Solving the multiple medications puzzle
Editor's Note: The following column is an interactive question-and-answer feature appearing the first Wednesday of each month. Readers are encouraged to send health-related questions that will be answered by a local medical professional to firstname.lastname@example.org. Today's question is being answered by Dustin Carneal, Pharm.D., a clinical pharmacist at Alliance Community Hospital.
Q. My elderly mother lives alone and for the most part is still independent. She has been visiting multiple doctors who have prescribed various medications. I visit her daily but increasingly she is becoming confused and frustrated about the number of pills she has to take and when she has to take them. In fact, she has threatened to stop all of her medications as a result. Suggestions? -- Tess B., Atwater.
A. One way to help ease the confusion is by empowering your mother emphasizing to her that each medication is important and has a specific reason why it is prescribed. This is best done by setting up a comprehensive medication review appointment with her pharmacist. Keeping medications straight can be a daunting task, but patients often don't realize that there is plenty of help available to sort through the confusion.
In 1992, the American Association of Colleges of Pharmacy (AACP) voted to require that all accredited pharmacy schools offer Doctor of Pharmacy degrees or Pharm.D. In the last 10 years, all graduating pharmacists have completed six to eight years of training to obtain their doctorate degree. Pharmacists are trained in medication therapy management, a process by which all medications can be reviewed for drug interactions, side effects and cost reduction. During a comprehensive medication review the pharmacist can help your mother understand each medication's purpose, identify an opportunity to simplify medication directions, and perhaps remove a medication after a discussion with her physician.
The task of taking daily medications will become less of a burden and your mother will become more comfortable knowing that these medications are to keep her healthy. Ask your pharmacist if you can schedule a comprehensive medication review, which may be covered by your insurance.
Record-keeping is also an important part of taking the right medications. Even with vast improvements in electronic health records, there is still a possibility that the electronic records and the prescriptions from physicians may not match. As a result, health care facilities like Alliance Community Hospital, have implemented clinical pharmacists in key patient care areas to help patients and physicians understand their medications and determine the best medication regimen for maximum effectiveness while reducing costs and side effects. These clinical pharmacists also help keep medication lists straight.
I encourage patients at Alliance Community Hospital to contact a pharmacist to help them make the right decisions regarding their medications. Below are some recommendations to help keep your mother's medication list up-to-date:
1. Use one pharmacy: Even though all of your medications may be prescribed by more than one physician. If you are able to fill all of your medications at one pharmacy the pharmacist will be the "keeper" of your best medications list. List this pharmacy and phone number on your medication list.
2. Ask your pharmacist: Your personal pharmacist knows your medications the best. They are the most accessible health care provider, just a brief phone call or visit can help remove confusion. Also ask your pharmacist if you can schedule a comprehensive medication review, which may be covered by your insurance.
3. Put it in writing: During this comprehensive medication review the pharmacist will help you create a medication action plan to help you write down and understand your medication and help you express medication-related concerns to your physicians. If you are unable to schedule a meeting with your pharmacist, ask a family member to help you write down all of your medications, then have it reviewed by your pharmacist.
4. Medication name: Medication names are very important. Some medications come in different formulations that may affect how they affect the body. Vitamins count, so be sure to also include over the counter medications, inhalers, vitamins, herbals and supplements on your medication list as they may interact with prescription medications.
5. Medication dose: The medication dose is often listed as mg or mcg on the bottle. However for medications like insulin these doses may change frequently or have conditions.
6. Directions: List the number of tablets and time of day you take the medication. If once a week or month, list the day of the week/month you take the medication.
7. Reason for taking: Some medications have multiple purposes. Ask your pharmacist or physician what the medication is for. This can help you understand your medication therapy better.
8. Date it: Medication changes can occur very often; be sure to place a date on your medication list so the nurse at the office or hospital can ask if any changes have occurred since the last time you updated your personal medication list.
9. Have it: Ensure the medication list will fit in your wallet or purse in case of an emergency.
10. Bring them: When in doubt bring all of your medications bottles, inhalers, vitamin, herbals and even over-the-counter medications to the hospital in an emergency.
Rest assured, you are not alone in dealing with this issue. If the task becomes overwhelming, we are here to help and I would encourage you to accompany your mother when you meet with the pharmacist.