Medication Adherence: A Tough Pill to Swallow

KIM MOON - KimPick1 - webresKimberly Moon, PharmD
Clinical Pharmacist

Blue Cross Blue Shield of Michigan David2


David Dadiomov
Doctor of Pharmacy Candidate
University of Michigan
College of Pharmacy

 

The number of Americans with chronic medical conditions is increasing, which means that chronic medication use is playing a larger role in their lives. The World Health Organization estimates that 157 million Americans will require medications for at least one chronic disease, such as high blood pressure, high cholesterol, or diabetes. Luckily, treatments exist for these diseases that prolong life and improve quality of life as well. Medications can help improve medical conditions when they are taken as prescribed.

Taking medications improperly not only affects people who take these medications, but is also costly for our entire health care system. Medication non-adherence leads to 1/3rd of all medication-related hospitalizations and about $300 billion in avoidable costs. It is clear that medication non-adherence is a huge problem; several common concerns may be responsible for this issue.

“I’m worried about cost”
Cost is an important factor for those that take medications. When people first get placed on medications it is a relatively unexpected cost that they must now budget for. Luckily, many oral medications for management of blood pressure, cholesterol or diabetes are available as affordable generic medications. These medications are on the most affordable level of co-payment on most health plans, but even those without insurance may still benefit from pricing at various pharmacies that offer these medications at a low cost. For those who are prescribed expensive medications, most drug manufacturers have patient assistance programs to help with medication costs for those who qualify. Also, taking a long-term perspective is important. The daily cost of most medications is certainly less than the cost of a hospitalization due to a heart attack, stroke, or dialysis due to kidney damage.

“I’m concerned about the side effects”
No drug is without side effects. Luckily, for most people, side effects are minimal and medications are generally well tolerated. Sometimes certain side effects may prevent people from taking their medications as prescribed. Often a pharmacist’s recommendation on medication use or management of side effects can help alleviate concerns. For instance, certain medications should be taken with food, or at a certain time of day. Other medications may have side effects for the first few weeks, but then go away. It is important to ask questions when being prescribed a new medication and calling the pharmacist with questions about the medication or how to take it. Keeping a clear line of communication is important to medication adherence.

“I take too many pills”
Taking several medications is often discouraging for people, and may make it hard to remember to take them at the correct times. A pill box for each day of the week can help manage medications and at the very least, help see how many doses were missed during the week. Many medications are available in a once-daily formulation or even in a combination with another routine medication to reduce the total number of pills taken per day. Again it is important to talk with your prescribing healthcare provider and pharmacist.

“I don’t feel I need my medications”
People with conditions such as high cholesterol don’t have symptoms, so they could feel medications for this condition are not needed. It is important to remember that medications that lower cholesterol are important in reducing the 10-year-risk of developing a heart attack or stroke. People may not “feel” the medicine working, but research studies show taking medications as prescribed can help reduce risk of heart attack or stroke. Remember: Having high blood pressure or diabetes may not always make you feel like there is anything wrong with you, but these diseases can damage your kidneys and lead to kidney disease that may require dialysis.

Questions to ask the pharmacist:

  • How am I supposed to take this medication?
  • What is this medication used for?
  • How does this medication work?
  • What can I expect with this medication?
  • How will I know this medication is working?

 

It’s Not Normal: Persistent Pain

Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio 

There are many issues facing older adults that are common, but should not be considered inevitable. This blog will launch a series for 2014, all bundled under the general heading of “It’s Not Normal”.  Over the next year, I intend to cover a variety of topics that include dementia, incontinence, falls and depression. If you have suggestions for this series, please leave a comment.

The kick-off for this series is pain. While pain is common as we age, it should never be considered “normal”.  Pain should always be discussed with your healthcare provider, so that he or she can help determine the cause (or causes).  Your healthcare provider can then help you figure out an approach to remove or reduce both the pain and the affect it has on your life.

Acute pain is pain that has happened recently and usually has a known cause. An example of this is a sprained ankle. A few weeks of ice, rest and over the counter pain medications (such as acetaminophen) is usually all that is required for relief to occur.

Chronic or persistent pain, however, is more of a problem. You may have had this pain for some time and the direct cause may not be known.  There are different kinds of chronic pain. These include:

  • pain from nerves, such as diabetic neuropathy or pain from a stroke
  • joint or bone pain such as arthritis or gout
  • some kinds of internal pain, such as abdominal pain from Irritable Bowel Syndrome

American Geriatrics Society Helps You “Choose Wisely”

This week, the American Board of International Medicine (ABIM) Foundation published the latest of its ground-breaking Choosing Wisely® “five-things” lists, and I’m pleased to report that one of these new lists comes from the American Geriatrics Society. In case you’re not familiar with these important Choosing Wisely lists, here’s a little background:

Two years ago, the ABIM Foundation and Consumer Reports launched the Choosing Wisely campaign to encourage people to learn more about the tests and treatments their healthcare providers recommend, and to question and discuss these with their healthcare professionals under certain circumstances. There are two parts to the Choosing Wisely campaign. Numerous medical societies have gone through an in-depth review process to identify five tests or treatments for which there may not be enough medical research that shows safety or effectiveness. In some cases, the research may even show unwanted effects. At the same time, the Foundation and Consumer Reports have been encouraging people to check the lists to see if tests or treatments their healthcare providers have recommended are on them. If so, the campaign urges people to bring this up with their healthcare professionals and discuss it. Continue reading

Beers Criteria

A century ago, the average American could expect to live 50 years or so.  Today, we can expect to live nearly 80. That’s a big jump. What contributed to that big jump in longevity? A lot of things — including the development of medications that prevent and treat serious illnesses like diabetes and heart disease. In addition to all the good they can do, though, drugs can also cause serious side effects and interact with one another in potentially harmful ways. That’s why weighing a medication’s benefits against the risks it poses is so important. It’s particularly important in later life, because age-related physical changes put older adults at particularly high  risk of  drug side effects and other “adverse drug events.”

To help healthcare providers safely prescribe medications for older adults, the American Geriatrics Society (AGS) recently revised, updated and expanded the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The criteria were first published by the late geriatrician Mark Beers, MD, and other experts in 1991, and were revised in 1997 and 2003. They have long been the leading source of information about safe prescribing for adults 65 and older.

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