Getting the most out of your medications

How to prevent errors, improve prescription drug efficacy for better health outcomes

Amazon Launches Online Pharmacy Service. Amazon has announced their entry into the $300 billion pharmacy market with a new service called Amazon Pharmacy. . Customers over the age of 18 in 45 states will now be able to order prescription medication for home delivery. Hawaii, Illinois, Kentucky, Louisiana and Minnesota are not included, but Amazon expects to serve those states in the future. Amazon Pharmacy will reportedly accept most forms of insurance as well as offer savings for uninsured customers. Doctors will also be able to send prescriptions directly to Amazon Pharmacy, as the service will have tools to verify legitimate prescriptions and prevent potential fraud. . In addition, Amazon Prime members will receive free two-day delivery and access to discounts of up to 80 percent on generic medications and 40 percent on brand-name. . We think this new benefit will add tremendous value to our members … It’s relevant as folks try to do more from the comfort and safety of their homes, Jamil Ghani, Vice President of Amazon Prime. . Since its launch on Tuesday, stocks for traditional pharmacies and retailers that offer pharmacy services have dropped. . CVS shares fell 7.5 percent, Walgreens Boots Alliance shares dropped more than 10 percent and shares of Rite Aid dropped more than 11 percent

Eighty-nine percent of people 65 and over are taking at least one prescription medication, and three-fourths of those ages 50-64 are on at least one prescription.

According to the Kaiser Family Foundation, 54% of people ages 65 and over have reported they’re taking more than four prescriptions.

Tracking medications and preventing missed doses or interactions becomes increasingly challenging with each new prescription. Risks of medication errors or drug interactions in older adults can be serious, and include falls and fractures, confusion or disorientation, dehydration, hospitalization, or even death, according to WebMD. The more medications that are combined, the more likely medication mistakes are to occur.

With so many different methods to track and accurately consume, how can older adults prevent medication errors?

Older adults face higher risk for bad outcomes from medication errors

“Medication errors are prevalent among seniors because many older Americans, and even their caregivers, may have health literacy challenges,” said Susan Schayes, M.D., MPH, FAAFP, Chief Transformation Officer for ChenMed, which operates JenCare Senior Medical Center facilities in Atlanta.“It’s a big issue. Patients and caregivers may not understand the instructions for taking the medicine or the proper dosage to take.

“Patients deserve a doctor who communicates using teach-back techniques. The best clinicians make sure each patient understands what they need to do. Tools the doctors can use to help patients understand include using pictures to show patients what to do and explaining procedures in living-room language.”

Susan Schayes, M.D., MPH, FAAFP, Chief Transformation Officer for ChenMed.

Credit: Provided

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Credit: Provided

Pharmacist Shane Bishop is the founder of Custom Health, a North American health tech firm committed to helping patients take medications as prescribed. He agrees that older adults are generally at greater risk for medication errors.

“The growing concern for seniors is that as people age, they may have several health problems that need to be treated and the use of multiple drugs can lead to problems or unwanted side effects,” he said.

According to Bishop, the most commonly prescribed drugs for adults in their 60s and 70s are medications for cholesterol, high blood pressure and diabetes.

Bishop cited the Centers for Disease Control and Prevention’s data on adverse drug events in adults. Adults over 65 visit emergency rooms more than twice as often as younger people. Older adults are also seven times more likely to be hospitalized following an emergency visit. Most are due to a few drugs such as blood thinners, diabetes medications, and seizure medications that should be carefully monitored.

Consult with a pharmacist, physician for help

“Pharmacists can play a huge role in managing medications. There is a broad spectrum of services that pharmacists can provide; from fill and dispense to full clinical monitoring,” Bishop said. “Most pharmacists are passionate about helping patients. I always encourage people to think of their pharmacist as their partner in health who knows everything about medication.

“Partner with one who you trust and (who) understands advances in technology. Technology available today for medication management means pharmacists can offer easy-to-use tools that can help optimize medication and avoid missed doses or mix-ups.”

Shane Bishop, pharmacist and founder of Custom Health.

