Todd Wormington is senior clinical product manager for MTS Medication Technologies an Omnicell company, working on the development and implementation of medication adherence solutions for the non-acute care space. Before coming to Omnicell, Wormington worked in various pharmaceutical settings as a chief pharmacist for an independent retail pharmacy chain. Todd earned a Bachelor of Science in Pharmacy and a master’s of Business Administration with an emphasis in Health Services Administration from the University of Missouri-Kansas City.
For people who have experienced long, full lives, one of the most difficult aspects of aging is the fear of losing one’s independence. Their self-reliance may become compromised when those closest to them notice changes in behavior, such as no longer being able to drive, prepare a meal or keep track of appointments.
Most seniors are eager to remain in their own home; approximately 90 percent intend to continue living in their current residence for the next five to ten years. This desire is not limited to the elderly—individuals with various health conditions may also experience a heightened reliance on support from others. When a patient is able to stay at home, family members are assured their loved one is as happy and comfortable as possible and professional caregivers are able to promote better patient health.
For many caregivers, the most important task that helps to keep a patient at home and out of the hospital is correctly managing medications. More often than not, elderly patients are managing numerous medications and are struggling with multiple chronic conditions. Half of all adult Americans have at least one chronic condition requiring medication, such as high blood pressure, diabetes, high cholesterol or asthma, and nearly 50 percent of these individuals do not take their medications as prescribed. Staying committed to a medication regimen can be complicated, especially when prescriptions need to be taken at different times during the day. Patients may be required take up to ten—if not more—pills a day and each medication’s dosing instructions may vary based on meal times or activity levels.
Challenges with Medication Management
Medication non-adherence and falling are the two biggest culprits of causing patients to move from their homes to long-term care or the hospital. Although falls may be unavoidable in certain situations, medication non-adherence is preventable and should not have to be a primary concern of patients.
Patients cite forgetfulness as the number one reason for medication non-adherence. When given multiple medications in different amber vials, almost anyone would struggle to organize these medications and take every dose as prescribed. As primary caregivers know, sorting medications can take hours of time, especially if the medication regimen is complex. For many, sitting at a counter each week with ten pill bottles and categorizing medications into a plastic weekly medication container is a familiar experience.
There are many aspects of caregiving that require specific training or professional assistance; however, medication management is something that can be done without special expertise. There are numerous options to simplify the process and reduce the risk factors.
Supporting Improved Adherence
Caregivers, with the support of community pharmacists, can use medication adherence tools to help support proper medication habits and provide their patients with a viable routine to keep them healthy and safe. This support can include medication therapy management counseling for the patient, medication refill synchronization to minimize the number of trips to the pharmacy and physical adherence packaging or technologies.
Medication adherence tools can take many forms; one that is particularly simple and easy to follow is the blister card format. Blister cards are provided by many local pharmacies in a prepackaged arrangement, helping the patient take the correct medication at the right time. This eliminates the burden and stress for caregivers to prepare the week’s medications for their patients and helps improve patient confidence. According to one focus group of elderly patients regarding this type of solution, the confidence level of patients in managing their medications increased from 7 percent to 93 percent, while patient adherence rates increased from 22 percent to 97 percent.
Most importantly, seniors who do not live with family members or have 24/7 care can rely on visual recognition to see when a medication was punched out of its blister and administered. If the card remains intact with medication inside, the patient and caregiver can easily tell which specific dose was missed. The card eliminates uncertainty as it clearly shows if, in fact, the medication was taken.
When relying on technology such as adherence packaging, correct medication administration is simplified and the initial responsibility of accurately categorizing the medications is lifted from the patient or caregiver and reallocated to the community pharmacist.
Other adherence technologies, such as mobile apps, can also be extremely helpful. Some applications promote communication between patients and health care providers, while others remind the patient to take medication at a certain time. Available features include the ability to automatically text a family member or caregiver if a medication is missed so that a patient living alone can then be reminded with a simple phone call.
True success in patient care will be achieved by combining the right tools, resources and personal support structures. Particularly tech-savvy seniors may be more inclined to use a mobile app, while others would prefer a daily phone call from a family member or caregiver to remind them of their medications and provide additional human contact. A multi-faceted approach to adherence that combines physical tools with provider support will be most successful in tackling medication non-adherence. As a caregiver, understanding the unique needs of each individual and suggesting tools that align with their personal care goals is essential to ensuring support is embraced by the patient.
Preventing the Controllable
Missing a single pill, never mind an entire dose of pills, puts the health and safety of a patient in jeopardy and impacts his or her ability to remain independent. Patients who are non-compliant with their medication use are 17 percent more likely to be admitted to the hospital. Remaining in one’s own home and comfort zone promotes better mental and physical health, and should not be threatened by medication adherence issues. Unlike accidental falls, repercussions from missing medications are avoidable and should be prevented at all costs.
As any patient on daily medications knows, adhering to medication is much easier said than done, particularly for elderly patients, and can have serious health consequences if a patient fails to comply. As a caregiver, it is important to leverage the expertise of community pharmacists to manage the medication needs of your patient. New innovations such as prepackaged cards are not only widely accessible, but also remarkably effective in easing the burden of independent living and care delivery.