Getting Medications Right: Five Questions Pharmacists, Physicians Should Ask Patients

Medicine is the primary way we treat disease, and we’re still getting it wrong. Approximately 75% to 80% of physician office and hospital outpatient clinic visits involve medication therapy, and nearly 30% of adults take 5 or more medications.¹

At the same time, more than 275,000 people die each year, with $528 billion in medications wasted due to poorly managed medications. The current trial-and-error approach to medication management in health systems may be the cause.²

Each stakeholder, including employers, clinicians, health systems, policymakers, has a role to play in solving this problem. However, it is especially important for pharmacists and physicians to step up and ensure medications are safe, effective, and appropriate for that specific patient.

In many ways, the problem underpinning poor medication management strategies in health systems comes down to communication; health care systems are not successfully closing the feedback loop between physicians and pharmacists relating to medication use. Several factors come into play around this communication breakdown:

A lack of benefit plan design integration creates a disconnect between health care clinicians. We must start reintegrating pharmacy services into the medical benefit and patient care models. PBM carve-out strategies create fragmentation and hide insight around total cost of care, and coordination of care suffers. This siloed approach to benefits management often disaggregates care delivery and discourages high-quality, comprehensive patient care. Moreover, true attribution of ROI and savings is often lost.

A lack of transparency prevents pharmacists, physicians and other prescribers from seeing the whole patient picture. All members of the patient care team should have full access to all relevant clinical information at the point of care. Physicians frequently lack access to a patient's complete medication list, and pharmacists also often lack access to the patient’s medical history and treatment goals.

A lack of team-based care leaves physicians isolated and burned out. It also fosters a piecemeal approach to treatment, with each provider working in a silo. A team-based approach, where a medication expert works in collaborative practice with the physician, can lower the total cost of care and help patients achieve the clinical goals of therapy.

Health care systems are working to tear down these hurdles. We aren’t there yet, but that doesn’t mean pharmacists and physicians can’t work together to ensure medications are optimized.

The 5 Questions

By asking these 5 questions to every patient, physicians and pharmacists can bypass hurdles and ensure patients receive the right medication.

1. Is this the right medication for my patient? For many patients, the answer is yes, but this is just the starting point of a new conversation with your patient and professional team. Appoint an active participant (patient or caregiver) to be a part of creating the health care strategy. Give the patient or caregiver an opportunity to invest the time to learn the answers.
2. Where can my patient go with their medication questions? The more doctors they see and the more medications they take, the more complicated it becomes to coordinate care. Identify a person on the team that your patient can contact with medication questions.
3. What is the right dosing for this medication? Make sure your patient understands how to take the medicine correctly. The pharmacists on the patient care team can play a crucial role in ensuring patients know whether their prescribed medication comes with a dosing device and how to use that device effectively and safely.
4. When is the right time to change or discontinue medications? Health conditions change, and new therapies come to the market every year. Physicians and pharmacists, in collaboration with patients and caregivers, need to reassess medications regularly to ensure they achieve the therapeutic goals.
5. How will my patient know if the medication is working? An effective assessment process is reiterative and ongoing. Goals are personalized and understood by patients, caregivers and all members of the care team, so it is imperative that your patient’s health care team conduct ongoing evaluations and assessments of medication outcomes. Encourage caregivers and patients to step in and speak up to make sure it happens.

All these questions come down to this: Does your patient have access to the right medications for them? That’s the question comprehensive medication management seeks to answer.

Getting the Medications Right

Comprehensive medication management starts with the health care experts. Patients deserve a coordinated, interprofessional team, empowered with information at the point-of-care, available to deal with medication therapy problems. Physicians and pharmacists, working together, can begin to make that happen.

About the Author

Katherine H. Capps is co-founder and executive director of The Get the Medications Right™ (GTMRx) Institute, a coalition of over 1,600 members calling for medication management reform to bring together critical stakeholders across health care.

Reference

1. More than a theory: Putting CMM in practice. Published November 2021. Accessed July 1, 2022. https://16bvl028dn7zhgp35k7rzh5c-wpengine.netdna-ssl.com/wp-content/uploads/2021/09/GTMR-Nov-IB-2021-WEB.pdf.
2. Watanabe JH, McInnis T, Hirsch JD. Cost of Prescription Drug-Related Morbidity and Mortality. Ann Pharmacother. 2018;52(9):829-837. doi:10.1177/1060028018765159