Thursday, October 15, 2009
Cheaper medical care is not always the best medical care

By Dr. Anthony Policastro
There are many ways to save money in our current health care system. There are also some situations where spending more money makes sense. A good example is prescription drugs. One of the biggest problems that we face with prescribed drugs is related to compliance. This is the term that is used to describe if a patient is taking the drug exactly as prescribed. There are many things that affect compliance. The main one is related to the number of daily doses of a drug. The more doses a patient has to take, the more likely he/she is to forget a dose. Thus, it is sometimes better to prescribe a more expensive drug that is given fewer times per day. That will increase the patient's likelihood of taking the drug as prescribed. Another is related to how complicated the prescription is. There are some drugs that should be taken with meals, others between meals. There are a variety of other complicated regimens. The more complicated the prescription the less likely it is to be followed. Therefore, it might make sense to prescribe a more costly drug that is easier to take. A third is the form of the drug. In pediatrics we frequently use liquids because children cannot take pills. There are some drugs that are applied to the skin, others like insulin need to be injected. Each form of a drug presents its own problems. Sometimes it might make sense to prescribe a more expensive drug in a form that you know the patient is more likely to take. A fourth issue is related to how many pills to take. The easiest way to take medication is to limit the number of pills that must be taken. For example, my blood pressure medication has two blood pressure lowering drugs in it. If I had to take them separately, it would be more complicated. I might take the wrong drug, take too much of one drug or forget one of the drugs. There are a variety of issues that would lead to a compliance problem. Thus, it might be more expensive to take a single drug. I recently had a good example of this problem. I had a patient on 81 mg a day of a drug. I started the drug in May. The patient was taking three 27 mg tablets. It was a single drug every morning. The prescription was refilled that way in June, July and August. I wrote the September refill. The pharmacy tried to put it through however, the insurer refused it and I had to call them. They explained to me that I needed to change the prescription. They would only approve it if I gave one 54 mg tablet plus one 27 mg tablet. That would save them approximately $100 per month. While I understand some of their logic, their view was somewhat short sighted. I had a successful treatment program for a child with ADHD. They were now going to change that program. They were assuming that the patient would be just as compliant. They were assuming that there would be no drug errors associated with it. We all know what the word assume means. I assume that the insurer has the patient's best interest at heart. I guess they assume that the patient's best interest is the cheapest route for them. Less expensive medical care is a good goal. In many cases cheaper medical care is better medical care. However, cheaper medical care is not always the best medical care.

Case Management team honored In honor of National Case Management Week (Oct. 11-19), the Case Management Department at Nanticoke Memorial Hospital would like to express their gratitude for allowing them to help provide the best coordination of care to their patients. The Case Management team at Nanticoke Memorial Hospital consists of registered nurse case managers, social work case managers, a community health outreach coordinator (CHAP), and a prescription assistance coordinator. Their primary jobs are to assess the appropriateness of medical treatment during admission to the hospital and to continue to assess treatment throughout the patient stay. They strive to establish appropriate treatment plans specific to each patient's needs by meeting with an interdisciplinary team of care providers to establish individualized plans of care.

Seasonal flu shots offered It's time to get your seasonal flu shot.Influenza is a serious disease that affects many people, including the elderly and those with long-term health problems. Nanticoke Memorial Hospital will be offering seasonal flu shots to individuals 18 and older at Nanticoke Occupational Health, 743 Shipley Street, Suite F, Seaford, from: 9 a.m. - 12:30 p.m. and 4 - 7:30 p.m. on Wednesdays, Oct. 21, Oct. 28 and Nov. 4; and 9 a.m. - 1 p.m. on Fridays, Oct. 16, Oct. 23, Oct. 30 and Nov. 6. Cost is $10 per adult. Medicare Part B billing is available with proof of Medicare insurance. Pre-registration is required. Call Nanticoke Occupational Health at 629-6875 to pre-register and schedule an appointment.

New Hope Holiday workshop Delaware Hospice invites area children and teens who have lost a loved one to a New Hope Holiday Workshop on Tuesday, Oct. 27, from 6-7:30 p.m. at the Delaware Hospice Center, 100 Patriots Way, Milford. Participants will complete a holiday ornament in remembrance of their loved one, learn helpful coping skills to deal with the upcoming holidays and meet other children who have had the same experiences that they have. The Holiday Workshop is free and open to the community, thanks to the generous support of donors and volunteers. Registration is required. To register, call Lezley Sexton, 302-856-7717, ext. 3104, by Oct. 19.

Bereavement support group A new bereavement support group will begin at Nanticoke Cancer Care Center on Tuesday, Oct. 20, at 10 a.m. Compassionate Care Hospice's Bereavement Coordinator, Mary Van House, will facilitate the monthly support group called, "The Next Step," in the conference room on the second floor of the Nanticoke Cancer Center. This group focuses on issues of loss that continue beyond the early stages of grief and is open to family members and friends who have lost a loved one to cancer or other causes. The group will continue to meet on the third Tuesday of each month at 10 a.m. To register for this free program, call Lisa at 629-6611, ext. 2378. For more information, call Mary Van House at 302-934-5900.

