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Medication Management – What, Why & How
Setting the Stage – Why Medication Management is Important
Taking the right medication at the right time in the right amount and in the right order is so important that it can determine how a person feels, how their symptoms are managed, and even whether they will live or die. Certain medications can interact with other medications or even with dietary supplements or over-the-counter drugs, further increasing these risks.
These days, chronic diseases are prevalent with many people are taking one or more prescriptions to manage their conditions. Because of this, errors can errors occur between doctors and pharmacists, and it can be difficult for patients to understand what they are supposed to be taking when and what foods, supplements and over-the-counter drugs can be taken with their medications. The likelihood of duplications, side effects, allergic reactions and contraindications further enhances the risks.When issues with medication do occur, they can lead to expensive emergency room visits and hospitalizations, not to mention the health risks that result. Seniors and people with more than one chronic disease are most likely to experience an issue with medication because they typically take multiple medications.
Important Statistics
- According to the Institute of Medicine, “there are at least 1.5 million preventable adverse drug events that occur in the United States each year.”[i]
- Over 3.5 billion prescriptions are written each year in the U.S.[ii]
- Four out of five patients leave with at least one prescription after visiting a physician.[iii]
- According to the World Health Organization, reduced health outcomes and higher healthcare costs are the main results of poor adherence to therapies for chronic diseases.[iv]
- Medicare beneficiaries who have multiple chronic illnesses see an average of 13 different physicians, fill 50 prescriptions each year, account for 76% of all hospital admissions, and are 100 times more likely to be hospitalized for a preventable condition than those without chronic conditions.[v]
- “Pharmaceuticals are the most common medical intervention, and their potential for both help and harm is enormous. Ensuring that the American people get the most benefit from advances in pharmacology is a critical component of improving the national health care system.”[vi] ~ Institute of Medicine of the National Academies
- “In hospitals, medication errors are more common than they should be at every step: they occur when procuring the drug, prescribing it, dispensing it, administering it, and monitoring its impact. Estimates of preventable hospital-based ADEs run from 380,000 to 450,000 a year, and they skyrocket to 800,000 a year in long-term care facilities.”[vii]~ Institute of Medicine of the National Academies
What is Medication Management?
Medication management is the process of reconciling, monitoring and tracking each individual’s medications (which includes their prescriptions, over-the-counter medications, nutritional supplements, vitamins, and other traditional and alternative therapies) and providing safety education to ensure patient compliance and avoid dangerous drug interactions and complications.
Medication Reconciliation
Medication reconciliation involves comparing the medications and dosages that are prescribed with what is actually being taken by the patient. This helps to ensure medications safety by decreasing the chance of duplications, omissions, substitutions, and allergic reactions. This process should be undergone each time a new medication is prescribed or when medication changes are considered.
Medication Monitoring
Medication monitoring is simply the monitoring of the medications a patient takes. The following is monitored during this process: a list of medications and their dosages is made, including when they should be taken, how they should be taken, and the reason each medication is being taken. Over time, this list will be monitored to determine any side effects and the benefits the drugs provide for the patient.
Medication Tracking
Tracking whether a person is taking their medications as prescribed is an important way to reduce medical complications. These days, this is accomplished through devices and apps that provide reminders for patients to take medications, medication dispensers that are marked to clearly indicate when and how the medication is to be taken, as well as written information about how to handle a situation in which a dose is missed. Caregivers can also help with the tracking of medication by providing reminders and answering any questions the patient might have.
Medication Safety Education
An important part of medication management is safety education. As patients and their family members better understand the risks and consequences that come along with not taking their medications as prescribed, they are more likely to comply. Compliance leads to a better maintenance of health and wellbeing and reduced medical costs.
Medication Management Accomplishes the Following:
- Knowing what medications are being taken and in what doses and intervals
- Knowing why the medications were prescribed
- Ensuring the doses are timed correctly and that doses are not missed
- Checking for harmful drug interactions
- Ensuring the patient follows directions for taking the medication properly
- Understanding if medications should be taken with or without food
- Warning about potential side effects
- Recording side effects
- Increasing communication between the patient and the healthcare team when it comes to medications
- Working directly with patients to increase compliance
- Patient education related to medication safety and information
- Improves collaboration between physicians, pharmacists and other healthcare providers
- Improves patient outcomes
- Empowers patients to take an active role in managing their medications
- Helps prevent medication-related morbidity and mortality
- Reduces medication errors
- Monitoring the effectiveness of the medication treatment plan
Medication Management As Part of Coordinated Care
Medication management is an essential part of a personalized care plan because it helps to achieve the goals of the care plan and help achieve the desired outcomes.
