucks, but if that's the price that needs to be paid so patients don't get meds that they don't need or don't do what they need, so be it. However, I don't think that's realistic. I feel like they could arrange weekly/monthly meetings that quickly go over new meds, so at least the docs know what's out there, what interacts well/poorly with what, etc.

I also think it would be a good idea to make someone's prescription list available in its entirety to any pharmacy which is filling their prescriptions, so they could catch if certain meds are being prescribed together that could cause problems.

Wow. Sounds like doctors and pharmacists should be working a little closer with each other. I noticed that at my clinic docs/nurses have to pick drugs from a drop list in order to get the prescription sent down to the pharmacy, so there's no way to prescribe something that doesn't exist/isn't available in their pharmacy.

Another thing I think is important to note is that if we had universal healthcare/everyone had affordable health care I would think that MORE people would go to the doctor regularly, which increases that chances that an individual would go to the same doctor for their yearly check-up and most illnesses. This could mean better care because the doctor, the clinic, the pharmacy are regularly dealing with the patient, and familiar with what's going on.

This. Being a doctor is not a 9-5 job. Unfortunately, there are really no requirements for doctors to stay up on current information regarding drugs (or anything else for that matter, with a few exceptions). There are for pharmacists, nurses, pharmacy techs, etc. But not doctors, the ones holding the prescription pad? This might be a good place to start.
As far as pharmacies knowing exactly what a person is taking, yes please! You have no idea how hard it is to get this information. Many people use not only more than one doctor but more than one pharmacy. And there are drug interactions that can kill you.
Also, can we please get rid of the wining and dining pharmaceutical reps? Their information is sometimes just flat out false. It's mini-lobbying. I can't stand when they come into my place of work and neither can my boss. Bad news is, no more Viagra travel mugs or Zovirax pens.

Because legally, even though a good pharmacy technician has a vast knowledge of drugs, side effects and interactions, it is still illegal for them to give any advice or make any suggestions to patients. Even about over the counter meds. And pharmacists are expensive.

What I find appalling is that it seems like most group homes don't have adequate counseling services. Fifteen minutes with a psychologist/psychiatrist isn't going to cut it, especially when you're in a group home (meaning you probably had a whole lot of fucked up shit happen to you already).

I also think that counseling should be more readily available at nursing homes. I'm not familiar with how much they get for counseling, but from what I've found (not scientific sources, more news) it seems like most nursing homes are barely bothering to pay their base staff a non-insulting wage for the amount of work they do.

not really...it's such a specific area and a specific and forgotten group. it doesn't even really help to overhaul the general healthcare system, because this deals with children's services and a "fuck it" attitude towards their well-being.

Mostly, this. Especially the competitive wage, although that is very much influenced by the cuts and availability of resources on the county, state and federal level. I tire of seeing the great ones go, as I might need to soon. But please, it's worth noting that not ALL residential care facilities have the same failures, completely.

Absolutely not! But unfortunately, the ones that foster kids end up in often do. I see it every day.

Overprescribed: The Human and Taxpayers' Costs of Antipsychotics in Nursing Homes

The Financial and Societal Costs of Medicating America’s Foster Children.

I know people tend to not read the informative links, but in case anyone wants to...

These posts are full of inaccuracies:

There are very specific and sometimes extensive continuing medical education requirements as well as continuous boardings. I don't know why that is even being discussed. Most doctors spend hours doing this every week and a minimum of about one is required a week (of in "class" or meeting or what have you didactics). Not to mention the hours spent at home reading journals and keeping up to date with studies, etc.

Furthermore, pharmacists do tend to have alerts to interactions (and do have entire prescribing lists), though I'm not sure how universal this is, most good places do. Pharmacists call the prescribing physician to double check before prescribing (that's part of why they train and don't just fill out blindly). In addition, in places with electronic medical records, as soon as you hit a drug with a potential interaction, a box pops up alerting the physician to the interaction that they have to legally verify having seen in order to prescribe (a lot of times "potential interactions" still need to be prescribed).

Lastly, transparency is a huge issue now, and most academic medical centers and anywhere with government (NIH) funding does not allow any compensation (dining, pens, etc.) for physicians from pharmaceutical companies. And it continues to trickle into other settings.

(Obviously none of those are entirely enacted or solved, but still...)