managing medication mayhem

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CHF Clinical Pathway Medication Reconciliation

Managing Medication MayhemPresented by:Laura Balsamini, Pharm D., BCPSand Gwen Egloff, Pharm D., BCPSDecember 8, 2016

Laura

Are you or a loved one overwhelmed with multiple medications? Learn how to manage a complex medication regimen to improve health and well-being. Pharmacists will be on hand to share helpful tips and answer questions.

1

ObjectivesExplain the importance of knowing your medications and why you take themImprove medication adherenceDevelop strategies to best manage medicationsLearn techniques to maintain an up-to-date medication list

Laura

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What you need to know!Name: Generic/BrandDose: How much? Directions: How often?Indication: Why you take them?Duration: How long you will take them?Side effects and how to manage

Laura

Can always ask pharmacist to add what the medication is for on the labelLoved ones need to know your medications, up to date copyAdd up-to date med list slide

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Reading a Prescription Label

Laura

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Medication AdherenceThe extent to which a patients behavior, whether it be taking a medication or following lifestyle modification recommendations, corresponds with agreed-upon recommendations from a health-care provider

Gwen

Who has heard of medication adherence before?Medication adherence is ..So in summary, medication adherence is how often patients follow their providers recommendations which includes medications, diet and exercise5

Question # 1What percent of patients DO NOT take their chronic medications as prescribed?

Gwen

We have our first knowledge check.

Does anyone have an idea of

Any other guesses?6

Answer to Question # 150%

Gwen

50%!So only half of patients are taking their medications as prescribed by their doctor7

Medication Non-Adherence>25% of new prescriptions never filledUp to 50% of patients dont take their chronic medication as directedWorse outcomes Up to 50% of treatment failures 125,000 deaths annually Higher cost to patient and healthcare$100 Billion per year in hospitalizations

Gwen

Medication Non-adherence, or not following doctors recommendations, is an extraordinarily complex issue The greatest concern with non-adherence it is directly linked to worse outcomes. Patients who dont take their medication are more likely than patients who do take their medication to have worse outcomes that directly relate to higher medical bills.

To give you an idea of the magnitude of this issueOver of patients never fill a new prescriptionAdditionally as we reviewed with Question #1, of patients dont take their chronic medication as directedNon-adherence causes ~30% to 50% of treatment failures and 125,000 deaths annually Not to mention, patients not taking their medications leads to $100 Billion per year in hospitalizations every year

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Making Your Meds AffordableConsult your pharmacist!GenericsEquivalent product at lower costGeneric Combination Products2 or more medications in one pillPatient Assistance ProgramsCouponsMedicare Part D

Laura

Cant afford your medications, your pharmacist may have affordable alternatives to suggest 9

Generic MedicationsCost 80-85% less than the brandSame quality, purity, effectiveness, performanceAll FDA-Approved generic drugs must be equivalent to the brand name drugSame active ingredientSame strengthSame dosage formSame route of administration

Laura

The Lower Price Doesnt Mean Its Inferior.

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Reduce Your Pill CountGeneric Combination ProductsOnce daily dosesMinimum necessary medications

Laura

Minimum: PPIs, Abx, OpioidsDiscuss with provider if necessary11

Reduce Trips to the Pharmacy90-day SupplyMedication Synchronization

Laura

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Patient Story

Gwen

As a pharmacist, Laura, Walter, Venus, John and I have so many patient stories to share about the benefit of taking medications as prescribed.

Medicine taken incorrectly- I see a number of patients on statins that take their medication in the morning instead of the evening which is the best time to take these agents.Medicines taken with no clear indication- I see this a lot with PPI. I see a lot of patients that take this class for extended periods of time. When I question how their stomach feels they generally say it feels fine but have not attempted to d/c the item.Cost-I know we want to get away from brand name meds but there are cases where the MD and patient have decided this is the best course of treatment. One of the things we help patients a lot with here are co pay cards. We enroll them right on the spot and they realize an immediate savings. Xarelto is a great example where this works well.

