Medication management is serious business

    This article is the first of two articles on medication management for patients and families. Next time we will write about how to reduce the cost of your medications.
    Multiple studies have shown that one of the major causes of hospital re-admissions, medical illness and death is failure of people to take prescribed medications properly. Thirty to fifty percent of patients are reported not to take the medications which have been prescribed and many more pick and choose which ones to take depending on other factors. The causes of this are many including financial (inability to pay for expensive medications), not having prescription drug coverage, failure to understand the importance or use of the medications, cognitive or memory loss making self administration unreliable, transportation problems making getting to pharmacy difficult, multiple medication changes related to recurrent hospital stays, etc.

    Even the most careful patients have difficulties adhering to doctors’ regimens when the medication list is long and complicated. While pharmacists can be helpful in sorting out which drugs should be taken when and how to avoid drug interactions, only the primary care provider can make the decisions about medication needs. The following is a proposed approach for patients and families to improve communication and compliance with proper medical regimens.
    1. Collect all the medications in your home which you take including over the counter medication. Any old medication which is no longer used should be discarded or placed in a single separate bag and labeled (DO NOT TAKE).
2. Collected medicines should be taken to your PCP office and shown to the nurse navigator, the PCP or the medical assistant at least once a year and after every hospital stay.
3. The office should help you to write a list of medications including how and why they are prescribed. It is up to you to understand the use of each medicine, so ASK if you don’t know why you are on something. You may need to bring a family member or friend with you to help translate and advocate for you at this visit.
4. If you have a problem paying for a medication, it is important to mention this to the office. Specifically ask about expensive brand name medication and whether it is essential or can be changed to a less expensive generic. We will cover this further in our next article.
5. If you cannot remember to always take the medicines, your PCP can help figure out a way to remember (there are specific pill holders with alarms to remind you a dose is due, for example).
6. If you can’t get to the pharmacy, consider a mail order pharmacy or a pharmacy that delivers. Or find a “buddy” who will help you with your pick ups.
7. Ask your PCP regularly to review whether all the medicines are still necessary. Sometimes problems resolve and medications can be stopped or the goals for your care can change as you age. It is essential you discuss your goals for medications with your PCP.
    We invite readers to offer feedback about this column and to suggest topics for future articles. You may do so by contacting Meg Callaway of the Charlotte White Center at (207) 947-1410 or meg.callaway@charlottewhite.org or Lesley Fernow at (207) 992-6822 and lmfernow@rcn.com.