Taking medications for various medical conditions can be confusing and a bit overwhelming.
“Medications are developed to help individuals treat medical conditions so that they can remain active and continue to thrive. However, observing medications in the homes of older adults, one might find medications scattered about in kitchens, bathrooms, and on dining room tables. It can leave one with the impression that medications are managing the lives of individuals, instead of the other way around,” said Brian Isetts, PhD, RPh, BCPS, a professor and geriatric practitioner in the Department of Pharmaceutical Care & Health Systems at the College of Pharmacy.
The unfortunate and unintended consequences of medications, known as drug-related morbidity and mortality, has been estimated to cost the U.S. $528 billion annually. Fortunately, collaborations among patient support groups, person and family engagement organizations, and health care professionals are providing a new approach to helping individuals make sense out of a seemingly complex and uncoordinated medication use system.
This is where the Minnesota Northstar Geriatric Workforce Enhancement Program (MN-GWEP) decided to take action. Isetts, in collaboration with Kristine Talley, PhD, RN, GNP-BC, an associate professor in the School of Nursing and the Interprofessional Geriatrics Coordinating Council, authored MN-GWEP’s recently launched Effective Medication Self-Management Toolkit which contains resources for teaching older persons and family caregivers how to conduct a medication self-management assessment.
Helping Older Persons Confidently Manage Their Medications
According to Isetts, health care teams in Minnesota have been applying a straightforward approach to help patients take medications, and it has worked to reduce hospitalizations and readmissions, save money, and keep patients active in their homes.
He says, “Simply stated, the way to make sense out of each person’s use of medications is based on a systematic four step process—starting first with understanding the medical reason for taking each medication, then ensuring that each medication is working, then describing any safety concerns specific to the individual, and then figuring out how to take and afford each medication. So, if this is working in clinics and pharmacies across Minnesota, why not prepare patients and family caregivers to apply this same systematic process at home?”
The “Best Kept Secret in Health Care”
If there’s a process to ensure that every medication in use in a person’s home is right for them, safe for them, and can be taken as intended, then why doesn’t everybody use this?
“The good news is that most health systems in Minnesota are at varying stages of implementing this amazingly straightforward process,” said Isetts. “This 4-step process, sometimes referred to as a pharmacotherapy workup, has been developed and tested over the past 30 years—a relatively new innovation in the context of systematic care processes used by colleagues in other health professions such as in medicine, dentistry, and physical therapy, to name a few.”
Isetts says one way to think about what this medication management workup process might look like in a person’s home is to draw an analogy to the card game, Solitaire.
“Waiting for a turkey to bake on Thanksgiving may be an ideal time to gather family members around a table containing all of a person’s medications,” Isetts said. “Medications can be grouped into piles by organ systems such as medications for the heart, lungs, muscles, etc. Keep in mind that individuals and family members may not have all the answers in this 4-step process, and that’s OK because it will provide valuable information when working with a health care team to obtain the answers.”
This process can start for medications in each pile. Using a person’s heart medications as an example, the process could look like this:
- Does the individual still have the heart condition related to use of each medication?
- Are the medications working to produce the intended benefits for the individual?
- What are any safety concerns specific to the individual’s mix of medical conditions and medications?
- Is the person able to take and afford their medications?
The Effective Medication Self-Management Toolkit also contains a short Self-Efficacy Checklist that closely mirrors this 4-step process so that individuals and family members can determine where they need more help from their health care team in each of these four areas.
Studies of Older Adults who are Successfully Managing Medications
Another important aspect of the toolkit is that lessons learned from studies of older adults who are successfully managing medications have been built into this resource. Common characteristics of individuals who are successfully managing medications pertaining to the toolkit include:
- Establishing habits - so that taking medications is automatic
- Adjusting routines - taking medications early when going out for the evening
- Tracking routines - using reminders and tricks to help remember taking medications
- Simplifying routines - grouping medications together to reduce complexity
- Valuing medicines - viewing medications as essential to maintain and improve health
- Collaborating - knowing when and how to engage health team members
- Managing costs - getting help for financial burdens
Amy Olson, who has managed her own medications for a chronic condition for more than 20 years, follows the easy and practical advice the toolkit has to offer.
“I thought the toolkit was well done and thorough,” said Olson. “It gave very good examples of questions that need to be asked and discussions that need to be had with patients. I believe it was both useful and engaging. It was also very well designed and nice to look at which made things really nice.”
Olson says she organizes her medication for a week at a time, and she adheres to a daily schedule for both morning and evening doses. She discusses any additions or changes in her medication regime with her pharmacist and physicians, which includes discussions on over the counter vitamins and supplements, some of which may have negative side effects with her prescribed medication.
“Maintaining a consistent medication schedule improves my day to day quality of life and lets me feel good,” Olson said.
Resources to Learn More
There are several Person and Family Engagement (PFE) Organizations, Patient and Family Advisory Councils (PFACs), and patient support groups that spend considerable time and resources helping individuals simplify the process of taking medications, including:
- Project Patient Care
- Institute for Patient and Family-Centered Care
- Consumers Advancing Patient Safety
- Patient & Family Centered Care
- Centers for Medicare & Medicaid Services Person and Family Engagement Network
The contributions of these patient engagement organizations, as well as their plea for more effective collaboration and shared decision-making with the medical community, has guided the development of the Effective Medication Self-Management Toolkit.
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