Video conference at Nanticoke Thanks to live video conferencing technology, members of the Delaware Chapter of the National Multiple Sclerosis Society can stay close to home and still take part in the chapter's annual meeting on Saturday, Oct. 24, at the Ammon Medical Education Center on the campus at Christiana Hospital in Newark. For the first time, the video conference will include participants at a satellite location at Nanticoke Memorial Hospital in Seaford. Like the participants in Newark, Sussex County residents who attend the satellite location will also receive lunch, take part in the chapter's annual meeting and recognition awards ceremony, and enjoy a client-focused discussion about MS research. Cost is $5 per person, and anyone who wants to attend must register by Friday, Oct. 9, either online at or by calling 302-655-5610.

Professional Caregiver Retreat Day Delaware Hospice's Family Support Center invites all those who work or volunteer in a helping profession to attend the Professional Caregiver Retreat Day on Friday, Nov. 13, from 8:30 a.m. to 4 p.m., at the Delaware Hospice Center, Milford. Dr. Judy Pierson, licensed clinical psychologist, published author and dynamic speaker, will discuss topics such as: the cost of caring–assess your own well-being; understanding vicarious trauma and compassion fatigue; strategies for coping with the stress of this work; and creating your own personal self-care plan. The retreat is $99 per person (continental breakfast and lunch included). Application has been made for 6.0 continuing education hours for social workers and nurses. Participants will leave with information about the impact of their work, specific coping techniques, and a strategy for improving their work life tomorrow. Due to space limitations, early registration is recommended. To register and for more information, call Vicki Costa, associate director of the Family Support Center, 302-856-7717, ext. 1129.

Hospice offers Grief Support group Delaware Hospice is offering an eight-week group meeting for adults who have experienced the death of a loved one. The group will meet Wednesday afternoons from 5 to 6:30 p.m., beginning Oct. 14 through Dec. 2, at Nanticoke Memorial Hospital, 801 Middleford Road, Seaford. Find out what normal grief "looks" like; learn about the "tasks of mourning;" identify your coping style and develop coping skills that feel right for you; share as much or as little as you would like. This activity is provided free to the public by Delaware Hospice; however, registration is required. To register, call Paul Ganster at 302-357-7147.

Delaware Hospice Grief Retreat Delaware Hospice's Family Support Center will hold a two-day Grief Retreat on Saturday, Oct. 31, from 10 to 3 p.m., and Sunday, Nov. 1, from noon to 3 p.m., at the Delaware Hospice Center, 100 Patriots Way, Milford. The retreat will be facilitated by Dr. Judy Pierson, licensed clinical psychologist. Admission is free and open to the public; however, registration is required due to space limitations. For more information and to register, call Vicki Costa, associate director of the Family Support Center, at 302-856-7717, ext. 1129.

Depression Support Group There is a free bimonthly Depression Support Group meeting in Laurel on the second and fourth Wednesday evenings from 7 to 8:30 p.m. Any person who has signs and symptoms of depression and is under the care of a professional counselor/MD is welcome to attend. To register, call Life Matters Counseling and Consulting at 302-465-6612.

Pampered Chef to benefit Hospice Delaware Hospice will benefit from a Pampered Chef fundraiser cooking show, organized by Karen Rogers, Pampered Chef senior consultant, at the Delaware Hospice Center in Milford, on Monday, Oct. 19, at 5 p.m. Delaware Hospice will receive 25% of sales exceeding $600 to benefit its programs and services to the community, including additional 10% bonuses at various sales levels. Orders to benefit Delaware Hospice will be accepted through October 26 at 5 p.m. Orders specifying "Delaware Hospice" may also be placed at For more information or to register, call 856-7717.

Insurance offers vaccine coverage Blue Cross Blue Shield of Delaware, Aetna, Coventry Health Care and AmeriHealth have voluntarily agreed to offer coverage of the H1N1 vaccinations for their covered policyholders. The Centers for Disease Control and Prevention expects to have 45-52 million doses of H1N1 flu vaccine available for distribution by mid-October, then more available weekly to total up to 195 million doses by year-end. According to Jay Butler, M.D., director of the CDC's H1N1 Vaccine Task Force, health care providers will order the vaccine through their states, which will coordinate with CDC and receive the vaccine and related supplies from a central distributor.

LDAF plans Blue Jean Ball The Lower Delaware Autism Foundation's Blue Jean Ball Fall Art Show is slated for Friday, Oct. 23, at Nassau Valley Vineyards in Lewes. The theme encourages guests to wear blue jeans and bling while enjoying an evening featuring the sale of original works of art from over 20 local artists. The night offers a live art auction and sale, catering by Espuma Restaurant & Martini and Porcini House & Treetop Lounge, open bar and the live sounds of local favorite Love Seed Mama Jump. Tickets are available for $75 online at or by calling 644-3410. This year the committee has decided to auction off a pair of tickets to see Robin Williams live at the Borgata in Atlantic City on Saturday, Nov. 28. For more information, call Mary Landon Green, Program and Event coordinator, at 644-3410 or visit