Occam’s Razor and COVID-19 Hospitalization Rates

By JASON Z. ROSE

It’s amazing that the word “medication” is not mentioned in a recent Morbidity and Mortality Weekly Report from the US Centers for Disease Control and Prevention (CDC). The research states that a staggering 90% of people hospitalized for COVID-19 have underlying conditions, including hypertension, diabetes mellitus and cardiovascular disease, all of which require drug treatments for patients to remain healthy.

Yet nowhere in the report is there mention of how patients can potentially prevent COVID-19 related health decline through better medication use for their underlying disease.  Are the COVID-19 hospitalization rates truly caused by the underlying disease and insufficient use of preventive measures like social distancing? Or are these underlying conditions unmanaged due to medication optimization issues placing these patients at higher risk for hospitalizations? 

Medication optimization is how the healthcare system supports the patient from the initial prescription to follow up and ongoing review. It aims to improve the safety, effectiveness, and affordable use of prescribed drugs.

The invisible threat enabling the spread of COVID-19 that no one seems to be talking about is that barriers to medication use are accelerating infections for these high-risk populations. Buried within the “People Who Need Extra Precautions” section of its website, the CDC states people with high-risk for severe illness from COVID-19 are “people of all ages with underlying medical conditions, particularly if not well controlled”. Clearly, optimizing medications is one of the most important aspects to controlling chronic illness. Optimization supports patients through medication therapy that aims to improve safety, effectiveness, and affordable use of prescribed drugs.

Recently, there has been justifiable focus on social determinants of health (SDOH) being the cause of health disparities and poor outcomes. The catchy phrase has been, “It’s not the genetic code, it’s the zip code”. Moreover, US Surgeon General Dr. Jerome Adams recently said, “We know communities of color are particularly at risk for being impacted, because there’s a higher incidence of chronic disease, of diabetes, of heart disease and lung disease, but also because of what we call the social determinants of health, the opportunities that people have to be healthy.”

Certainly, these social circumstances are a material issue, but what if patients overcame these problems and could take their medications by evidence-based guidelines; would they really have been as susceptible to hospitalization and/or mortality?

Pharmacies need to step in and play a bigger role in this crisis, particularly those that provide pharmacy services to low income, underserved, disabled and elderly patients. These pharmacists understand social challenges and how to overcome barriers to health care and drug treatments for complex populations. 

In ‘normal’ times, just 50 percent of patients with chronic conditions take their medication as directed, and the estimated annual US cost of this impact is an astounding half a trillion dollars. These are not normal times. The radical societal changes of the past few weeks have upended the routines that these high-risk patients rely on for getting their critical medications. As more of our communities face quarantines, social distancing and increased unemployment, nonadherence is likely to get worse.

Hope is not a strategy — we cannot sit and wait for patients to reach out for help. Health plans have data that can be used to target patients most at risk. Plans should partner with pharmacies that take a proactive, data-driven approach and provide high-risk patients with medication and utilization reviews, improve patient health literacy and use specialized delivery services to ensure the medications are actually received.

Research has demonstrated that this more holistic approach not only leads to better patient outcomes, but it also reduces medical costs substantially. A study found that just a 1 percent increase in medication adherence among Medicaid enrollees reduces annual medical spend by $7.20 per member.

Occam’s Razor is the scientific principle with the thesis being, “the most likely explanation for an event is usually the simplest explanation”. William of Ockham, an English philosopher and theologian, sought to focus on answering problems using a theoretical razor that trims or shaves superfluous information.

If he were alive today, Ockham might have stated: “If medications are optimized for high-risk patients with underlying chronic conditions, COVID-19 related hospitalizations would be reduced.”

Jason Z. Rose, MHSA, is CEO of AdhereHealth, a healthcare technology company addressing the estimated $500 billion of unnecessary annual medical costs due to medication adherence issues.

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