On August 22nd, the U.S. News & World Report published an article by Lisa Esposito entitled "How to Help Aging Parents Manage Medications". In this piece, the author describes an all too common, yet dangerous scenario, whereby the medications of an older adult, perhaps your grandmother, aunt or father, are found to be uncoordinated, mismanaged and in total disarray.
It's been 15 years since the Institute of Medicine published the "To Err is Human" report and two years later put out a follow-up report "Crossing the Quality Chasm: A New Health System for the 21st Century"; yet, two of the most fundamental health-related problems, medication non-adherence and medication mis-management remain commonplace.
A little over one year ago the IMS Institute for Healthcare Informatics published a report on "Avoidable Costs in U.S. Healthcare". In this report, the IMS Institute quantified the indirect and direct avoidable cost estimates for six medication-related problem areas in healthcare in 2012. It may not be surprising that non-adherence was problematic. However, non-adherence wasn't just one of six, but rather was the overwhelming contributor, to the tune of $105 billion out of $213 billion.
Source:IMS Institute for Healthcare Informatics. June 2013. http://www.imshealth.com/deployedfiles/imshealth/Global/Content/Corporate/IMS%20Institute/RUOM-2013/IHII_Responsible_Use_Medicines_2013.pdf
In addition to this continued and alarming trend, it is important to remember that senior citizens take a disproportionate amount of prescription and over-the-counter medications. Therefore, without significant intervention, medication-related problems will increase even more so over the next two decades as the Baby Boom Generation, approximately 75 million strong, age into Medicare.
In a time when we have some of the most advanced technologies and informatics capabilities, why is non-adherence still so problematic? Why hasn't the profession of pharmacy stepped up to own this problem and to produce solutions that really make a difference? There has been a great deal of change within pharmacy to address non-adherence. The vast majority of pharmacies are doing more to automate refills and track refill frequencies. Many pharmacists are addressing adherence when conducting a comprehensive medication therapy management assessment. Yet these changes were in place, while the $105 billion avoidable costs, due to non-adherence, were generated.
This brings me back to Ms. Esposito's article. In healthcare, we may give the best of therapies and we may provide the best of instruction and directions; yet, many times for many different reasons, what happens when the patient gets home is very different from the best of our intentions. For years, my clinical teaching site was part of an aging agency, Resources for Seniors, Inc, in Wake County, North Carolina. Students would often accompany me on home visits to review medications and to assess medication management for patients referred by local nurses, social workers, case managers and physicians. After conducting a home visit, it was not uncommon to have a student say "wow, I never would have expected to see 'that'". It is my opinion, that without the ability for pharmacists to interact and see into the patient's home environment, we will never be able to truly address the negative health impact of non-adherence.
So I ask our profession two things: 1) isn't it time, that we accept the responsibility for medication adherence and actively implement interventions, which really improve adherence and treatment outcomes; and 2) should pharmacists step away from the counter and consider making house calls in person or virtually?
The IMS Institute presented the alarming $213 billion medication-related, avoidable costs data as an "opportunity". Does a possible solution rest within pharmacy? Does an innovative solution rest within future pharmacists harkening back to the days of old and offering up a solution in the form of house calls?
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It's been 15 years since the Institute of Medicine published the "To Err is Human" report and two years later put out a follow-up report "Crossing the Quality Chasm: A New Health System for the 21st Century"; yet, two of the most fundamental health-related problems, medication non-adherence and medication mis-management remain commonplace.
A little over one year ago the IMS Institute for Healthcare Informatics published a report on "Avoidable Costs in U.S. Healthcare". In this report, the IMS Institute quantified the indirect and direct avoidable cost estimates for six medication-related problem areas in healthcare in 2012. It may not be surprising that non-adherence was problematic. However, non-adherence wasn't just one of six, but rather was the overwhelming contributor, to the tune of $105 billion out of $213 billion.
In a time when we have some of the most advanced technologies and informatics capabilities, why is non-adherence still so problematic? Why hasn't the profession of pharmacy stepped up to own this problem and to produce solutions that really make a difference? There has been a great deal of change within pharmacy to address non-adherence. The vast majority of pharmacies are doing more to automate refills and track refill frequencies. Many pharmacists are addressing adherence when conducting a comprehensive medication therapy management assessment. Yet these changes were in place, while the $105 billion avoidable costs, due to non-adherence, were generated.
This brings me back to Ms. Esposito's article. In healthcare, we may give the best of therapies and we may provide the best of instruction and directions; yet, many times for many different reasons, what happens when the patient gets home is very different from the best of our intentions. For years, my clinical teaching site was part of an aging agency, Resources for Seniors, Inc, in Wake County, North Carolina. Students would often accompany me on home visits to review medications and to assess medication management for patients referred by local nurses, social workers, case managers and physicians. After conducting a home visit, it was not uncommon to have a student say "wow, I never would have expected to see 'that'". It is my opinion, that without the ability for pharmacists to interact and see into the patient's home environment, we will never be able to truly address the negative health impact of non-adherence.
So I ask our profession two things: 1) isn't it time, that we accept the responsibility for medication adherence and actively implement interventions, which really improve adherence and treatment outcomes; and 2) should pharmacists step away from the counter and consider making house calls in person or virtually?
The IMS Institute presented the alarming $213 billion medication-related, avoidable costs data as an "opportunity". Does a possible solution rest within pharmacy? Does an innovative solution rest within future pharmacists harkening back to the days of old and offering up a solution in the form of house calls?
