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Striving for Better Medication Management

Author:  Nick Zamora

Better Medication Management Series: Part 1 of 4

How improving data availability can support clinical decision making and reduce medication errors, leading to better patient outcomes

Prescription medications are part of the daily lives of millions of Americans. A staggering 80 percent of treatment plans in the US involve prescription drugs, and use of prescription medications in the US has been steadily rising. According to one report, five billion prescriptions were projected to be dispensed by the end of 2021, reflecting an increase of about one billion prescriptions over 10 years. Polypharmacy is also on the rise, with 42 percent of older adults in the US taking five or more prescription medications and nearly 20 percent taking 10 drugs or more. 

The most commonly prescribed drug classes in the US are analgesics (painkillers), antihyperlipidemic agents (cholesterol-lowering drugs) and antidepressants.

More Prescriptions, More Problems

Americans’ increasing reliance on prescription medications for managing chronic conditions or treating temporary medical conditions comes with increased risks and opportunities for errors; the consequences of which can be serious, even deadly. 

One major issue is that many people don’t follow their prescribed drug regimen. According to the Centers for Disease Control and Prevention (CDC), medication is not taken as prescribed 50 percent of the time and 20 to 30 percent of new prescriptions are never even filled at the pharmacy. The costs of this are steep: non-adherence is responsible for 30 to 50 percent of chronic disease treatment failures and 125,000 deaths per year in the US.

Another fundamental problem is medication error, whereby patients aren’t taking the right drugs to treat their condition. This can result in hospitalization, disability, birth defects and death.

Finally, a lack of follow-up after a provider has prescribed medication is also common. This means no one is tracking a medication’s side effects to determine how a patient’s regimen may need to be adjusted.

Compounding the issues outlined above is the fact that 53 percent of patients get their drugs from more than one healthcare provider, creating room for further error and oversight – especially if the right communication systems aren’t in place. Taken together, these issues underscore an urgent need for a collaborative approach to medication management that prioritizes seamless communication and ease of data sharing among patients, healthcare providers and pharmacists across all healthcare settings.  

The Solution: Collaborative, Evidence-Based Medication Management

Resolving the wide-ranging problems described above requires a collaborative, evidence-based approach to medication management. Precision medication management describes a patient-centric outlook that focuses on getting a patient’s medications right by ensuring the right processes are in place. This approach involves collaboration with physicians, other members of a patient’s health care team, pharmacists as well as patient involvement to ensure the patient receives safe, effective and appropriate drug therapy. Facilitating this requires a coordinated and monitored effort to ensure the right drug is being taken at the right time - and in the right dose - to achieve optimal patient-centered healthcare.

Many incidences of medication error could be avoided if patients had access to their medication history. This information could easily be accessed by clinicians upon a patient’s admission to a healthcare institution; whether it’s the ER or for an elective procedure. The importance of this can’t be overstated. Consider the following, reported by da Silva and Krishnamurthy in the Journal of Community Hospital Internal Medicine Perspectives:

  • The emergency department is the third most common source of medication errors, including wrong doses and overdoses 
  • The average hospitalized patient experiences at least one medication error each day 
  • Upon hospital discharge, 30 percent of patients have at least one medication discrepancy 

An ideal state of precision medication management requires fixing gaps inherent in health systems that impede the seamless transfer of important medication information, resulting in errors being made by pharmacies, physicians and patients. The healthcare system needs to operate according to a new paradigm in which evidence-based standards dictate that pharmacists, outpatient providers, hospital physicians and specialists review medications and their respective indications as a matter of course, while providing education to patients. 

In this ideal state, office and hospital medication reconciliation would be done by prescribers, and the development of unusual symptoms or poor treatment response would trigger an evaluation by the physician and/or pharmacist along with a pill bottle review.

There is one roadblock to overcome in order to make this ideal state a reality: the right data infrastructure needs to be in place to enable precision medication management. 

Enabling Collaborative Medication Management through Data Interoperability

An evidence-based, collaborative medication management model starts with patients and clinicians having easy and fast access to a patient’s medication history. This information should travel with the patient and be available to any clinician, pharmacist, healthcare facility, or other healthcare provider who makes clinical decisions and is involved in the patient’s healthcare journey.

A FHIR-based platform, such as the HealthChain Health Information Exchange (HIE), built on the Smile CDR data repository, provides the data fabric infrastructure needed to easily surface medication information, either in the form of a longitudinal health record or patient summary. Implementation of a platform based on FHIR, the global standard and common language for interoperability, ensures data is no longer siloed and can be easily accessed by patients, clinicians, and anyone who needs accurate up-to-date medication data.

Implementing a FHIR-based data platform such as HealthChain’s HIE would allow any healthcare provider to easily review a patient’s current and previous medications during transitions of care. This would, in turn, support clinical decision-making when there’s a change in a patient’s condition, a change in diagnosis or an adverse reaction to a drug. 

Making medication information easily accessible in a FHIR-based clinical data repository also ensures that any clinical decision is communicated to the people who must act upon this information, such as a home care nurse or family member. Information about medication side effects is also stored in the platform and communicated to those involved in the patient’s care, resolving issues related to ongoing medication monitoring. 

Improving communication among physicians, pharmacists and patients during transitions of care is more important than ever. With a growing population, longer life expectancy and the increasing prevalence of polypharmacy, occurrences of medication errors and adverse drug events will likely escalate if the right solutions aren’t implemented and broadly adopted by health systems, care providers and patients.

To continue learning about Better Medication Management, read our blog series.

Part 1: Striving for Better Medication Management
Part 2: The Barriers to Evidence-Based Medication Management
Part 3: Achieving Drug Data Interoperability with FHIR
Part 4: Practical IT Steps for Drug Management (Coming Soon)