Da. Redelmeier et al., THE TREATMENT OF UNRELATED DISORDERS IN PATIENTS WITH CHRONIC MEDICALDISEASES, The New England journal of medicine, 338(21), 1998, pp. 1516-1520
Background Patients can have several illnesses concurrently, yet some
of these diseases may be neglected if one problem consumes attention.
We conducted a population-based analysis in Ontario, Canada - where un
iversal health insurance is provided - to determine whether unrelated
disorders are less likely to be treated in patients with chronic disea
ses, Methods We studied the 1,344,145 residents of Ontario in 1995 who
were 65 or older and eligible to receive prescription medications fre
e of charge as part of the Ontario Drug Benefit program. Patients with
diabetes mellitus were identified by prescriptions for insulin, pulmo
nary emphysema by prescriptions for ipratropium bromide, and psychotic
syndromes by prescriptions for haloperidol. For each chronic disease,
we selected an unrelated treatment: estrogen-replacement therapy for
patients with diabetes mellitus, lipid-lowering medications for those
with pulmonary emphysema, and medical treatment of arthritis for those
with psychotic syndromes. Results The 30,669 patients with diabetes m
ellitus were less likely to receive estrogen-replacement therapy than
the other subjects in the study (2.4 percent vs. 5.9 percent, P<0.001)
. The disease was associated with a 60 percent reduction in the odds o
f estrogen treatment (odds ratio, 0.40; 95 percent confidence interval
, 0.37 to 0.43). Findings were similar for the 56,779 patients with pu
lmonary emphysema, who were less likely to receive lipid-lowering medi
cations (odds ratio, 0.69; 95 percent confidence interval, 0.67 to 0.7
2; P<0.001), and the 17,336 patients with psychotic syndromes, who wer
e less likely to receive medical treatments for arthritis (odds ratio,
0.59; 95 percent confidence interval, 0.57 to 0.62; P<0.001). Conclus
ions In patients 65 or older who have chronic medical diseases and who
receive prescription medications free of charge, unrelated disorders
are undertreated. Clinicians caring for patients with chronic diseases
should remain alert to other disorders and minimize the number of mis
sed opportunities for treating them. (C) 1998, Massachusetts Medical S
ociety.