Medication management is the process of overseeing the medications prescribed for a patient to ensure they are taken properly and achieving their planned, therapeutic outcome. The process includes initial and ongoing medication review to address safety and adherence concerns, reduce adverse drug events, educate patients, and engage patients and their caregivers.
When implemented effectively, such programs are widely known to effectively reduce costs and improve care. Which is why CMS as well as a growing number of commercial payors have implemented or are implementing medication therapy management (MTM) services, a specific, programmatic approach to medication management.
Here are eight tips for improving various elements of the medication management process.
1. Put a pharmacist in charge
A number of quality and safety organizations support pharmacists as the key professional to manage medication therapy and reconciliation for patients. A few examples are the Agency for Healthcare Research and Quality (AHRQ), Institute for Healthcare Improvement (IHI), and the American Society of Health-System Pharmacists (ASHP).
Putting a pharmacist in charge of a medication management initiative can ensure that policies and procedures follow best practice guidelines. Their training makes them uniquely qualified to provide in-depth, medication-related education, consultation, and advice to patients, family and/or caregivers. When integrated into the care team through the medication management process, pharmacists collaborate with the patient, physician, and other providers to develop and achieve optimal goals of medication therapy.
2. Ensure patients have ample access to a pharmacist or pharmacy students
To gain the full benefit of having a pharmacist involved in medication management, they must be available to patients during clinic and after hours. A lesson learned in the Rx Pilot study, conducted by the Agency for Healthcare Research and Quality (AHRQ), was that constraining pharmacist availability to half time, or only certain hours during the day, was an impediment to getting patients engaged. Researchers concluded that having a pharmacist available on-site to speak with patients was a key driver to them enrolling in the program and following their plan.
One way to deliver this cost effectively is through the use of pharmacy students, who were included in the Rx Pilot study. The study summary cautions, however, that the demanding and limited schedules of the students may reduce their availability for patients. Carefully think through these scheduling issues and create an effective plan that supports patients as well as the rest of the care team.
3. Educate patients about the most common medication mistakes
Taking too much of a medication - even non-prescription medicines such as Tylenol - confusing one medication with another, taking a medicine with food when it should be taken on an empty stomach. These are a few of the common mistakes that lead to ineffectiveness, side effects, or overdosing. Even patients who have been taking a medicine for a long time may be making these mistakes, not even realizing they are contributing to a poor outcome.
A good medication management process considers the time involved to educate and re-educate patients and their caregivers about these kinds of mistakes, which are easy and fast to correct. A good way to strengthen patient learning to to provide a handout to every patient and caregiver, so it can be referred to at home.
4. Check the Beers list
The Beers list, put together by the American Geriatrics Society, is a list of medications that should be avoided, or used with caution, when prescribing medication for older patients. Unfortunately, despite the data that supports these recommendations, physicians still often prescribe older patients a drug from the list. Checking the Beers list as part of reviewing an older patient’s medication management process will rule out the possibility that the patient is taking something that should be removed from his or her therapy.
5. Remove unnecessary medications when possible
Generally speaking, it’s safer for patients to take as few medications as possible. Keeping the number of medicines low decreases the chance of interactions and side effects. Removing medications should be a goal in a medication management program, whenever clinically appropriate.
6. Watch for the “prescription cascade”
The “prescription cascade” occurs when the side effects of drugs are misdiagnosed as symptoms of another problem. The result is that a provider writes a prescription for the side effect instead of identifying and discontinuing the causal medication. This can lead to further side effects and additional prescriptions, which increases the chance of additional interactions.
Although it’s true that short appointment slots make it challenging for physicians and other providers to dig deeply on every issue, spending the time to understand whether a patient’s presenting complaint is actually a medication side effect has multiple benefits, including better outcomes and lower costs for the patient as well as payors. Prioritize the inclusion of an assessment to identify the prescription cascade in your medication management process.
7. Suggest reminder and organization tools that are most comfortable for patients
Some patients prefer a pill box. Others prefer a reminder app. Still others prefer a combination of an alarm on their watch and a medication reference sheet that lists pills to take, dosages, and times. Take the time to discuss each patient’s routines and preferences and determine a reminder system that is right for the patient. The more easily medication taking fits into a patient’s routine, the higher the likelihood that they will stick with it.
8. Talk about adherence at every visit
When it comes to educating and counseling patients about taking their medicines properly, it’s impossible to over-communicate. Review each medicine and why the patient is taking it. Discuss reasons for missed refills or pills, as well as strategies for consistency. And if the patient shows signs of confusion about taking their medications, or has a cognitive impairment diagnosis or a form of dementia, make sure your medication management process includes the action step of involving a family member or caregiver to manage prescription pick-ups and daily medication regimens.