Jerry Fahrni

Tag: Medication Adherence

  • Saturday morning coffee [January 26 2013]

    Amsterdam Coffee MugSo much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    The coffee mug to the right comes straight from Amsterdam. I stopped there back in November 2011 on my way to Germany on a work trip. It’s a dirty city with a weird vibe to it. Everyone smokes and you better watch your butt or you’re likely to get run down by a bicycle, which appears to be a popular form of transportation. I walked through the Red Light District just to say that I’ve seen it. It was disturbing and depressing. It’s sad to see that kind of thing in my opinion.  Overall I didn’t like Amsterdam. You can have it. By the way, that’s a pretty big coffee mug. It hold a lot of coffee.
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  • Cool Pharmacy App – MediSafe Medication Reminder [#android]

    MediSafeI came across this app the other day and thought it was pretty interesting. The app, MediSafe Medication Minder, is part of the MediSafe Project. The website isn’t very informative, but it’s worth checking out.

    What’s the MediSafe app all about? Well, this pretty much sums it up: “It’s simple. When it’s time for you to take your medication, the app will remind you. You can also update your app manually. Your caretaker is notified if you don’t check in, so they can remind you only if needed.” The application also supports barcode scanning. Pretty cool stuff.

    I’m not convinced that these apps work for everyone when it comes to improving medication adherence, but I think they have their place and should be an option for those that are comfortable using mobile technology.

    You can grab it for free on Google Play. I think I’ll download it and give it a whirl.

  • Saturday morning coffee [January 12 2013]

    Welcome to my first Saturday morning coffee post of 2013. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    The coffee mug below was a Christmas present from my youngest daughter, Mikaela. Apparently she reads my blog; yeah, I’m as surprised by that as anyone. She thought I needed a customized coffee mug to go along with my Saturday morning coffee post. I’m thrilled to be displaying it here today for the first time. I had to move it down because it deserved an image from both sides.

    Christmas SMC Mug
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  • Cool Pharmacy Technology – NFC-enabled medication compliance

    Thanks to Timothy Aungst for the tip. His Tweet led me to this Quand Medical page where I found a little bit of information about their medication compliance software. Their solution utilizes NFC technology to aid patients with tracking and taking their medication as well as potentially reducing errors.

    The Tweet from Timothy was timely as I’ve been musing about using NFC technology in the medication use process. With the popularity of smartphones and the slow, but steady adoption of things like Google Wallet, it makes sense to take a deeper dive and give the technology a long hard look.

    I would have liked to have seen a video of the product in action, but I couldn’t find one. Who knows whether or not this is the solution for medication compliance, but it’s certainly a tool worth investigation.
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  • Impact of alcohol intake on medication adherence [abstract]

    Does alcohol consumption impact medication adherence? I don’t know, but it’s a fair question. I would assume that it all depends on when you drink, how much, how often, if there’s any correlation between drinking time and medication consumption, age and social status of the patient, and so on. The variables one would have to look at would be quite extensive in my opinion. We’re talking about human behavior here, which is notoriously difficult to quantify and control.
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  • Saturday morning coffee [September 1 2012]

    So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    The coffee mug to the right is from Stanford University. I took my daughters on a site visit to the Stanford campus in the Summer of 2011. The campus is beautiful. This is the last time I will use this particular mug. I haven’t decided whether to simply put it in storage or smash it to pieces and throw it in the trash. I’m a little upset with Stanford. My daughter applied to Stanford in late 2011 and was promptly turned down. My daughter has the highest GPA that can be earned in high school, graduated Summa Cum Laude, was Valedictorian, took the maximum number of AP courses allowed (received A’s in all of them), did community service, was on the Forensics team, part of the leadership club, did school cheer, was part of two National Championship Competitive Cheer teams (outside school activity), etc, etc. She really wanted to attend Stanford, and they broke her heart. Their loss. My daughter will be attending UCLA this fall. I’m very proud.

    - The Expendables 2 was #1 at the box office last weekend. My family and I saw it. Great movie. It was exactly what I wanted. It was action from beginning to end. Remember, I go to movies to be entertained, not to be enlightened. And I was entertained.

    Sylvester Stallone: I heard you were bit by a rattlesnake.

    Chuck Norris: I was and after 5 days of agonizing pain… it died.

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  • Greater adherence to diabetes drugs linked to less hospital use, could save billions [article]

    Medication adherence/compliance is an important issue for all patients with chronic disease, but some are potentially worth more in healthcare dollars than others. Disease states like diabetes, heart failure, asthma and HIV/AIDS, among others rely heavily on proper medication use to prevent frequent visits to urgent care centers, or in worst case scenarios hospital admissions. It’s not hard to imagine where reducing urgent care visits and hospitalizations could add up quickly.

    Medication adherence/compliance is also one of those areas where it makes sense for pharmacists to be heavily involved. A little proactive counseling, MTM and follow-up with patients goes a long way. The abstract below makes no mention of pharmacists, nor does it mention how they mined their data. If I had to guess I’d say they used insurance claims data to get their information. Not the most accurate way to go about it, but interesting nonetheless.

