February 25, 2021
When patients visit your independent community pharmacy, they may not know much about the medication they’ve just been prescribed. They probably don’t know if there are any side effects or if it’s safe to take the medication in conjunction with another medication.
But the more medications a patient is taking, the higher the risk becomes for cumulative side effects or adverse events. As a pharmacist, an expert in health care, and a trusted confidante, you can help patients reduce their risk for polypharmacy.
Elderly patients and patients with chronic medical conditions are the most susceptible to polypharmacy, which happens when patients have been prescribed a variety of drugs that could duplicate therapy or have bad interactions with each other.
It commonly occurs when patients have multiple doctors — they may see a primary care physician, a specialist for one chronic illness, and another specialist for a different chronic illness. If providers are focused on treating a particular condition, they may not look at the whole picture and end up contraindicating or duplicating therapies.
The same risk occurs when patients are receiving prescriptions from multiple pharmacies. When a patient gets all their prescriptions filled at the same location, it’s easy to flag potential issues, but if they are visiting you and a box store and using mail-order pharmacies, it’s hard to nail down potential adverse reactions or cumulative side effects.
Patients are also at risk for polypharmacy when they take supplements in addition to their prescription medications without talking to their doctor about it. Certain supplements can reduce the effectiveness of prescription medications, like St. John’s Wort and warfarin.
When it comes to prescription drugs, more is not always better, and polypharmacy can lead to adverse drug reactions that result in hospitalizations and death. An average of 99,628 emergency hospitalizations occur every year because of adverse drug events, which means you could save your patients a lot of pain by actively working against polypharmacy.
But even if they don’t have an adverse reaction, polypharmacy could mean that patients are paying for more drugs than they actually need. By reducing polypharmacy, you may be able to help patients reduce the number of medical appointments they need to attend and the number of prescriptions they need to pay for.
In order to identify potential polypharmacy problems, ask your patients these five questions.
Although you probably have your patients’ prescription and health history on file, you may not be aware of all the medications they take.
Patients may have stopped taking a prescription or filled a new prescription at a different pharmacy. Plus, they could also be taking supplements or over-the-counter (OTC) medications on a regular basis.
This is a good time to perform a medication reconciliation.
Ask your patients for a complete list of medications (prescription and non-prescription) that they’re currently taking or planning to take and analyze them for potential contraindications and or therapy duplications.
From there, you’ll be able to inform your patients which medications have possible side effects if taken together, or which medication could lessen the effects of another medication.
This is likely something you always ask patients before giving them their medication. Nonetheless, it’s imperative you continue asking patients this simple question because it can help you better determine a patient’s knowledge.
If your patient has been prescribed a new medication they’ll likely want clarification on how to take it, when to take it, and the possible side effects. Not only does asking this simple question help you better educate your patients and lessen the potential for polypharmacy, your patients will also appreciate the individualized attention and further trust your guidance as an expert in health care.
It’s a good idea to ask patients if they’ve noticed any differences in their health since beginning a new medication regimen. While patients may not recognize that a change is because of a medication interaction, they may realize that they’ve recently had memory fog or felt particularly sluggish lately, which is a cue for you to investigate potential polypharmacy problems.
You may want to pay closer attention to your elderly patients because they may be at a higher risk for having adverse reactions to certain medications.
According to American Nurse, “Older persons react differently to medications than younger persons. Although absorption rates for most drugs don’t change with age, aging alters body fat and water composition: fat stores increase while total body water decreases. These changes can alter therapeutic drug levels, causing greater concentrations of water-soluble drugs and longer half-lives of fat-soluble drugs.”
A lack of medication adherence, or simple forgetfulness can lead to dangerous implications. For example, patients may forget they have taken a certain medication and take double the dosage.
If you haven’t already, implementing a medication adherence program at your pharmacy is a good way to prevent polypharmacy. Apps can help patients keep their medications straight by sending them a notification when it’s time to take their pills.
You can also provide services like adherence packaging that puts all of the patient’s medications in a single package, sorted by the time of day they should take them. This way, a patient will be able to check if they really did take their morning doses instead of accidentally doubling up.
Although prescription sales may play a pivotal role in your pharmacy’s bottom line, your patients’ health is likely at the forefront of your concerns. And sometimes a prescription medication isn’t the only way to treat an ailment.
For example, if your patient has trouble falling asleep at night you may be able to help them find alternative ways to treat their sleeplessness versus relying on a sleeping pill.
And just because you may be cutting out one prescription sale doesn’t mean you have to lose a profit. Bolster your front-end sales by recommending a therapeutic pillow or a non-prescription sleep aid, such as melatonin.
PBA Health is dedicated to helping independent pharmacies reach their full potential on the buy side of their business. The member-owned company serves independent pharmacies with group purchasing services, expert contract negotiations, proprietary purchasing tools, distribution services, and more.
An HDA member, PBA Health operates its own NABP-accredited (formerly VAWD) warehouse with more than 6,000 SKUs, including brands, generics, narcotics CII-CV, cold-storage products, and over-the-counter (OTC) products.
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