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Medication Management: No Simple Task

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$320 billion – this is how much money was spent in 2015 on prescription medications, according to the Centers for Medicare & Medicaid Services' Office of the Actuary National Health Statistics.

10 percent – this is the percentage of people who are taking at least five medications a month, according to the Centers for Disease Control and Prevention's National Center for Health Statistics.

We know that older adults are likely to be on more medications to manage their chronic conditions, and we also know that four out of every 1,000 patients visit the emergency room for adverse events related to their medications. Patients see many different providers. New drugs are coming into the market that may interact with others. Transport to the pharmacy may be an issue. Older patients may not be able to hear the prompts to refill a prescription. And, of course, costs continue to rise. How do patients and their care givers keep on top of all of this?

I saw this very clearly a year or so ago when Jack – the 86-year-old husband of the lady with dementia that I sat with once a week – showed me his spare bedroom. He was completely dedicated to storing and managing his wife's medications, and the room was littered with medication organizers and pill bottles. A small refrigerator stored a vast quantity of similar-looking containers of drugs with unpronounceable names and a large handwritten chart, which, he proudly showed me, covered the top of the dresser. This chart listed drugs Charlotte had been prescribed; some were crossed out, some had the labels cut out and pasted next to the name and some had a description like "heart drug" next to them. There were alarm clocks and electronic reminders tried out and abandoned on the bed, and I quickly understood the tremendous responsibility that Jack felt every day.

Reconciling medications has become something that health care providers, hospitals, home health agencies, nursing homes and caregivers have had to learn to do. This involves comparing lists of orders and medications taken to identify the most accurate picture for a person. With the evolution of the electronic health record this process would seem to be a simple one, but we know that is not always the case. What can caregivers and family members do to help? Here are some tips:

  • Support family and friends by encouraging them to become comfortable asking questions of their health care providers when prescribed a drug or a treatment.
  • Understand the medication the best you can. Ask the pharmacist to clarify when you are unsure.
  • Always follow the directions carefully when taking a medication and encourage others to do the same. How and when you take a medication can be important.
  • Keep medications in their original containers.
  • Keep a current list of medications taken, dosage, the reason for taking them, refill frequency and any allergies along with contact information. The list should be easy to access and should include over-the-counter drugs, vitamins and supplements.
  • Be vigilant for signs of side effects in those taking multiple medications, such as sleepiness or an increase in falls.

Until technology advances to the stage that our bodies contain chips with medication information that can be read by every clinician, managing medications will be an important part of health care. Time and effort needs to be dedicated to this - just like Jack did.

Resources on this topic are available at Choosing Wisely: https://healthinsight.org/choosing-wisely

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