Insurance Company Causes Negative Patient Outcome

Many patients get medication management suggestions from their insurance companies addressed to their primary physician.  A patient who had diabetes and CHF was not on an ACE Inhibitor or an ARB which are commonly recommended as standard of care for hypertension and these coexisting conditions.  In following this patient, there were records that an ACE inhibitor had been tried in the past and had been discontinued due to hyperkalemia (elevated potassium).  The patient had recently switched to a new physician who received the letter and proceeded to put this patient on Lisinopril.  Sure enough, after checking some lab work, the lisinopril was causing hyperkalemia again and was discontinued.  A few questions I’d like to get some interprofessional thoughts on: 1. Should the new provider have caught this and are they totally responsible?  2. Should the adverse effect have been noted in the allergy/intolerance list – Many adverse effects in my experience are not added to this list? 3.  Did the insurance company letter set the patient/prescriber up for this negative outcome and should insurances send out these letters?

Written By Eric Christianson

May 28, 2014

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