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The Benefits of Medication Management & Optimisation

My post last week on Tools to help pharmacies manage medications has received comment in various places, so I thought I would extend it out a little more.

Last week I observed that both here in New Zealand and in the USA, pharmacies are increasingly moving into the field of medicine optimisation through medicine management. Why not? After all pharmacists are acknowledged experts at handling medications.

Dave Nazaruk in a white paper he produced for Stay Well Custom Communications lists some revealing statistics on P.15 that show the cost of not managing medicines properly:

  • The (US) healthcare system incurs more than US$177 billion annually in mostly avoidable health care costs to treat adverse events from inappropriate medication use.
  • MRPs (medication-related problems) rival the costs of cardiovascular disease…for every dollar spent on prescription medications, we spent approximately the same amount treating MRPs associated with those medications.

These are pretty sobering statistics. Medication management and optimisation is currently a very ad-hoc system, full of loopholes and inefficiencies. GPs do not necessarily know where your prescriptions will be filled, and pharmacies do not know if you are on medications from other GPs in addition to the GP clinic that their pharmacy prescribing systems is directly connected to.

Apart from the inefficiencies, it is downright dangerous for people to be on multiple medications without having a systematic method of management. From my own anecdotal evidence, earlier this year a GP here in Dunedin told me that the worst case he had heard of in New Zealand concerning a lack of medication management resulted in an elderly lady being on 73 medications prescribed from 42 GPs! I asked him what safeguards were in place to prevent that kind of situation, and he replied, “Nothing!”.

So what might better risk assessment tools look like? Ultimately, such a tool needs to be wrapped around the patient, so the record can travel with them. In the short term however, a lot of efficiencies would be gained from community pharmacists and GPs and other providers being able to better comprehend a multi-medication patient’s medication regime. Currently, the data sources are not only disparate, but understanding them is non-intuitive, difficult and time-consuming.

This is easier said than done, gathering medication sources is not just difficult technologically, but involves an exercise of covering up data gaps and assumptions behind members of the care providing team that are often not captured systematically. And then reconciliation of all the data take the challenge to a new level altogether! However, the rewards in terms of better health outcomes for individuals, as well as system savings as a result greater efficiencies make this space an imperative for innovation.

Yours in health,

Hamish

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