  • Teaching Medication Adherence in US Colleges and Schools of Pharmacy [article]

    An article in the American Journal of Pharmaceutical Education takes a look at “the nature and extent of medication adherence education in US colleges and schools of pharmacy”. Surprise, the authors found that “Intermediate and advanced concepts in medication adherence, such as conducting interventions, are not adequately covered in pharmacy curriculums”. Disappointing outcome as medication adherence is one of those areas where I think pharmacists could make a significant impact in not only healthcare outcomes, but reducing costs associated with patient care as well.

    The authors used a combination of surveys to gather information: “(1) a national Web-based survey of faculty members at colleges and schools of pharmacy, (2) a national Web-based survey of student chapters of 2 national pharmacy organizations, Phi Delta Chi (PDC) and the National Community Pharmacists Association (NCPA), and (3) conference calls with a convenience sample of pharmacy preceptors and faculty members.”  While the study isn’t exactly comprehensive, I think it may be representative of what’s really going on in pharmacy schools these days. Let’s face it, the focus is on “clinical” activities of which medication adherence is often overlooked.

    I won’t bore you with the details as the full text of the article is available for free at the journal’s website. What I will say is that it appears that pharmacy schools teach medication adherence, but fail to dig deep enough or allow students to participate in a meaningful manner when given an opportunity to become involved. This is similar to my experience in pharmacy school. The only place I was really exposed to medication adherence was during a six week internal med rotation. Other than that the subject was only covered in passing.

    [cite]10.5688/ajpe76579[/cite]

  • Pharmacy student adherence to a simulated medication regimen

    A Tweet from Anthony Cox (@drarcox) led me to this article in the American Journal of Pharmaceutical Education.

    In this study, 72 second-year pharmacy students were given “medications” (Starburst JellyBeans) to take with varying administration schedules. The table below shows the results of the little experiment, and it speaks volumes.

    Not surprisingly a “once daily” regimen was the easiest to follow, but still resulted in more than 10% of the doeses being missed. As the regimens grew in complexity, the percentage of missed doses increased.

    We did a similar experiment with M&M’s when I was a pharmacy student at UCSF. The results were similar, i.e. the more complex the regimen, the harder it was to adhere.

    Oh, and these were pharmacy students we’re talking about here. What do you think happens when you ask the average non-healthcare professional to adhere to a medication regimen?

    The entire article is available for free here.

  • Effect of med reconciliation on med cost after hospital D/C [article]

    The Annals of Pharmacotherapy March 20121

    BACKGROUND: Medication reconciliation aims to correct discrepancies in medication use between health care settings and to check the quality of pharmacotherapy to improve effectiveness and safety. In addition, medication reconciliation might also reduce costs.

    OBJECTIVE: To evaluate the effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs.

    METHODS: A prospective observational study was performed. Patients discharged from the pulmonology department were included. A pharmacy team assessed medication errors prevented by medication reconciliation. Interventions were classified into 3 categories: correcting hospital formulary-induced medication changes (eg, reinstating less costly generic drugs used before admission), optimizing pharmacotherapy (eg, discontinuing unnecessary laxative), and eliminating discrepancies (eg, restarting omitted preadmission medication). Because eliminating discrepancies does not represent real costs to society (before hospitalization, the patient was also using the medication), these medication costs were not included in the cost calculation. Medication costs at 1 month and 6 months after hospital discharge and the associated labor costs were assessed using descriptive statistics and scenario analyses. For the 6-month extrapolation, only medication intended for chronic use was included.

    RESULTS: Two hundred sixty-two patients were included. Correcting hospital formulary changes saved €1.63/patient (exchange rate: EUR 1 = USD 1.3443) in medication costs at 1 month after discharge and €9.79 at 6 months. Optimizing pharmacotherapy saved €20.13/patient in medication costs at 1 month and €86.86 at 6 months. The associated labor costs for performing medication reconciliation were €41.04/patient. Medication cost savings from correcting hospital formulary-induced changes and optimizing of pharmacotherapy (€96.65/patient) outweighed the labor costs at 6 months extrapolation by €55.62/patient (sensitivity analysis €37.25-71.10).

    CONCLUSIONS: Preventing medication errors through medication reconciliation results in higher benefits than the costs related to the net time investment.

    Based on the exchange rate mentioned in the study (EUR 1 = USD 1.3443) the six month savings associated with medication reconciliation was about $75 U.S. per patient after factoring in labor. Not exactly earth shattering, but nothing to turn your back on either. At least there’s a positive ROI.

    I would have liked to have seen the authors take the study one step further by linking the medication reconciliation savings back to hospitalization readmission and/or effect on the patient’s lifestyle/activity. Once in a while optimizing a patient’s therapy might mean trading a more expensive drug for ease of use or improved patient compliance.

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    1. Karapinar-Çarkit F, Borgsteede SD, Zoer J, Egberts TC, van den Bemt PM, van Tulder M.Effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs. Ann Pharmacother. 2012 Mar;46(3):329-38. Epub 2012 Mar 6. PubMed PMID: 22395255.