More than a decade ago, World Health Organization (WHO) identified medication non-adherence a problem of great importance. In a 2003 white paper, WHO states that the medication non-adherence rate for patients with chronic diseases in developed countries is a full 50%.1 George, et al. performed a systematic review in 2008 and determined complex medication regimens as a key root cause for medication non-adherence.2 Our previous posts in this blog speak to the many causes of adherence, and we have always posited “To get to the root causes we need to talk to our patients.”
Well, that’s exactly what a group of pharmacists from the Massachusetts College of Pharmacy and Health Sciences (MCPHS University) did, and are reporting in the March 2015 issue of The Consultant Pharmacist, the peer-reviewed journal of the American Society of Consultant Pharmacists.3 The authors noted that previous work has shown that older adults often had increasing difficulty in scheduling their medications as the number reaches seven or more, that only 18% of independent-living seniors reported that any health care provider worked with them to simplify their medication regimen, and that 40% of the time seniors did not even realize there was an option to work with their care team in streamlining medication use.4,5
The authors reported on the effects of a face-to-face Comprehensive Medication Review (CMR) between a pharmacist and a group of 75 independent-living older adults as part of an outreach program at a New England community senior center. While the CMR was comprehensive in nature, the patient encounter focused on two areas: 1) simplifying complex medication regimens and thereby improving adherence, and 2) educating older adults that medications can be an important risk factor for falls.
The study participants were presented with a Personal Medication List (PML) and a Medication Action Plan (MAP) that outlined opportunities for simplification of their medication use and were urged to contact their prescribers to discuss the pharmacist’s recommendations. Upon follow up, it was noted that there was a statistically signification reduction in the number of medications per patient and patients had reduced multiple daily dosing periods from more than six, to three or fewer. In addition, at follow up, study participants’ awareness of medications that could contribute to fall risk increased from 28% pre-survey to 56% post-survey.
These results are encouraging; we have often written about the value that pharmacists can bring to care teams, particularly for independent-living seniors and those seniors in assisted-living communities. Like most medication review, this was a” one and done” CMR encounter with patients who were only given an Action Plan and urged to contact their prescribers. How much more of a difference could we all make for our patients by introducing routine engagement by pharmacists with the rest of the care team to simplify complex regimens and identify and resolve medication related problems which pre-dispose older adults to falls and fractures?
We believe ActualMeds has a “secret sauce” for helping older adults in ambulatory settings who so desperately want to age in place with dignity and quality of life. The ingredients are professionals and technology which foster a team-based approach and a pro-active longitudinal personal engagement with patients and providers. This assures first, that we know what medications patients are actually taking, second that all medications are necessary and not harmful, and third that the regimen is designed to be as simple as possible. The ActualMeds solution can facilitate all of these critical elements by bringing the care team together with the right information at the right time.
Joseph Gruber, RPh, CGP, FASCP: Chief Clinical Officer, ActualMeds Corporation. Past President, American Society of Consultant Pharmacists. @jgactualmeds
1Sabate E, ed. Adherence To Long-Term Therapies: Evidence for Action. Geneva, Switzerland: World Health Organization 2003
2Geroge,J, et al: A systemic review of interventions to improve medication taking in elder patients prescribed multiple medications. Drug Aging 2008;25:307-24
3Bartlet, D. et al: Pharmacist Consultations: Simplifying Daily Drug Regimens and Providing Education on Fall Risk for Older Adults. Consult Pharm 2015;29:141-52
4Wolf, M.S. et al: Helping patients simplify and safely use complex prescription regimens. Arch Intern Med 2011;171:300-5
5Lakey, S.L. et al: Assessment of older adults’ knowledge of and preferences for medication management tools and support systems. Ann Pharmacother 2009;43:1011-9