Medication Management – A Guide for Patients
Betty Chaffee, PharmD, is owner and sole proprietor of BetterMyMeds, a Medication Management service devoted to helping people get the maximum benefit from their medications.
So many of us take it. 70% of Americans take at least one medication, and 20% of us take five or more. The older we get, the more likely we are to have health problems and need medicine to treat them. Medications are the mainstay of treatment for chronic health problems like heart disease and diabetes. That's because so much research shows they work well to keep people with health problems healthier and more active.
But the reality of medication use isn't all that rosy. Less than half of those who take prescription drugs actually take them as prescribed. There are lots of reasons: cost, forgetfulness (all ages!), wondering if it really works or is still needed, safety concerns, unwanted side effects and sometimes just not considering it a priority. Not only that, but many people who THINK they're taking their medicine correctly actually are not. Sometimes people don't read the prescription label, thinking they remember the directions they were givenby their doctor or pharmacist. People who use devices like inhalers often never acquire the right technique to get the best effect of the medicine. Other times, people may use a medicine regularly every day when it was really intended just to be used "as needed". In the end, the majority of people who take prescription drugs take them incorrectly at least some of the time.
And there's more. Only about a third of those who take prescriptions know what side effects to watch for, so when side effects do happen, they may be ignored, treated with another medication, or worse, require a doctor's visit or even hospitalization. Drug interactions are also a problem, not only between prescription drugs but also with dietary supplements and non-prescription medicines. As you might expect, the risk of side effects and drug interactions increases as the number of medications goes up. Age also can affect these risks. As our bodies age and change, risks of side effects and dose limits of some medications also change.
All in all, it's estimated that problems with medication including incorrect use and adverse reactions cause at least 1.3 million emergency room visits, 350,000 hospitalizations, and 125,000 deaths annually in the United States. And the wasted dollars that go along with that add up to between $100 and $300 BILLION.
How in the world do we find a way to help people use medications correctly and safely so that they can get the best health outcomes from them?
Enter Medication Management!
Medication Management is "a patient-centered, pharmacist-provided, collaborative service that focuses on medication appropriateness, effectiveness, safety, and adherence with the goal of improving health outcomes." In simpler terms, your pharmacist works with you and your healthcare team to make sure all your medicines are the right ones for you. Together, you and your pharmacist will find and resolve barriers to medication use like cost, side effects, and misunderstandings about how or when to take it. For anyone who takes medications, it's exactly the right tool to improve health, decrease hospitalizations, and decrease overall healthcare costs. Here are some of the Frequently Asked Questions about Medication Management.
Who provides Medication Management Services?
Your pharmacist is always the best person to ask when you need information about medicine! Among all the care providers on your healthcare team, pharmacists are the medication experts. A pharmacist graduating today has 6-8 years of university-level training centered around medication use, and some even get extra training (residency) after graduating. A pharmacists's professional title is "Doctor of Pharmacy". Pharmacists are in the best position to help people get the most value from the medicines they take. Pharmacists who work in retail pharmacies, clinics, hospitals, or with insurance companies or self-insured employers are all qualified to provide MMS.
Medication Management works best with a team approach. That means each member of the healthcare team, including you (the patient), your pharmacist, your doctor(s), and any other specialist or provider you routinely see has a part to play in making decisions about your treatment. When pharmacists help manage medication use, people stay healthier, are hospitalized less often, and spend less money on healthcare.
What's the difference between Medication Management and Medication Therapy Management?
Medication Management is kind of an umbrella term, and there are lots of different services that fall under it. Medication Therapy Management (MTM) is a term that refers to services provided under Medicare rules. You're most likely to hear this term in community pharmacies who provide the services through Medicare prescription drug policies. Insurers who offer Medicare prescription drug policies are required to offer MTM to people who meet certain criteria. Medicare has strict guidelines for MTM, but it's still done with the same goal in mind -- to optimize the use of medications.
Comprehensive Medication Management (CMM) is another term for services that fall under the MMS umbrella. You may hear the term CMM if you receive care in a clinic that employ pharmacists as part of the healthcare team.
Where are Medication Management Services provided?
Your own community pharmacy may offer MTM. Some pharmacies, both independent and chain, already have successful programs in place to provide MTM to their customers. Some go even further by providing immunizations, health screenings, and even some lab tests. Most community pharmacies that provide MTM limit services to customers whose insurance covers the cost (usually a subset of those with Medicare benefits), but some have broader reach. Ask about MTM services at your pharmacy and be sure to schedule an appointment when your pharmacist contacts you!
Unfortunately, not all pharmacies have the extra staff needed to allow a pharmacist time to provide MTM. Some community pharmacies without their own MTM program use a central call center to provide services by telephone to their customers. More and more, video calls are being used for long-distance appointments to make communication a little easier. Though face-to-face visits have their advantages, a telephone or video appointment still allows you to get help with your medicines.
