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Simple strategies to help your patients manage their medications.
Drug therapies to treat chronic conditions have never been more effective, or more mind-numbingly complex. Patients battling life-threatening disease frequently pop a dozen pills per day to keep their bodies symptom free, not including any injectables or self-monitoring they may need to manage. Understandably, it can be tough for them to keep track of what to take, when to take it, and when prescriptions are set to expire - a particular problem for seniors who may be suffering a decline in cognitive function. "It's especially difficult if they go to multiple doctors," says Eileen McManus, office manager for Primecare Medical Practice in Oswego, N.Y. "When they call for a refill at the last minute we have to scramble to try to get it approved by the doctor and rush it to the pharmacy. They could go a day or two without their meds."
That creates a health risk for patients, of course, who can ill afford to stray from their medication regimens, but also a headache for your practice - which gets stuck putting out fires. A proactive policy that helps patients manage their meds can benefit all, says Rosemarie Nelson, a Medical Group Management Association consultant.
Start by training your intake nursing staff to review any medications patients say they're taking against what you have in their records, she says. "That should be done automatically, like weighing patients and asking about their symptoms," says Nelson. The interview process, in fact, is an important opportunity to keep their charts up to date. You may, for example, find that a patient no longer needs the Ambien he was prescribed two years ago, or that he has stopped taking a drug that he needs because he doesn't like the side effects. "If they're on blood pressure control meds, ask them if they're actually taking it," Nelson says, noting the doctor can adjust their regimen as needed.
McManus says the medication reconciliation process is an important part of patient check-in at her practice "At every visit, we review the medication list in their charts and update it if necessary," she says, noting discrepancies often arise if the patient was prescribed a medication in the hospital. That, then, necessitates a call to the hospital for their discharge summary, and a phone call to the patient to be sure "we're on the same page." To minimize last-minute refill requests, her office also makes it a point to ask every patient at check-in whether they need any refills.
Nelson notes you can also instruct clinical staff every morning to pull the charts, whether electronic or paper, for each patient who is scheduled. "Look at their medications and make note of which ones are about to expire," she says. Depending on your EHR, you may also be able to automate the process by running daily reports that flag any medications that are within 30 days of expiration.
In many cases, patients suffering chronic conditions rely on their spouse or adult children to help them manage their illness - especially elderly patients. As such, it's important to keep caregivers and family members in the loop, and make sure they have the required legal documentation to assist in their loved one's care, says Nelson. Where appropriate, e-mails regarding medication changes, refills, and upcoming appointments should be sent to the designated caregiver as well as the patient. "Those with cognitive issues absolutely need a patient advocate in the exam room and that advocate (family member or hired gun) needs to ask specific questions about risks," says Nelson. For example, what happens if the patient misses a dose? Should she skip it or double up on the next round? How can the caregiver reach the practice after hours if he has any questions? The inexpensive pill containers that can be prefilled for a day or a week make it easier for patients and their loved ones to determine if the patient took her medication on schedule.
Higher tech solutions are also useful. Most EHRs and practice management software enables practices to send prescriptions and refill orders electronically to the pharmacy, saving everyone a phone call. Practices that offer secure patient portals, through which patients can access their records and request refills, should also make a point of educating patients how to use them. "E-prescribing decreases the number of calls coming into the practice and the requests get handled in a more timely manner without all the communication back and forth between patient and pharmacy," says Julie Lineberger, administrator of the 10-physician Idaho Urologic Institute in Meridian, Idaho. "That allows the front desk staff to focus on the patient in front of them." The practice, which is switching to a new e-prescribing product through its practice management system, tells patients requesting refills to give the office 24 hours for processing, but Lineberger says her staff is instructed to process incoming faxes within three hours. The staff then alerts patients by e-mail or text that they've got a message waiting for them in their patient portal, letting them know when their order has been refilled.
Smartphone users should also be encouraged to utilize the latest mobile phone applications, including HealthPrize, MediRemind, and Pillboxie, which send text messages to remind patients that it's time to take their pills, and in what dosage, says Nelson. "The key is to have the practice staff, nurses who will be talking with the patients, feel comfortable with the app, because most likely they will be the 'help desk' for the patients who use it," says Nelson.
A final option that can reduce the number of calls between practice and patient is to give those patients who are eligible a full year's prescription, says Nelson. "The well-controlled patient taking blood pressure medication or a cholesterol medication who has an annual exam should be given their full year of prescriptions (four 90-day scripts) so no one has to call or take a call," she says. "If the patient uses a mail order, the practice can instruct the patient to simply use the automated refill request with the mail order supplier, which will electronically request the renewal from the practice and the practice responds electronically, saving multiple phone calls."
Medication management is a growing challenge for patients and providers alike. You can improve the quality of care at your practice, however, and ensure staff resources are used most effectively, by asking patients at every visit what they're currently taking, enlisting the help of caregivers, and relying on the latest technology.
Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via firstname.lastname@example.org.
This article originally appeared in the July/August 2012 issue of Physicians Practice.