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    Prevent polypharmacy problems


    Pharmacists as key players

    Adam Woolley, PharmD, associate clinical professor, Northeastern University in Boston, suggests that electronic health records (EHRs) carrying information across transitions of care; using evidence-based guidelines at a patient level; evaluating a patient’s renal function and comorbidities; and medication assessments by pharmacists are some of the solutions for managing polypharmacy.      

    Woolley goes on hospital rounds with a medical team to evaluate risks and benefits of various medications.

    Amelung and Brown agree with Woolley that pharmacists are an underutilized resource. “Doctors can’t know all therapies for every condition but could use pharmacists as a knowledge base,” Amelung says.

    “The role of a pharmacist in the management of polypharmacy is absolutely critical,” Brown says. “Most senior residents—particularly those who struggle with multiple disease states)—see multiple prescribers. When this occurs, the patient is at a higher risk for drug interactions and duplicate therapy, making it critical that a pharmacist closely monitor a patient’s drug regimen to ensure efficacy and safety.”

    Another cheerleader for the pharmacist’s role is Nicholas Ratto, manager, consumer drug information group, First Databank. He suggests that pharmacists sit down face-to-face with patients who have comorbidities and review conditions and drugs, verifying their safety and efficacy annually. But without knowing a patient’s history, it is difficult for a pharmacist to provide clinical assistance, he says.

    He points out that a comprehensive medication review is available as part of medication therapy management reimbursed by CMS for Medicare beneficiaries.

    Ideally, Charles Lee, president/founder Polyglot Systems, says there should be a universal medication list EHRs can tap into to prevent problems with polypharmacy.

    Patient resources

    To assist patients on the receiving end of polypharmacy, Polyglot has developed Meducation, an online tool that generates simpler, personalized medication instructions in a patient's preferred language.

    “In addition,” Lee says, “patients need to understand when to take a drug and why, and potential interactions with OTC medications.”

    Woolley places some responsibility on patients’ shoulders by emphasizing the importance of ensuring they buy into their medication regimens to promote adherence.

    Amelung suggests patients share their medication lists with their doctors or pharmacists for a review of side effects, interactions and availability of lower-cost alternatives.

    The new paradigm, says John Beckner, RPh, senior director of strategic initiatives, National Community Pharmacists Association, is putting a patient in the middle of a physician and pharmacist. “We often lose sight of the importance of the patient,” he says. “Pharmacists and physicians also need to trust each other; if a relationship doesn’t exist, it could impact prescriptions.”

    As Brown suggests, it isn't always easy to decide which drugs are appropriate for which patient to optimize outcomes. “Every patient is unique; there really isn’t a one-size-fits-all solution when choosing a drug regimen. The disease state being treated, current drug regimens ensuring there aren’t any drug interactions, and the ability for a patient to tolerate a particular drug are all important factors (among others) when attempting to optimize outcomes.”

    Mari Edlin, a frequent contributor to Managed Healthcare Executive, is based in Sonoma, California.



    Mari Edlin
    Mari Edlin is a frequent contributor to Managed Healthcare Executive. She is based in Sonoma, California.


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