Credit: Provided

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Credit: Provided

Additionally, a trusted physician can provide valuable oversight and resources as well to avoid problems and maximize the efficacy of multiple prescriptions. It’s advisable for patients to schedule a meeting with their primary care physician to review all medications.

“If you are taking five, six or even more medications, patients run the risk of adverse drug effects, that could cause acute health episodes, hospitalizations or even deaths,” Schayes said. She recommends asking your physician several specific questions about your prescriptions:

  • Might my dose for any medication being taken be lowered or discontinued?
  • Could diet, exercise, or other lifestyle changes help me better manage my health problems?
  • What side effects might I have by taking this prescribed medication?
  • Should I have a medic alert bracelet for any major health condition or a drug allergy?

Schayes suggests talking with your doctor before you stop taking any medication unless you have a strong, adverse reaction to that medicine.

“If that happens, your doctor may be able to prescribe an alternative medication (to) take instead,” Schayes said.

Once you’ve reviewed all medications, how do you ensure you’re taking all doses properly daily?

“There are essentially three levels of resources available to help people with medications,” Bishop said. “The first level is packaging that organizes medication by date and administration time such as dosettes, multidose strips, or blister cards. The second level is medication reminder digital tools like apps or devices to dispense or remind with alerts throughout the day. The top tier is a monitored and fully integrated dispensing device with alerts and reminders connected to clinical oversight with monitoring for adherence as well as any side effects and medication effectiveness.”

Until the most advanced technology is available to you, pill organizers are a good start for keeping your medications in order.

“A simple pill organizer is a great tool to use and there are even ‘smart’ organizers that prevent the user from taking the wrong pill on the wrong day or the wrong time of day. Also, if a patient gets all medications from the same pharmacy, their pharmacist can help check for proper medications, as well as help prevent bad interactions. Some pharmacies color code bottles or offer pill packs to simplify medication taking,” Schayes said.

And when you need help, don’t be afraid to reach out to your pharmacist.

“Pharmacists are medication experts, and therefore they’re among the best resource for medication management — particularly senior care pharmacists who have specialized knowledge in the unique medication-related needs of this population,” said Lori Newcomb of Guardian Pharmacy Atlanta. She is a board-certified geriatric pharmacist.

“While multiple doctors may prescribe, the pharmacist has a complete view of all medications and supplements and can make sure certain drug combinations are safe, ensure medications are necessary and assess possible side effects helping you identify issues when you have them. Establish a relationship with your pharmacist and ask them to review all of your medications when new meds are added.”

By collaborating with your physician and pharmacist, and being assisted by today’s technology, older adults can get the most out of their medications to optimize their health while minimizing errors or medication mix-ups.

Along with working with your pharmacist, “primary care providers should serve as quarterbacks for the care of every senior. PCPs should know their patients best and should be transforming care with VIP service,” Schayes said. “Achieving better health outcomes requires a strong partnership between the PCP and the patient, and patients should bring all medications with them each time they visit the doctor.”

How caregivers can help with medications

Caregivers for older adults may also play an important role in ensuring medications are consumed properly. Whether it’s a family member or hired professional, caregivers should be able to help provide some oversight of medications as well.

Ideally, “caregivers should accompany patients to doctor appointments. Patients and caregivers should write everything down and create/post reminders to take medications. Simple, inexpensive reminders are very important,” Schayes said.

“Caregivers can place sticky notes on bathroom mirrors, set cell phone alarms, and even create prescription charts noting all medications, dosages, and times to take medications. Also, if there is any way to have fewer medications taken fewer times each day, that is valuable simplicity to achieve better health.”

Make medication management a priority

A report from the Lown Institute, a nonpartisan think tank, said that in 2014, at least 200,000 older adults were hospitalized because of an adverse drug event. But you can avoid becoming a statistic.

“The best advice I can give older adults and caregivers is not to delay making medication management a priority,” Newcomb said. “Instead of sitting on the sideline, they should be proactive and work with a pharmacy to develop a personal medication management plan. Seniors and caregivers will feel more confident knowing they’ve invested time in establishing and implementing a strategy instead of pushing planning off and hoping it will all work out. Delaying or avoiding (proactive medication management) is not worth the gamble.”

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