Some doctor's offices and clinics employ pharmacists to provide MMS or CMM. Clinics with a team-based approach to healthcare are more likely to have a pharmacist available. Getting care from a pharmacist right there at your doctor's office is efficient for you, your doctor, and your pharmacist. Everyone can join the conversation, view the same records, and make decisions together. If you have access to a pharmacist at your doctor's office, get to know him or her. Bring medication-related questions to your visit when they come up, and get the most out of your healthcare!
Pharmacists employed by hospitals may also provide MMS. This may happen behind the scenes when pharmacists consult with doctors about medication choices, doses, or side effects. Or you may talk with a pharmacist to review your medicines before you go home. Some hospitals even employ pharmacists to follow up with patients AFTER they get home. That's the time when changes in medicine can get confusing, and problems can lead to another hospitalization. If you have contact with a hospital pharmacist, be sure to find out who to call if you have questions after you go home!
Nursing homes employ pharmacists to review the medications of all residents every month. Sometimes the pharmacist has a chance to talk to the residents he or she cares for. If you or someone you love is in a nursing home, be confident that there is a pharmacist there watching over you. If you have questions about medications, be sure to ask the nursing home staff how to reach a pharmacist who can help!
And finally, there are pharmacists who provide MMS right in the comfort of your own home! An independent pharmacy practice with a focus on MMS may provide home visits or video/telephone appointments. BetterMyMeds currently provides MMS almost exclusively through home visits. We've learned that home visits are not only convenient for patients, but allow a pharmacist to learn more about day-to-day medication problems patients may face that may not come up in conversation. There are other pharmacy practices that may provide most services by video, which can also give the pharmacist more insight than just a telephone call. Telephone calls are also used by some pharmacy practices to provide needed MMS to patients when no other type of communication is available.
How does Medication Management work?
MMS may look a little different from place to place. But the basic pieces are the same, and are illustrated by the "Pharmacist Patient Care Process" wheel shown here. Your pharmacist starts by learning about you (collecting information). The information may come directly from you, or some may come from your health record if your pharmacist has access to it. Then, you and your pharmacist evaluate (assess) each medicine to see if it's effective, safe, and personalized to you. This is the time when any problems you're having (cost, side effects, and so forth) should be brought up. Together, you and your pharmacist (with the help of your doctor if needed) will make a plan to resolve any problems that came up during your discussion. This may include setting health-related goals as well as tracking progress toward goals. Next, you'll put the plan into action (implement). Your pharmacist will follow up with you at a scheduled time(s) to see if the plan is working. Then, if needed, you and your team can change the plan to help you meet your goals, and the process continues.
MMS always works best when you and your pharmacist have an ongoing relationship. That way, you can ask questions or discuss problems whenever they come up, and your pharmacist can check back with you periodically. If you find the plan isn't working, changes can be made and new goals set. This process is a great way to help you use your medicines more effectively and maintain better health!.
When should you consider Medication Management?
Studies show that people begin to go off track with medications nearly as soon as they start taking them. Most people would prefer not to take medicine, and research shows that many people stop taking medicine within about a year after starting it. Children, young adults, the middle-aged and the elderly all make mistakes with medicine or simply decide not to take it. Developing a relationship with your pharmacist early on allows you to talk openly about medicines. This is where you can learn about risks and benefits of your medicine, lifestyle change options, and be honest about your values and motivations. In short, the earlier you get to know your pharmacist and begin talking about your medications, the better!
Who will pay for Medication Management?
The truth is, right now we're all paying for Medication Mis-Management. The $100-$300 billion I talked about earlier? That's just the excess expense for incorrect use of medications and treating side effects. When you add in improper dosing, duplications, unnecessary use of medications and other problems, that dollar value goes way up. Last year it was estimated that suboptimal use of medications resulted in over $500 billion in unneeded expenses.
In the community pharmacy setting, Medicare Prescription Drug Policies cover MTM for those who qualify. Though it's getting easier each year to qualify, it's still just a small proportion of those who could benefit from help. Some other insurers, seeing the value pharmacists add to healthcare, are making MTM a benefit for more of their customers. Some clinics have pharmacists on their medical team, and the pharmacist's time generally comes at no added expense to patients in these settings. Nursing homes generally include the cost of the pharmacist's services into the overall cost of medications.
But if you're not one of those whose insurance covers MMS, paying for the service out of pocket is very likely still a winning strategy for you. Why? Because ongoing help from a pharmacist can add real value to your healthcare. Your health will improve, you'll understand the risks and benefits of your medicine, and you'll spend less money overall on your healthcare.
Independent Medication Management practices such as BetterMyMeds employ pharmacists to focus on medication use rather than medication sales, and they are slowly gaining traction as the value of pharmacist input becomes clearer. This type of practice offers a variety of MMS at different prices. Contact us to make your appointment today!
Originally published May 9. 2019. Revised July 31, 2019