Stop Rounds

My grandmother was 93 years of age. She had recently been hospitalized and was ready to leave the hospital. As she readied for discharge, the doctor came into her room with more than 10 prescriptions for her to fill. Although she was not involved in the healthcare field, she was never shy or afraid to challenge authority, including her physician. She asked her doctor some very important questions: “Why do I need all of these medications?” “What are they for?” “Are the benefi ts of these medications long-term or near-term benefits?” In the end, she left the hospital with only 3 medications. Medications, such as her statin, would not confer benefi ts likely to matter at her age. I would argue that this conversation is one we should all be having with our physicians on a regular basis.

Clinical programs have long been part of pharmacy benefit design. We often hear about “The right drug, in the right dose, for the right patient.” Often, what we forget is the fourth pillar to appropriate drug use: “For the right time.” It is time we create a forum in which to regularly assess whether a healthcare consumer should stay on a medication. I believe that part of an annual review of all medications that a person is taking should include “stop rounds.” Can 1 or more medications that a person is on be discontinued?

Medication therapy management (MTM) has become an important part of Medicare Part D. Each year since the benefit was initiated in 2006 we have seen increasingly more focused guidelines of what MTM should include from the Centers for Medicare & Medicaid Services. I would argue we need to take this a step further and consider having an annual provider visit to assess the efficacy, potential side effects, and ongoing need of each medication that a healthcare consumer is on. I would go so far as to say that this visit should be part of the preventive care services that are covered through healthcare reform for healthcare consumers of all ages. I am sure that there will be a few people that will accuse me of raising healthcare costs by mandating another service, while others will accuse me of institutionalizing the “rationing” of medications. I would argue for the following:

1. A true annual review that is focused solely on medication management, which would include whether the healthcare consumer is adherent to their medications, and if not what those barriers to adherence are; and discussions of costs associated with their medications—whether medications are working and whether the goals to continued medication use still remain pertinent to the healthcare consumer.

2. This review should be done by someone that understands the medications that the healthcare consumer is on, the needs and desires of the healthcare consumer, and the interactions of all medications, both prescription and over the counter.

3. This person can be a physician, pharmacist, or nurse. In the best of all worlds each medical practice would have a clinical pharmacist as part of the team. The annual medication review would occur with this team pharmacist, the healthcare consumer, and potentially a family member or friend (as many of us cannot remember

all that is said during a healthcare visit).

As I work with a number of my clients across the country, I am suggesting that they have the conversation about not only what medications are appropriate for their members or employees to begin but also what medications can be stopped.

I look forward to hearing what you think of “stop rounds.”