One Dose Fits All?

You have high blood pressure. Your uncle has high blood pressure. Both of you, despite differences in age, weight, actual BP readings, and many other characteristics are dosed in a very similar way. Does this really make sense?

Another good example of this is blood donation. Blood is donated in single pints, regardless of the biology of the donor. This means that a 238lb football player is donating the exact same amount of blood as the 106lb cheerleader or, more alarmingly, the 65 year old grandmother.

Why does this happen? Common wisdom says that it is because patients who need blood receive it one pint at a time. It’s simply easier for everyone if the rate at which blood is donated matches the rate at which blood is distributed. It stands to reason, then, that medication is distributed with the same philosophy.

one dose fits allJust as the one-pint-fits-all strategy seems illogical in blood donation, providing a single level of dosage on medication for any person regardless of individual characteristics is also counterintuitive. Every patient that meets a set of rather narrow criteria is dosed the same way as thousands of others, without regard for unique circumstances.

Some things are on the horizon that could drastically change the way medication is dosed and administered. Look at the frontier of pharmaceuticals.

Monitored & Responsive Dosing

How much medicine a patient truly needs is determined by three basic variables: The patient’s size, the extent of the condition being treated, and the levels of medication already present in the body. A scale reports the first variable; provides the other services necessary. When all that data can be monitored simultaneously and fed back into the dosing system, care is more efficient.

Already in wide use with diabetics and patients with chronic pain, medication pumps are an area with great promise for reducing medication use. These conditions can fluctuate in terms of the amount of medication needed for control as patients use other techniques to manage their health.

As a result, no standard dosage is correct for every single administration of the drug. That opens the possibility of excessive medication use, leading to overdose conditions, or short-dosing, which permits the condition to endanger the patient’s health and life.

In time, we can expect medical devices that will monitor the patient’s body for a wider array of variables, then automatically give the patient the needed amount of appropriate medication for management. We’re already on the way there with medications that are administered via skin absorption (aka transdermal medications).

Transdermal Medications

Many different pharmaceuticals are administered through the skin today, utilizing a self-adhesive bandage that is impregnated with the medication. The drug moves through the skin at a calculated rate, providing a steady level of the medication in the patient’s body. This eliminates the surges and ebbs of medication levels through the day, providing better control of conditions and better patient comfort levels.

Patients can even receive a steady dose of medicine through the night, with no need to get out of bed for critical cardiac medicines. Fewer doses are missed or forgotten, stomach irritation is avoided, and patients have easier daily routines without the regular task of scheduling and counting out medication. Transdermal looks to gain more widespread implementation in the coming years.

Impact of the Affordable Care Act

For many years, uninsured or underinsured patients used a variety of strategies to stay on their maintenance medications without regular, expensive trips to the doctor. Large quantities of refills were written for them, and patients got those new bottles with little follow-up as to whether they needed to change or discontinue the medication.

Under the Affordable Care Act, more of these patients should be able to get appropriate care to ensure that they are managing their conditions appropriately and not simply continuing a years-long routine. The result can be lower rates of medication, better control of illnesses and chronic conditions, and reduced economic strain on patients with medical needs.

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