Removing unnecessary and even potentially dangerous meds from your pile of pills can be the most effective aspects of medication management
Most of the time, we think of physicians prescribing a different or additional medication when we have a new medical problem. But what about taking some away from your already overcrowded medicine chest?
That can be a very good thing indeed, and what I and my fellow RxLive clinical pharmacists often recommend. Over-medication can lead to drug interactions and increase your medical costs. And there are a number of reasons why you may be taking more meds than necessary, which should be discussed. However, removing meds from your regimen can also cause side effects if they’re stopped “cold turkey,” so part of our role as medication experts is to counsel patients on proper weaning to avoid those problems.
Following are some of the reasons why over-prescribing can occur:
Aggressive marketing of the ‘next great new thing’
Part of how your pile of pills has grown is, honestly, that those of us in the field of medicine are genuinely always seeking better solutions. Yes, most of us — all of us at RxLive — read the research once a medication is approved by the FDA. We know the limitations that sometimes come with existing options, such as HIV meds that can be very effective in reducing the risk of dying from or passing on the virus, but can come with significant side effects and still don’t represent a cure. People worldwide would jump at the chance to try a thoroughly researched, true cure for HIV infections. Or cancer. Or…
In other instances where we recommend stopping or changing meds, other options can have significant side effects or are partially to totally ineffective for some members of the population, depending on their genetic background. That’s why we strongly recommend pharmacogenetic (PGx) testing, by the way — so you, your caregivers and your clinicians can be armed with the richest possible information on the likelihood of drug effectiveness and potential dangers based on your unique genetic makeup.
I also must admit that doctors and other clinicians are human. If something sounds good…is marketed aggressively and convincing…we may jump onto the bandwagon and hope the ride is successful. Sometimes results are equal to the hype, sometimes they’re not. And it can often take some time for the risks to fully become known, such as the addictive nature of opioids in many people. Overdose deaths from prescription opioids were five times higher in 2017 than in 1999, for example. Or think of the dangerous combination of “uppers” and “downers” that have sent people like a young Judy Garland down a yellow brick road of a lifetime of dependence. Few if any knew at the time the damage that was being done by these “miracle pills.” (See the Centers for Disease Control & Prevention’s Guideline for Prescribing Opioids for Chronic Pain.)
At least with the changes to payment structures such as CPC+, PCMH or other advanced payment models (see below), providers are paid more for achieving improved patient outcomes instead of the U.S.’ traditional system of fee-for-service — where providers are paid to order a test or procedure and then are reimbursed for it, whether it’s effective or not. That’s why FFS is quickly giving way to value-based reimbursement models that pay for results.
Specialization, lack of coordinated care impacts medication ‘overkill’
Another reason for over-prescribing is the challenge to coordinate care across a patient’s multiple providers and specialists. As the body of medical knowledge has accelerated from doubling every 50 years in 1950 to an estimated 73 days by 2020, the field of medicine has had to become more highly specialized. And even with the rise of electronic health records, patient portals and Blue Button 2.0 standards for information-sharing, true interoperability and a single personal health record that follows the patient — shared by the patient’s permission with his or her caregivers — is still an elusive goal. (Have you spent hours inputting all of your meds and the rest of your health history in each of your doctors’ patient portal? It’s not fun.)
So what do we do? Check!
Patient-centered care models such as CPC+ (comprehensive patient care plus), PCMH (patient-centered medical home) and other advanced payment models are designed to focus on the primary-care practice and its unique ability to guide truly patient-centered care, serving as the hub for all their care needs by coordinating and managing care holistically. This can reduce some existing causes of unnecessary meds, but over-medication remains a constant challenge to keep it from recurring as specialization continues.
This is why RxLive was founded, and why regular medication counseling and ongoing management play a big role in Medicare and other programs to improve patient health and satisfaction while lowering costs. Today, yearly or even monthly medication-management check-ins are invaluable to ensuring the patient takes only those meds which are truly required to achieve optimal health, and that neither they nor their health plan pay any more than is necessary.
Case study
Our clinical pharmacists regularly see patients taking PPIs (Nexium, Prilosec, Protonix, etc.) without a physician diagnosed problem. We discuss the risks (less stomach acid increases the risk of life-threatening diarrhea & decreases absorption of key vitamins & minerals) and benefits (prevent acid reflux that can lead to ulcers, protect stomach from bleeding risk) and often recommend the provider taper and stop the med.
Recently, one of our clinical pharmacists met with a 72-year-old woman with COPD, high blood pressure, depression and GERD. She’d been hospitalized for a worsening in her COPD in the last year; while there, she ended up with C. diff. During her complete medication review, the use and need for her pantoprazole was considered. She was provided education on how its use puts her at an increased risk of having C. diff again and that if her PCP agreed, a trial taper off and switch to ranitidine as needed would reduce this risk. She was very open to this plan since C. diff was an awful experience for her and kept her in the hospital longer. She hadn’t been aware that this was a risk of using the pantoprazole. An added benefit for her was a simplification of her medication regimen and the cost-savings of taking one less medication.
So…de-prescribing can be good!
Our motto of “It’s good to check your meds” means more than our doctors of pharmacy chatting with you and giving some advice to be shared with your doctor. It also includes us recommending things that you should stop taking, probably ASAP as directed. These include prescriptions or over-the-counter (OTC) meds that can add unnecessary challenges to how your body deals with everything you’re putting into it…and the $$s you’re spending in the process.
Talk to your physician and care team about the benefits of having direct access to an expert clinical pharmacist to help expand their ability to serve you, or call us at (866) 234-4974 to schedule a consultation. It’ll help both your bodily and financial health in often life-changing ways.
