Medication problems: Taking drugs at wrong times
Pharmacists could intervene more often with provider status
“Lynette” was taking 16 different medications. Some were for hypertension, others for diabetes, and others still for heart disease, along with a handful of supplements. Though she seemed to be adherent—the regularity of her refills suggested as much—her blood pressure was anything but under control. Sometimes it was too high; other times it was too low. So Lynette contacted Kathleen Brown, BSPharm, at Munson Community Health Center Pharmacy, in Traverse City, MI, for medication therapy management (MTM).
Brown reviewed each of the 16 medications with Lynette, who correctly reported how often she should take each medication. .
“She seemed so good, but unless I have the time to talk to people, I can’t get to what’s really wrong,” Brown said.
Time with a patient is increasingly difficult to come by. Because physicians struggle within the confines of the 10-minute visit, they share patient care with other members of the care team, including pharmacists. But pharmacists, like Brown and others in this series, also face barriers to spending quality time with patients. Most insurers don’t cover pharmacist services because, unlike most health professionals, pharmacists do not have provider status.
Lynette’s health plan did cover MTM services, so Brown was able to keep probing until she found the cause of the problem. “I said, ‘So, 16 medications? How are you remembering to take all of these?’” Brown recalled. Lynette’s answer told Brown everything she needed to know.
Every morning, Lynette put all the day’s pills into a bowl in the middle of her dining room table. Every time she walked by, she took a handful without consideration for what she should take when, which pills she shouldn’t take together, and which ones she should take with food.
“The meds that she was supposed to be taking in the morning and at night, at least some of the time, she was taking together as a single dose, sometimes in the morning, sometimes in the afternoon, sometimes at bedtime,” Brown said. “Her timing could have been virtually anything with a mixture like that to grab from.”
Working within Lynette’s “bowl system,” Brown recommended dividing the pills into two bowls, one for the morning and one for the evening. And Lynette’s blood pressure soon improved.
Unlike Lynette, not everyone can access a pharmacist to help make their medications work for them. Brown gets frequent calls from people who have been referred by physicians, nurses, colleagues, and Brown’s previous patients. Brown often has to tell them that their insurance doesn’t cover the comprehensive medication review necessary to address their concerns, and offers them a cash payment alternative. If patients can’t afford the review, Brown can only provide abbreviated assistance within the scope of the typical pharmacist–patient relationship; she can’t conduct a comprehensive assessment of all a patient’s medications for free for fear she could be charged with insurance fraud.
“I will try to help them in a short way. But most things don’t come in the first seconds that you’re talking to somebody,” Brown said. “It tears me up because I want so badly to provide this service. I know how much it can help people, but I don’t have the means to do that.”
Every day, Brown and pharmacists like her affirm the adage, “Listen to your patient. He is telling you the diagnosis.” While pharmacists don’t diagnose conditions, they are expert at diagnosing problems in a medication regimen. But they are rarely afforded the time to listen.
Even when health insurance does include MTM, the benefit is usually for about one session a year. “It’s awfully hard to do one interaction once a year and see huge changes in their behaviors. It’s a bit unrealistic,” Brown said. “If I could change MTM in one way it would be to have more interaction with patients.”