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Pharmaceutical Counseling

by Kristene Diggins, DNP
NOVANT HEALTH INC

Introduction

  Polypharmacy is a problem that exacerbates drug nonadherence. As people age it is common for their list of prescribed medications to increase. In older adults, the number of prescriptions is more than twice that of the national population and nearly three times that of persons under age 65 years. 1 Polypharmacy is often defined as four or more prescribed drugs.2

  It is important to note that 1.5 million Americans are sickened, injured or killed by medication errors each year; seniors most at risk due to the polypharmacy risk factor. 3 Adding pharmaceutical counseling to patients on four or more medications decreases the risk of medication errors.4 Elderly patients use more medications than younger patients and the trend of increasing drug use continues through 80 years of age as medication usage increases. For example, in a survey of drug adherence among 800 elderly outpatients, adherence rates were 81.5%, prescriptions were taken in reduced doses by 13.7% of the patients, in higher doses by 2.1%, and not at all by 2.6%.

Purpose and Aims

  Evidence supports pharmaceutical counseling as a method of reducing the risk of medication nonadherence and errors.6 The purpose of this quality improvement project is to address the risk of medication nonadherence for older patients in an outpatient clinic. The goal was to evaluate the results of pharmaceutical counseling on objective outcomes of LDL, A1C, and blood pressure. More specifically, the aim of this quality improvement was to equip patients on a regimen of four or more medications towards greater understanding and adherence of their medication regimens.

  Comprehensive medication therapy management is effective in managing chronic disease and drug-related issues in the elderly. Current evidence points to the fact that medication management programs to treat chronic conditions can be improved through collaboration between physicians and pharmacists. Spending more time with patients at the pharmacy translates into important improvements in their health status and in cost reductions. Pharmacists' involvement with individual patients is pivotal to improve medication regimen adherence. Such counseling programs have been used in NC to assist patients with understanding their medication regimens.

Methods

Site selection

  A community hospital senior citizen's outpatient clinic was chosen as the site for this project, as this outpatient clinic has 5000+ established patients, ages 60 years and older. This is an ideal setting for this quality improvement project. A needs assessment was conducted to determine the percentage of patients taking four or more prescriptions meds, and it was determined that 60% of the patients in this particular setting were on four or more meds, placing them at risk for medication errors and noncompliance.

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