NATIONAL REPORTS—At Premera Blue Cross of Washington state, a simple brown bag might hold the solution to avoiding adverse drug reactions for
patients taking multiple medications.
Premera Blue Cross mails a brown bag labeled "Promoting a health partnership between you and your physician" to a carefully
targeted list of members over the age of 18 who take five or more maintenance medications on a daily basis. Instructions come
with the bag, and patients are asked to fill it with their vitamin and herbal supplements, in addition to their prescription
and over-the-counter drugs, and take the bag to their doctor for review. Doctors then might need to make medication changes,
including discontinuing medications, adjusting dosages or adding new medications.
In M arch 2001, Premera analyzed its pharmacy claims data and discovered that about 21,000 of its members over the age of
45 were taking five or more maintenance drugs at once for chronic conditions. Premera's "Polypharmacy" program began in June
2001.
PREVENTING ERRORS "The impetus started from our chief medical officer [Dr. John Castiglia]," explains Ed Wong, pharmacy director for Premera.
Dr. Castiglia and the Premera pharmacy team took note of the 1999 Institute of Medicine report that said that more than 7,000
people die each year from preventable medication errors in hospitals. "We also believed that medication errors occurred in
the private population, as well. These patients were likely seeing two or three different providers and having their prescriptions
filled at different pharmacies, thus adding to the level of complexity," Wong adds. The Premera program is a combination of sophistication and simplicity, according to Wong. "With the advantage of having member
pharmacy claims information, Premera was able to develop mailing lists to deliver a simple brown paper bag to these members.
This program brings an intervention to the most-effective point in the healthcare system—a conversation between patients and
their providers," he says. To date, 56,000 Polypharmacy brochures and brown bags have been mailed.
The Polypharmacy program is a joint effort by the Washington State Medical Assn. (WSMA), Department of Health and Premera.
The original brown-bag concept was developed by WSMA in 1993. The "MedCheck" brown-bag program started as an educational program
jointly sponsored by the WSMA's Patient Awareness and Community Education (PACE) program and the Northwest Area 10 Office
of AARP. In that program, bags were offered to providers, who then gave them to their patients.
"The program encouraged physicians and older patients—or their families/adult caregivers—to work as partners to ensure prescription
and non-prescription medications are regularly reviewed," according to Jennifer Lawrence Hanscom, WSMA director of communications
and membership.
"Over time, especially when the alternative care movement really took off, we began to encourage our members to use the MedCheck
program with all of their patients," Lawrence Hanscom says. "This allowed doctors to keep track of all medications—prescription
or non-prescription—and they could make sure that they wouldn't react against each other.
"We also believed the MedCheck program could help to reduce any adverse reaction that may occur when taking several prescriptions,"
she adds.
