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It's important for patients to take medications just as prescribed and to let their health care provider know what over-the-counter and alternative remedies they're taking, since some of these can cause dangerous side effects or interact with other medications.

Failing to take prescribed medications as directed, taking medicines at the wrong times or in wrong doses, or taking over-the-counter medications and supplements without telling your doctor may contribute to health problems. And because older adults tend to take more medications than younger adults, they're more likely to be affected by such differences in the use of medications than are others. More than 40% of adults 65 years and older use 5 or more medications weekly. And 12% use 10 or more.

Letting physicians know when their patients are not taking medications as prescribed or recommended could improve patient safety, particularly among older adults - if physicians are receptive to this kind of feedback.

New Research in the Journal of the American Geriatrics Society

To find out how receptive physicians might be to such feedback, a research team that included research nurses first reviewed the medical charts of more than 200 patients aged 65 years or older. The team looked at the medications listed on the patients' charts and then phoned the patients to find out what prescription and over-the-counter medications and supplements they were actually taking, at what doses, and at what times of day.

If the researchers found discrepancies -for instance, that an older patient wasn't taking a prescribed medication, or was taking it in the wrong dose or at the wrong time, or that a patient was taking an over-the-counter medication or supplement that he or she hadn't told his or her physician about -they notified the patient's physician in writing. (If the research team found that a patient was taking medications improperly and that this put the patient in danger, they immediately contacted the patient's doctor to alert him or her.)

All told, the researchers found medication discrepancies in about 84% of the cases they reviewed. The majority of discrepancies, nearly 53%, occurred because patients were not taking medications that were on their medical charts. About 34% of discrepancies were due to patients taking medications - including over-the-counter drugs and alternative remedies such as herbs - that were not on their medical charts.

After notifying the patients' physicians of these discrepancies, the researchers surveyed the doctors to find out how they felt about getting this kind of feedback. More than 93% of the physicians said the information was helpful.

It would be too expensive to have nurses review every patient's medication chart, check with every patient to make sure he or she is taking prescription and over-the-counter drugs and supplements as the chart recommends, and notify each patient's physician when that is not the case, the researchers note. But there are other ways to learn of medication discrepancies and address them. One possibility: having physicians or their office staff give each patient a list of the medications on his or her chart, and asking him or her to report any differences between what the chart shows and how he or she is actually taking medications and supplements.

"An added advantage to this approach could be an improved partnership between patients and their physicians, as well as an emphasis to patients that they too have responsibilities related to maintaining communication regarding any changes in their medications," the researchers conclude.

What Should I Do?

Always let your health care provider know what prescription and over-the-counter medications, herbal and other alternative remedies, and supplements you're taking. If you are prescribed a drug, take it at the time and dose indicated. If a drug appears to be causing side effects, let your doctor know immediately.

At least once a year, you should review the entire list of prescription and over-the-counter medications, alternative remedies and supplements that you're taking with your health care provider. Among other things, you should check to make sure you need all the medications on your list.

For more information on taking medications properly visit: http://www.healthinaging.org/agingintheknow/chapters_ch_trial.asp?ch=6#reactions

The summary above is from the full report titled, "Physician Response to Written Feedback on a Medication Discrepancy Found With Their Elderly Ambulatory Patients." It is in the December 2005 issue of the Journal of the American Geriatrics Society (Volume 53, Issue 12). The report is authored by Samuel N. Forjuoh, MD, DrPH, Michael D. Reis, MD, Glen R. Couchman, MD, Barbalee Symm, PhD, RN, Saundra Mason, BSN, RN, and Ricky O'Banon, BA.