It is a very important part of coordinated care management, such as that offered by CarpeVITA Care Management. All points of care and the medications that come out of those points of care are interconnected because they all interact with and affect each other. For this reason, medication management services must be comprehensive and personalized.
When included in the comprehensive services of coordinated health networks, such as CarpeVITA Health Networks, medication management can help the entire healthcare team to be more effective and helps promote P4 Health (Prediction, Prevention, Personalization, Participation).
When is Medication Management Used?
Health Status Changes
As a person’s health status changes, a change in daily living activities often results, as well as new medications and changes to medications. During this time, it is important to re-reconcile the patient’s medications to ensure that the medication schedule is supportive of the treatment plan.
Care Setting Changes
Medication management is particularly important when there is a change in care settings, such as a hospitalization, a move to a nursing home or treatment center, discharge out of a facility, or the start of home heath care. At these times, it is especially likely that changes will take place in doctors, caregivers, services and medications.
Changes in Healthcare Providers
When there is a change in healthcare providers, for whatever reason, medication management can help provide much needed communication that will ensure a patient’s medications are followed through with and understood by the new healthcare provider(s).
Additional Patients Who Benefit Most From Medication Management
- People who are experiencing adverse medication effects
- People who have trouble understanding their medication regimen
- Seniors and people with multiple chronic conditions
- People who are frequently readmitted to the hospital
- People who are not experiencing the outcomes they seek
- People who need preventative therapy
How the Medication Management Process Works
According to the guidelines set forth by the Patient-Centered Primary Care Collaborative[viii], medication management is a process that utilizes the following four steps:
1) Assessment – First an assessment is done to uncover the patient’s medication needs, history and experience, including their understanding, expectations, beliefs and concerns about his or her medications. This way, a basis about their decision-making process can be gained when it comes to whether or not the patient will take the medication or even fill it and if it will be taken properly.
2) Identify Problems – From the data gathered during the assessment, an identification of any medication-related problems can be made with regards to the appropriateness, effectiveness and safety of the medication, as well as patient adherence.
3) Develop Personalized Care Plan – At this point a personalized care plan can either be put into place or medication management can be added into an existing comprehensive personalized care plan for the patient. This might include interventions such as drug therapy, changes in drugs or doses, or patient education, as well as therapy goals, measurable outcome parameters and a follow up schedule.
4) Follow Up – By following up and monitoring whether the therapy goals are being met, the patient’s outcomes can be measured and new medication issues can be detected and worked on.
How is Medication Management Paid For?
Medication management can be paid for in a number of ways:
- Some Medicaid programs provide paid benefits for medication management.
- Some employers offer medication management services for their employees.
- Many medical homes offer the service.
- Care management services, such as CarpeVITA Care Management, often covers medication management. With a monthly membership, comprehensive care management covers many of the health services that might otherwise not be covered, including medication management.
Download the Medication Management Whitepaper Here!
[i]https://iom.nationalacademies.org/~/media/Files/Report%20Files/2006/Preventing-Medication-Errors-Quality-Chasm-Series/medicationerrorsnew.pdf
[ii]http://meps.ahrq.gov/mepsweb/data_files/publications/st196/stat196.pdf
[iii] The chain pharmacy industry profile. National association of Chain Drug stores. 2001
[iv] http://whqlibdoc.who.int/publications/2003/9241545992.pdf
[v] Anderson GF. Testimony before the senate special Committee on aging. The Future of Medicare: recognizing the Need for Chronic Care Coordination. serial No. 110-7, pp 19-20 (May 9, 2007)
[vi] Institute of Medicine of the National Academies, Informing the Future: Critical Issues in Health, 4th Edition, http://www.nap.edu/read/12014/chapter/4
[vii] Institute of Medicine of the National Academies, Informing the Future: Critical Issues in Health, 4th Edition, http://www.nap.edu/read/12014/chapter/4#14
[viii] https://www.pcpcc.org/sites/default/files/media/medmanagement.pdf
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