Health and Wellness
Are Your Medicines Working Their Best for You?
By BreakThrough Care Center
Over the past 30 years an incredible number of new medications have entered the health care arena. Doctors today have over 10,000 prescription medications for use in treating their patients. Remarkable benefits have come with the use of new medications, including relief of suffering, prolongation of life and if not cure at least control of many medical conditions.
Unfortunately, the increased use of medications has also created some significant medication problems. Currently one-third of older adults in the United States take 5 or more medications (ref 1). Some startling statistics are that 15 out of every 1000 patients on medications will have an adverse drug event every month, for which one third are preventable. For every prescription dispensed, 25 % will result in and adverse drug event in a patient within 4 weeks.
Problems with medication results in 4.3 million medical visits a year, from doctor office visits to emergency room visits and hospital stays. In the United States it is estimated nearly $180 billion is spent to treat medication related problems, or about $1.33 for every $1 we spend on medications.
We know that adverse events such as side effects and medication errors occur more frequently when patients take more than 6 chronic medications, or have complex medication regimens. (ref 2,3). Many of us as we age and acquire chronic medical conditions find ourselves or our loved ones in this situation and therefore at risk for medication problems.
SOLVING THE PROBLEM
Fortunately, this looming problem was recognized back in the 1990’s. One initiative at that time was to optimize the use a member of the health care team that is trained to understand medications, the pharmacist.
Pharmacists training changed and intensified to include dramatically more education on diseases, how medications are used in treatment, medication problems they may cause and how to manage those problems. Currently pharmacists now earn a Doctor of Pharmacy degree, or Pharm.D. and have four years of training after 2 or 4 years of undergraduate preparation. Many also do post graduate training or residencies, and sit for certification exams to be even more prepared to handle complex medication problems.
At the same time pharmacists were beginning to work in doctor offices and medical clinics helping patients and their doctors manage medications and medication related problems. The Veterans Administration and Indian Health Services were some early adopters of these services.
The results of imbedding and using pharmacists in this way showed better outcomes for patients related to their use of medications and a benefit in overall costs. Consequently the term Medication Therapy Management (MTM) was promoted and placed into the 2004 law that created prescription benefits for seniors.
If you are a Medicare patient you may have seen this term, or even been offered to participate in some of the programs available. There will be a continued growing focus on MTM services because initial results from the 2004 law is MTM services are improving patient care and decreasing costs.
At DuPage Medical Group (DMG), the leadership has recognized the benefit to their patients by having MTM services. Through a partnership with the Chicago College of Pharmacy at Midwestern University, DMG has 6 core pharmacists, pharmacy residents and pharmacy students in their last year of training providing MTM services. For patients in the new and innovative Breakthrough Care Centers pharmacists are available for patients every day for medication management.
WHAT IS MEDICATION THERAPY MANAGEMENT?
MTM is a set of services that address medication use with a patient. (ref 4,5) The first step entails a visit with the pharmacist for what is called a comprehensive medication review. The pharmacist will review each of your medications (prescription, over-the counter medications, vitamins, and herbals or natural products you may take), usually by going through your medical conditions and what medication(s) you take for each of them. Having all your medicines with you at the visit is often very helpful.
The pharmacist reviews your medical record, communicates with your other providers and will ask you questions on several key aspects of your health and medications. The pharmacist will determine if you are taking your medication the optimal way for you personally; if the medication is working as it is intended to for your condition; determine if you are having any problems (side effects, cost issues, etc) with your medication; and determine if the medication is the best one for you personally. Problems the pharmacist may identify can be from inability to afford medications to an annoying but not serious side effect such as dry mouth to something potentially harmful such as dizziness and falling.
Once the pharmacist has identified any problems they will set out to fix them. Some they may fix right at the visit based on agreements already established with your doctor (for example changing a dose of a medication so that you get more benefit from a drug) or they may talk to your doctor to recommend a drug that may cause fewer problems. Often the medication problems identified is that the patient needs more knowledge about how best to self manage their medications. A good deal of work is educating you as a patient to understand how best to use your medications. For example when is the best time to take that water pill? Or what do you do when you miss that blood pressure medication? We know that 30-50% of medication problems occur at home while taking medications, mainly due to patients not having the best understanding in managing their medications.
As you can imagine solving medication problems is an ongoing process and new medication problems may occur at any time, consequently MTM services is ongoing process. You will get the most out of the MTM services by building an ongoing relationship between you and your pharmacist as well as all the other members of your health care team. What you can expect from your MTM visit is a sense of empowerment that you understand your own care and medication such that your medications are working their very best for you. You can also expect to receive a current medication list as well as any information or tools (called a medication self action plan) you may need to use your medications well at home.
IS IT FOR ME AND HOW MUCH DOES IT COST?
Anyone with medication problems and desires more knowledge about how to use their medications may use MTM services. If you are on more than 8 chronic medications, or seeing many doctors, or often in and out of the hospital with frequent changes in your medications, you may gain the most benefit from regular touches with MTM services.
Coverage and co-pays unfortunately vary depending on your particular plan. For many there is no co-pay, for some there is and you would need to check with your particular plan. MTM services have consistently shown that they do decrease hospitalizations which are very costly both in dollars and the personal toll on you or family members. DMG and the pharmacist are committed to keeping you as healthy as possible and assuring the services your receive are valuable both in your satisfaction and in your cost.
1. Gu Q, Dillon CF. Prescription Drug Use Continues to Increase: US Prescription Drug Data for 2007-2008, NCHS Data Brief No.42 Sept. 2010. http://www.cdc.gov/data/databriefs/db42.pdf accessed 7/2013
2. Touchette,DR, Stubbings J, Schumock G. Improving Medication Safety in High Risk Medicare Beneficiaries Toolkit. Effective Health Care Program Research Reports. Number 38 (Prepared by the Duke University DEcIDE Center under Contract No. 290-05-003, the RTI International DEcIDE Center, under Contract no> 290-05-0036, and The University of Illinois at Chicago (UIC) Chicago-Area DEcIDE center under Contract No. 290-05-0038). AHRQ Publication No. 12.EHC027-EF. Rockville, MD. Agency for Healthcare Research and Quality. July 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm. Accessed 7/2013
3. Sarkar U, Lopez A, Maselli J, et.al. Adverse Drug Events in US Adult Ambulatory Medical Care. Health Serv Res. 2011;46:1517-1533.
4. Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. A Report to the US Surgeon General. Office of the Chief Pharmacist. US Public Health Service. Dec. 2011.
5. McInnis, T, Strand LM, Webb CE. Patient-Centered Primary Care Collaborative. Integrating Comprehensive Medication Management to Optimize Patient Outcomes. A Resource Guide. http://www.pcpcc.org/guide/patient-health-through-medication-management. acessed 7/2013