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Tips for avoiding adverse drug events in elderly and chronically ill populations.
Despite an increased national focus on medication management, coordinating and managing drugs for elderly patients and those with multiple chronic conditions presents numerous challenges for primary care physicians.
Patients 65 years of age and older metabolize medications differently than younger adults due to diminished kidney and liver functions. Additionally, elderly patients can be forgetful, and don’t always remember to take their medications in the right dose or at the right time. They may not remember the over-the-counter (OTC) medications they’re taking or fail to list medications prescribed to them from specialist providers, making it hard for the primary care physician to manage their holistic care and ward off any potential adverse drug interactions.
Similarly, patients being treated for multiple chronic conditions may see multiple providers, each lacking visibility into the full set of medications a patient is taking.
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These issues can be amplified if a patient fills their prescriptions at more than one pharmacy. Additionally, their adult caregiver at home can miss important information about their medications or give them OTC medications for common ailments that end up interacting with their prescription drugs.
Since the impact of adverse drug events can be significant-resulting in 1.3 million emergency department visits each year-identifying an approach to more coordinated and informed care for older patients and those managing multiple chronic conditions, such as diabetes, high blood pressure, or asthma becomes an important part of the patient care conversation.
That said, the primary care physician should be the center of this coordinated care effort. The physician-patient interaction is the most important element in ensuring medications are managed appropriately, making it less likely that a patient has an adverse drug event.
In doing so, there are several tactics that can be used to make a difference.
Encouraging openness, honesty, and inquiries. It’s widely known that patients don’t always share fully truthful or complete information with their provider. While that’s not necessarily a deliberate act, when patients sense they can trust their provider with information that will be received without judgment, they’re more inclined to share details about their lifestyle and medication routines. That information that could turn out to be highly relevant to their treatment. Encouraging patients or caregivers to write down questions and bring in the paperwork they receive when filling a prescription is a good idea. When the patient has questions, following up to ensure they understand the answer can help clarify the concern has been addressed.
Knowing the patients’ full medication list. Ask the patient to bring in their prescription bottles with them. Ask them to describe how and when they take the medication to make sure they’re properly following directions and to clear up any confusion. It is important to clarify that they should list any and all OTC medications or herbal supplements they may be using regularly or even occasionally.
Repeating the process during each visit. Repeating the step above each time the patient visits can expose any new medications or side effects the patient is encountering. Additionally, asking patients to describe any challenges they have with their prescription is also important and may help in uncovering any social determinants of health that may be impacting the patients’ medication regime.
Spending the right amount of time for the patients’ needs. It’s important to gauge which patients may need more time to have their questions answered, review their medications, and discuss their treatment plans. Doing so provides a triple benefit: ensuring the patient is informed, strengthening the doctor-patient relationship, and improving satisfaction all around.
Suggesting the patient fill all of their prescriptions at a single pharmacy. In doing so, the pharmacist becomes a more active, involved member of the care team. They can use available patient and pharmacological information, history, and data to highlight potential concerns before they become issues.
Using available tools, such as medication profiling, to help provide insights that the patient otherwise can’t. Working with a medical laboratory that offers screening specifically for chronic care conditions, as well as blood tests or urine drug tests to detect the presence of medication can give physicians additional answers they need to intervene on the patient’s behalf. With objective laboratory drug testing, physicians can objectively reconcile polypharmacy medications prescribed to patients, monitor medication levels to improve dosing, reduce the likelihood of adverse drug reactions, and decrease the cost of medical expenses related to treating patients with chronic conditions.
Ultimately, being proactive with each patient goes a long way to ensure they understand their medications, how and when to take them, and how to avoid potential complications. An increased focus on care coordination can help providers understand what patients are taking and how they’re working for the patient, which can ultimately help to reduce adverse drug events and associated costs, especially for elderly populations and those with multiple chronic conditions.
Steven Lobel, PhD, is laboratory director at LifeBrite Labs, an accredited, national medical laboratory services provider located in Atlanta, GA.