American consumers spent $208.1 billion on prescription drugs in 2006, and $38 billion of this total was represented by metabolic drugs, including cholesterol-lowerers and treatments to control weight and diabetes, according to new government figures.

Other top-spending categories were: - cardiovascular drugs, including diuretics, blood pressure treatments and products to control heart rhythm problems, on which Americans spent $33 billion during the year; - central nervous system drugs including analgesics - $28 billion; - psychotherapeutics, including antidepressants - $17.5 billion; and – hormone treatments - $14 billion.

Overall, these five categories accounted for more than 60% of total consumer spending on prescription drugs during the year, according to the latest data from the Agency for Healthcare Research and Quality (AHRQ). While this is 2006 data, the rankings have remained generally constant in recent years, although these latest figures show hormone products replacing gastrointestinal (GI) drugs in the rankings, which could be due to more GI treatments becoming available over-the-counter (OTC), say the analysts.

Patients need full info to avoid hospital returns
The AHRQ has also published the results of a new study which show that patients who have a clear understanding of their after-hospital care instructions, including how to take their medicines, are 30% less likely to be readmitted or visit the emergency department than patients who d not have this information.

Total per-patient costs - actual hospitalisation plus estimated outpatient costs – were $412 lower on average for patients who received complete information than for those who did not, adds the study, which is published this month in the Annals of Internal Medicine.

Currently, one in five patients has a complication or an adverse event, such as a drug interaction, after being discharged from the hospital, the study found. One reason for this is a lack of understanding about their follow-up care, for example which medications to take, and while this information is contained in the standard discharge summary, previous studies have shown that hospitals often do not make this document available to patients’ primary care doctors in a timely fashion.

The researchers, from Boston University, tested the effects of a multi-faceted programme, the Re-Engineered Hospital Discharge Program (RED), which used specially-trained nurses to help one group of patients arrange follow-up appointments, confirm medication routines and understand their diagnoses using a personalised instruction booklet. A pharmacist contacted patients between two and four days after hospital discharge to reinforce the medication plan and answer any questions.

30 days after they where discharged from hospital, the 370 patients participating in the RED programme had 30% fewer subsequent emergency visits and readmissions than the 368 patients who did not. 94% of those participating in the RED programme left the hospital with a follow-up appointment with their primary care physician, compared to 35% for patients who did not participate, while 91% had their discharge information sent to their primary care physician within 24 hours of leaving the hospital.

However, making medication review available to patients did not prevent problems, the researchers noted. 65% of the RED participants who completed a medication review with the pharmacist had at least one problem with their drugs, and in half of those cases, the pharmacist needed to take corrective action such as contacting the patient’s doctor.