Medication Management - Who is it for?

So, what is Medication Management, really? Simply put—it is service overseen by a medical professional, typically a registered nurse, that puts a plan in place to help individuals manage their medications so that they are taken all the time, on time, and avert the dangers that are possible with medication mismanagement. This service is commonly provided by a Home Health Agency in the comfort of the patients’ home and is overseen by one of the patient’s medical providers (usually their primary care doctor.)

You might be asking yourself, why is medication management even a thing? What could be so difficult about taking medication? Sure, it might seem like a simple concept to most. The patient receives prescribed medication and is to take as directed. Simple, right? Perhaps that is the case for patients who are lucky enough to only need to one or two medications to manage.

However, it is likely that if you are reading this article about Medication Management that you, or a loved one, were given orders for a reason from your medical provider to receive this service. Either the prescribed medication instructions have become too complex to correctly manage while ensuring the patients safety, or the health of the patient is not improving despite taking medication. Therefore, their quality of life is declining. To guarantee the patients safety and improvement on the quality of life, it becomes necessary to have another medical professional oversee their medication management to ensure adherence and compliance.

Let’s walk through a story example to help make sense of the importance and need for medication management services – Our patient, who we will call Anne, is in her 70’s and recently had a fall at home due to unknown causes of dizziness. The paramedics were called, who then checked her vital signs and advised her to follow-up with her primary care physician. During a follow-up visit, Anne’s physician reviewed her medications and ordered up lab work. The test results showed that her potassium levels were highly deficient, and her electrolytes were out of order, despite being prescribed two medications to help increase her potassium levels as well as a potassium supplement. Anne’s PCP decided having a home health agency step in for medication management was a necessary step to take.

So, what is it exactly that makes managing medications difficult for patients? While many factors such as age, race, culture, literacy and gender play roles, there are also added factors that make medication management more difficult to adhere to and stay compliant. Additional factors that lead to the increase in risk of health problems related to medication mismanagement are:

· Multiple chronic diseases

· Seeing multiple doctors

· Cognitive issues like memory problems

· Not having primary care to coordinate care

· Mental health Conditions

· Frailty

Let us now get back to our patient, Anne. Along with her electrolyte levels being out of sorts, Anne also suffers a neuro-cognitive disorder, limiting her ability to effectively reason with judgement. With that diagnosis there was a plan put in place to help manager her medications. So why were her potassium levels highly deficient? Why was Anne experiencing dizzy spells?

Interestingly enough, it turns out that a large percentage of individuals do not take their medications as prescribed, for one reason or another.

Here are a couple of points from a study published in the NIH/NLM that shed some light on the seriousness of medication mismanagement:

· Patients with chronic illnesses take only ~ 50% of their prescribed medications for those conditions. This creates a huge increase in the possibility of hospitalizations, additional medical expenses, mortality rate, and disease progression.

· In another study, 40-60% of patients could not correctly report what their physician had expected of them only 10-80 minutes after they were provided the information.

· A shocking 60% of patients interviewed immediately after visiting their doctors misunderstood the directions regarding prescribed medications.

· 37% of patients do not comply with their medications that are aimed at disease prevention.

· Compliance for medications that are to be taken over a long period of time drastically drop to ~50% for either prevention or cure.

Sure, for some patients a simple over-the-counter reminder device or a downloaded app on their phone may be sufficient to ensure they take their medications as prescribed. However, patients with more advanced medical histories may need more consistent help and reminders. Without, the costs could be detrimental and even deadly.

Within a 48-hr window, Anne’s home health nurse came for her initial visit and evaluation. It was discovered that Anne had prescriptions not listed on her medication list from her PCP. Two of which had the potential to cause a major cardiovascular interaction with the potassium medication she was supposed to take. How would Anne have been able to know that? Why were these conflicting medications not caught by the prescribing providers? As unfortunate as it is, medical errors do occur.

During Anne’s initial evaluation it was learned that her prescriptions instructions were not being followed diligently and consistently. There was also a high possibility that the mismanagement of her medication had been happening for quite some time, leading to the decline in her health. At this point, the home health nurse has assumed all medication management responsibilities.

All prescriptions were updated correctly across the board for all her physicians. After two-week’s time, the nurse ordered new labs to evaluate the potassium and other electrolytes. While Anne’s potassium levels increased, it was learned that some medications still needed to be adjusted to address the dizziness. The nurse will continue to manage Anne’s medication until her health has resolved to safe levels. During this time, the nurse will also be educating other members of Anne’s family the importance of and how to properly manage her medications to avoid serious health risks. The goal of home health is not to keep patients on the services for extended periods of time, but to help patients return to their normal life activity.

As a Home Health Agency, we wanted to share this particular example because this is real life. Real patients, facing real and multiple health issues and dealing with multiple physicians. While this is only one example of factors contributing to medication mismanagement, there are other problems that directly relate to medication mismanagement. Some of which may not always be clear at the surface for the patient or their family members to recognize prior to a health-related injury or hospital admission.

Here are a few more examples of problems that relate directly to medication mismanagement:

· Drug interactions (not only between medications but taking certain medications with different foods/drinks or herbal supplements could cause adverse or alter the effects.)

· Multiple chronic health conditions

· Risk of falls and fractures increase

· Discontinuation of treatment (may unintentionally forget to stop medications, financial problems making obtaining Rx's difficult or lower on patients priority list.)

Overall, if you or a loved one is prescribed medication and are having a decline in health or quality of life is not improving, medication management may be a necessary service.

At El Mirador it is our duty to strive that our patients’ rate of hospital visits and hospital admissions decrease while their quality of life increases.

Let us help you or your loved one stay safe and healthy! Call us today.