Areas of focus include drug discrepancies during care transitions, polypharmacy and self-management promotion.
Older adults, generally defined as individuals 65 years of age or older, are expected to make up a quarter of the U.S. population in the coming years and represent the fastest growing age group in America.1.2
Pharmacists and pharmacy technicians are known for being some of the most accessible and most visited members of the healthcare industry.3 There are indications that pharmacists deal with patients up to 10 times more often than general practitioners.4 With the continued expansion of the older adult population, pharmacists and technicians have the opportunity to play an important role in addressing their healthcare and medication needs. Some of these include medication discrepancies that occur during care transitions, polypharmacy and the need to end deprescription, and promoting greater self-efficacy through medication self-management, especially for those who do not have effective social support structures.
Older adults often deal with multiple chronic health conditions, increasing the likelihood of polypharmacy.5 Polypharmacy, or the simultaneous use of multiple chronic medications, has been widely associated with negative health outcomes.6.7 A study of 2206 independent adults of all ages
Ages 62 to 85 were surveyed through home interviews and use of medication logs between 2010 and 2011. 87% of the participants used at least 1 prescription medication. Five or more prescription drugs were used
with 36% and 38% using OTC medications. Polypharmacy can contribute
to an increase in drug interactions, inappropriate drug combinations, adherence issues, and cascade prescribing. Technicians in all settings can help identify patients with polypharmacy who could benefit from a comprehensive medication review by their pharmacists. Pharmacists can then conduct a polypharmacy-focused medication review and make prescriptions for prescription to the patient’s primary care physician. Deprescription involves evidence-based systematic decisions in reducing unnecessary drugs that can contribute to harmful health outcomes, rather than promoting positive ones.
Older adults are also more than twice as likely to be hospitalized compared to middle-aged adults,8 which not only increases the risk of polypharmacy and medication errors. Transition points in care represent moments of increased risk of medication deviations and miscommunication. Seamless care transitions are especially vital for elderly people with multimorbidity, who are cared for by multiple specialist caregivers, are seen more often in the hospital, and often have complex medication regimens.9 Medication reconciliation, a pharmacy-driven process, plays an important step in the identification of medication abnormalities and polypharmacy. Evidence has shown that trained technicians can obtain medication histories accurately and completely.10 A retrospective chart review conducted at a New Jersey teaching hospital assessed 200 inpatients who had received a technician’s medication history of medications prior to admission, followed by medication reconciliation of the electronic health record (EHR) by a pharmacist.11 Medication history taking by technicians involved a brief interview of the medication history with the healthcare provider or patient, which was then verified against objective data, such as prescribing data, prescription refill history, and prescription vials. A total of 325 medication discrepancies were identified, with drug omissions being the most frequently observed (64.7%). This study demonstrated the utility of including technicians in drug reconciliation programs.
In the community setting, there are additional measures that technicians can take to protect older adult patients. If possible, technicians can encourage periodic so-called brown-bag checks. They can instruct patients to
in all their medicines and check the expiration dates of these medicines, among other things. During these assessments, patients brought home medications can also be linked to their profile in the EHR. This process can help identify patients with medication abnormalities and the use of multiple pharmacies. A review of each patient’s refill history can also shed light on adherence. Available methods to encourage adherence include letting patients choose auto-refill, providing medication statements, and using medication organizers. Also, because older adults generally have multiple specialty providers, techs may encourage patients to transfer all their prescriptions to 1 health care system or pharmacy as this helps maintain an accurate and up-to-date list of all outpatient medications that are on the patient. prescribed. Finally, cognitive decline is common in older adults and has been linked to poor drug self-management skills.12 Technicians play a critical role in ensuring that patients leave the pharmacy with adequate resources for successful self-management of medication.
This may include printed prescribing information, ensuring patient materials are printed in legible font size, and verbal communication of medication changes to patients and their healthcare providers.
Technicians are a valuable resource to health systems and play a key role in working with older adult patients to reduce medication errors. In healthcare transitions, highly skilled technicians can positively influence the workflow by carrying out medication coordination on admission. This process helps identify discrepancies in medication history and medication list and also identifies patients with polypharmacy. In the community, technicians interact with patients more often than pharmacists, making them ideal candidates for identifying adherence issues.13 Proactively reviewing patients’ electronic records for dispensing history can help identify patients struggling with adherence and provide technicians with an opportunity to alert and collaborate with pharmacists to share effective adherence strategies. Finally, communication of medication changes often falls to technicians when retrieving prescriptions. Ensuring clear, patient-friendly communication maintains an environment of trust and reduces medication errors. Trust is especially important for patient outcomes, but it also helps foster customer loyalty.
About the author
Lyubov Villanueva is a PharmD candidate at Touro University California College of Pharmacy in Vallejo.
Jennifer Chen, PharmD, BCPSis a clinical pharmacy practitioner at VA Northern California Health Care System in Sacramento.
Shane P. Desselle, PhD, RPh, FAPhAis a professor of social, behavioral, and administrative sciences at Touro University California College of Pharmacy in Vallejo.
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