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Record keeping may be responsible for prescription spike

By C. Todd Lopez

WASHINGTON (March 31, 2010) -- A change in record keeping methods may be partially responsible for a spike reported in prescription drug use among Soldiers, said the Army surgeon general.

Department of Defense data shows that prescriptions for painkillers to military members have gone up by four times since 2001 -- from just under 900,000 in 2001, to nearly 4 million in 2009.

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Surgeon General of the Army Lt. Gen. Eric B. Schoomaker and Dr. Charles Rice, performing the duties of the assistant secretary of defense, Health Affairs, spoke March 24 during a hearing before the Senate Armed Services Committee subcommittee on personnel. They said that some of that increase in painkiller prescriptions may be due to changes in the in the way the Army tracked those on prescription drugs.

The general said that between 2001 and 2006, changes in a Soldier's status, from active-duty to retiree, for instance, could change the way his prescription drug use was counted. When a Soldier retired, their entire prescription drug use history recorded in the Department of Defense Pharmacy Data Transaction Service became marked as belonging to that of a retiree -- so historical numbers for prescriptions to active-duty Soldiers were not accurately reflected.

"Everything attributed to his active-duty time -- or her active-duty time -- would have disappeared from the active-duty roster," he said.

In 2007, the general noted, the Pharmacy Data Transaction Service changed the way it tracks the use of prescription drugs to more accurately record actual usage. Now, a Soldier's prescription drug use while on active duty will always reflect that the prescription was written for an active-duty Soldier.

"We're looking at trends from 2007 and beyond as being much more accurately reflecting the trends in use," he said. "And there is no question ... we are all concerned about the amount of use of drugs and the stress on the force that this reflects. But the increase is not quite as marked as the data would suggest there."

The general also discussed Army efforts to expand "healthcare product lines," including the expansion of clinical space in 14 areas across the United States. In those places, he said, the Army is establishing "community-based primary care clinics" by leasing and operating clinics located in off-post communities that are close to where active-duty families live.

"These clinics will provide a patient-centered medical home for families, an effort which is warmly embraced and resourced by all three of the medical services in the military health system," he said.

The Army is also engaged in an effort to educate Soldiers about mild traumatic brain injuries, mTBI for short -- and commonly called concussions.

"Army leadership is also engaged in an all-out effort to change the DoD culture regarding mild traumatic brain injury," he said.

The general told senators that TBI encompasses a wide spectrum from concussion to penetrating head injuries, for instance. But the Army is focusing on concussive injury, which is the most common.

"Every warrior requires appropriate treatment to minimize concussive injury and maximize recovery," he said. "To achieve this goal we are educating the force so as to have a trained and prepared Soldier, a leader, and our medical professional and personnel to provide early recognition, treatment and tracking of these concussive injuries."

Also, the general said, the Army is issuing standards to healthcare providers and commanders to include an automatic "grounding" and medical assessment of Soldiers who meet certain injury criteria.

"The end-state of these efforts is that every servicemember sustaining a possible concussion will receive early detection, state-of-the-art treatment, and return-to-duty evaluation with long-term digital health record-tracking of their management."

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