It’s resolution season and I’m excited that the CHAMP team has asked me to be a guest blogger this week, as they’ve kicked-off a New Year’s resolution to help all of us achieve our goals of improving care for older adults. Each year, we find ourselves pondering a New Year’s resolution that we’ll be able to achieve; one that will stick.  If you’re thinking about a perfect New Year’s resolution for you or your agency to improve medication management for older adults, why not consider recruiting a pharmacist to be on the all- star patient care team? As a clinical pharmacist, I’ve been actively involved in geriatric pharmacotherapy for over 20 years and in my opinion, when caring for an older home care patient, it is always a team effort that should involve a pharmacist.

One of the most dramatic cases I’ve been involved in was an elderly woman who was nearly blind from complications of diabetes and glaucoma.  She lived in a one bedroom basement apartment with a single bare light bulb to light her kitchen/living room.  She took a dozen medications for her diabetes, glaucoma, high blood pressure, heart, pain, and warfarin to prevent blood clots.  When our team made a house call we found dozens of medication bottles scattered around her kitchen.  The bottle of warfarin she was using contained three different tablet strengths – her eye sight was so poor and the lighting so bad she couldn’t see the different colors or read the numbers on the tablets.  Every time she got a new bottle she combined them with her other bottles.  She also could not tell apart the color-coded lids of her glaucoma medications or self administer the drops.  It took some time to figure out what she was supposed to be taking, remove the unneeded medications, and set up a medication management system.  We also were able to enroll her in the home health program located in the hospital across the street from her apartment.

Here are five ways that a pharmacist can really help home care clinicians more effectively manage patient medications:

1. Provide information on new drugs and help avoid DDIs. A pharmacist can help the home care clinician better understand a new drug that has come out into the market by explaining major side effects, important information on administration, and determining whether or not there may be any drug-drug interactions by reviewing a patient’s existing medication list.

2. Ensure desired therapeutic result is achieved. If a particular medication is not producing the desired therapeutic outcome (i.e. reducing chronic pain), the pharmacist can help the clinician determine why and decide if a medication should be altered to fix the problem.

3. Identify whether a symptom is likely caused by a patient’s medication. A pharmacist can quickly identify if a new patient symptom could be caused by a medication the patient is taking.

4. Identify opportunities to lower medication costs. A pharmacist can help determine if there is a lower cost medication option for patients with high drug costs or stated financial concerns, or at risk for hitting the Medicare Part D doughnut hole.

5. Improve communication. When a pharmacist is part of a patient’s care team, the pharmacist can intervene and explain who should be called when there is a problem that arises from the medication. Depending on the severity of the problem, it may be best for the patient to call the pharmacist vs. the physician or the clinician to receive the appropriate care.

Here are a few medication management tools that I’ve found to be helpful:
http://www.healthinaging.org/public_education/eldercare/
http://champ-program.org/blog/?page_id=4/quality-improvement/have-you-great-success-with-of-these-medication-management-tools/
http://www.ahrq.gov/qual/nurseshdbk/docs/MarekK_MMCDOA.pdf
http://www.healthyagingprograms.org/content.asp?sectionid=70&ElementID=212
http://nihseniorhealth.gov/takingmedicines/toc.html
http://consultgerirn.org/topics/medication/want_to_know_more

Dr. Todd Semla, President
American Geriatrics Society

Todd Semla is a Clinical Pharmacy Specialist for Pharmacy Benefits Management Services for the Department of Veterans Affairs and Associate Professor in the Department of Medicine, and Psychiatry & Behavioral Science at Northwestern University’s Feinberg School of Medicine.  Dr. Semla served as President of the American Geriatrics Society from 2007-2008 and is a member of the CHAMP Advisory Council. He was also a member of the Framework Initiative’s National Advisory Council.