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Question # 2Raise your hand if you ever MISS doses of your medication

Gwen

I would like to ask for some audience participation again.

Please ..

Everyone misses their medication! No one is immune to being too busy to take medications or occasionally forgetting a dose or two. Thankfully, there are plently of tips and tricks we can all employ to improve how often medications are taken and therefore improve our health.

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Taking Your Medications DailyPill BoxUnit-dose packagingAutomatic refillRemindersAlarmsCalendarMyMeds

Gwen

Taking medications everyday, sometimes multiple times a day, is tough! Although not every tool will work for everyone, it is important to find what works best for you to ensure you are able to take your medications every day.

Some patients find a pill box to be helpful. Now pill boxes come in so many shapes and sizes. Pill boxes are available in 7-day sets, 7-day morning and evening, morning, lunch, dinner, evening, month pill boxes and even more!

Some pharmacies provide Unit-dose services which are very helpful for patients who take several medications multiple times per day. The pharmacy pre-packages all the medications to be taken at the same time in one convenient pouch. For example, for a patient that takes medication in the morning and evening, the pharmacy would provide all morning medications in one pouch and all the evening medications in another.

Another great tool is setting reminders. I personally find alarms helpful. I set it on my phone for a time I am always home, and when the alarm goes off, I take my medication.

Other patients use a calendar to mark off once medications are taken on that day. This is especially helpful for patients who take medications only on certain days of the week.

Walgreens pharmacists like Walter can print out a list to help keep track of medications that includes all your medications and you can check off once its taken.

Finally, MyMeds is a fantastic app for patients with smartphones. This is a comprehensive health app. Patients can add all medications, doctors, allergies and even their pharmacy! This is also helpful is you help to manage someone elses medications. In that case, you could set them up with this app, and then you are able to set up access as a caregiver with the ability to edit the medications list, view adherence, etc. In addition to storing medication information, this app can remind patients to take their medications 3 ways! The app can text you and you text back yes when you take your medication. It can also e-mail you or send a notification to your phone to take your medication.

What tools are you using to remind you to take your medications?15

When to Take MedicationsEmpty stomachWith foodBedtime

Gwen

Whenever you have questions about when to take your medications, always talk to your pharmacist!

Some medications work best with or without food or even at bedtime.

For example, some medications work best on an Empty stomach, PPIs which reduce stomach acid. Other medications are best on an empty stomach because they are Improve effectiveness: Proton pump inhibitorsImprove absorptionSome antibioticsIronBisphosphonatesSome HIV medsLevothyroxineSeparate from calciumTetracyclinesQuinolonesSome medications should be taken with food because it reduces stomach upset, like Advil or metformin, or taken with food because it helps make the medication work better, like With foodReduce stomach upsetCorticosteroidsOpioidsNSAIDsMetforminImprove absorptionLovastatinRivaroxabanBedtimeOther medications like some cholesterol medicaitons including simvastatin/zocor, work best at bedtime. This is because your body makes the most cholesterol overnight.Some statins: simvastatin, fluvastatin, lovastatin

Real life exampleshttp://pharmacistsletter.therapeuticresearch.com/pl/ArticleDD.aspx?nidchk=1&cs=RITEAID~CEPDA&s=PL&pt=2&fpt=31&dd=320511&pb=PL&searchid=58842340&segment=9682

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Missed DosesDont panic!Rule of thumb:Take as soon as you rememberIf it is close to your next dose, skip the missed doseDo not take 2 doses at the same timeThere are exceptions to this ruleWhen in doubt, call your pharmacist

Gwen

As I previous mentioned, everyone can miss doses when life happens. Its important to know what to do when this happens. General principles, miss dose > 6 hours (PL)

Don't panic if you miss a dose of your medication. Take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your regular medication schedule. Do not take two doses to make up for the dose you missed.http://my.clevelandclinic.org/health/healthy_living/hic_What_You_Need_to_Know_About_Taking_Your_Medications17

Over-The-CountersNasal Corticosteroid SpraysProton Pump InhibitorsOxybutynin PatchAntihistaminesHistamine-2 AntagonistsSleep Ai