Pharmacists offer crucial help to people with complex medication regimens.
As people get older, the number of medications they take often keeps growing. That can make for a tricky exercise in making sure they use the right prescribed medicine at the right time.
But they’re not alone in managing multiple medications. Pharmacists, and specifically consulting geriatric pharmacists, offer help in a number of ways.
At Washington State University’s College of Pharmacy and Pharmaceutical Sciences, pharmacotherapy professor Brian Gates (’99 PharmD) and associate professor Jeffrey Clark (’09 PharmD), both board-certified geriatric pharmacists, teach pharmacy students as well as practice as consulting pharmacists.
They primarily work in home health as part of their work at WSU. Learning about the role of a consulting pharmacists in home health is a rare educational opportunity offered to WSU students.
Here are some the areas where pharmacists such as Gates and Clark assist older people with medication management.
Provide comprehensive medication management.
Pharmacists do more than fill prescriptions. They help resolve problems via telephone calls, home visits, and communication with home health care clinicians.
“It’s not just a simple question of, ‘Can I take my med list to the pharmacist and ask if they are all working?’” Clark says. “We’re more like a consultant. We understand how the medications work, and we understand how they’re used. And we can help you, as the patient, understand what they’re doing for you. We can talk about the individual risks and benefits of each one of those medications. So, it becomes a fairly nuanced conversation when you start thinking about everybody’s individual risk and benefit profile.”
Identify medication discrepancies during the transition from hospital to home.
Pharmacists can ensure that patients have an accurate and up-to-date medication list, especially during transitions in care from hospital to home. That transition can throw off medication regimens for patients, and that’s a key time when pharmacists can support them.
This support can help to prevent errors such as unintentional nonadherence or duplication of medication therapy.
“We started a quality improvement project just a couple of years ago that really focused on helping nurses with that transitional piece,” Clark says. “Whether patients are coming from a doctor’s office but haven’t been to the hospital and starting home health care; or whether they have been to the hospital, maybe then to a nursing home, and now starting home health care, we help identify medication-related problems. What did they do with medications when they came home? What happens fairly frequently is they go back to doing whatever they were doing before they went to the hospital in the first place.”
Collaborate with other home health care clinicians and patients’ prescribers to adjust medications.
Pharmacists work with prescribers, such as doctors, to initiate new medications, change dosages, discontinue medications, suggest alternative medications, clarify medications, and provide updates on the patient’s general medical situation.
There are times when medications should be “deprescribed,” which is slowly and carefully cutting down on unnecessary medications in consultation with health care providers.
“Sometimes what we do as a pharmacist working with older adults is suggest that medications are stopped or reduced, especially when the risk outweighs the benefit and side effects are present,” Clark says.
Educate patients about their medications.
The people taking the medications play perhaps the most important role in managing their medications. Pharmacists can help patients understand the purpose of their medications, how to take them safely and effectively, and potential side effects.
Patients need to understand the importance of taking their medications as prescribed, address any concerns they may have about their medications, and develop strategies to improve adherence.
“Even if we got the meds correct, it’s important what people actually do with them,” Gates says. “Some of that could be forgetting, on a simple level. But it might also be that they’re having problems and aren’t telling anybody. Or they are actually trying really hard to manage it and maybe misunderstand sometimes what they need to do, and actually making it harder for themselves and maybe even causing some issues.”
Assess medication regimen complexity.
Pharmacists use tools like the Medication Regimen Complexity Index (MRCI), built to help identify patients who are at higher risk for poor medication adherence and target interventions accordingly.
“I think one thing that we’re still missing in health care is how we can identify, and more intensely help, those people who do have really complicated medication regimens. Some people really need a longer look; we need to get into more depth with their meds and identify issues,” Gates says.
Read more in “Pills and more pills,” Fall 2024 issue.
Find a consulting pharmacist (American Society of Consultant Pharmacists)