Home Profile Bridging the inpatient-outpatient gap

Bridging the inpatient-outpatient gap

February 2008

Published in the February 2008 issue of Today’s Hospitalist

HOSPITALIST SARAH CUTRONA, MD, MPH, is used to a balancing act, dividing her work week between clinical care and research.

Now 32 years old, Dr. Cutrona is the lead author of research that appears in this month’s American Journal of Public Health. The study, which is the first national analysis of how free drug samples are distributed, found that most samples go to affluent and insured patients instead of those in greater need.

“The samples are really not decreasing the inequity in the health care system,” says Dr. Cutrona, who practices at the Somerville, Mass., campus of Cambridge Health Alliance. She spoke with Today’s Hospitalist:

Drug samples are billed as a safety net for uninsured patients, yet your research found that samples go predominantly to patients who can afford prescriptions.

Our study does support the idea that doctors are trying to target the neediest patients. But there are society-wide factors that determine access to care that also target samples to more affluent, insured patients.

As a hospitalist, why did you focus on a topic that seems more relevant to outpatient physicians?

Any outpatient medication issue affects us because we get the patients when things go wrong, and samples can pose a lot of problems related to adherence and safety.

Samples bypass any review from pharmacists, so they can have potential adverse effects such as drug/drug interactions. And samples make it harder for patients to pass on an accurate medication list when they’re admitted to the hospital.

How did you get interested in the topic?

As a resident, I had a patient come in with bradycardia. It turned out he was taking the wrong dose of a medicine used for blood pressure that can slow the heart. He was taking it from a sample, which didn’t come with any instructions.

Are you finding many opportunities for inpatient research?

A lot of sites now encourage inpatient research, particularly in quality improvement, and that sounds really interesting. I think I’m unusual in that I split my week between patient care and research. Most researchers who also practice tend to do clinical work in chunks of two or four weeks at a time.

What other research do you plan to tackle?

One topic I’m looking at now is medication adherence, which “like free sample use “affects both outpatient and inpatient practitioners. Poor medication adherence as an outpatient can exacerbate a chronic disease and lead to a hospital admission.