By Elizabeth Helms, Director, Chronic Care Policy Alliance; President & CEO, California Chronic Care Coalition; Executive Member, GTMRx Institute
August 5, 2020
To optimize medication use, listen to the patient’s perspective
We know that successfully implementing comprehensive medication management (CMM) will improve quality of life and save lives of people with chronic conditions, while lowering the total cost of care.
The operative word is “successfully.” For comprehensive medication management to be successful and sustainable, the patient must be recognized as a full member of the integrated team and have a role in the development of their own medication plan.
Patients are the biggest stakeholders. It’s their lives on the line, so they have the most to lose and gain.
The human toll
As others have already pointed out, non-optimized medication therapy was responsible for 275,000 avoidable deaths in 2016.1 Non-optimization includes–but is not limited to–the use of unnecessary and ineffective medication, subtherapeutic and excessive dosage, inadequate monitoring, medication interactions, poor adherence and the inability of the patient to afford the medication. Although every prescriber of medications is expected to consider these variables when prescribing medications, many barriers can prevent this from happening.
Fragmentation of data (the inability to access clinical information across health systems) and the limited time allotted for medical visits makes optimal medication prescribing virtually impossible, particularly for high-risk patients with complex medication requirements or multiple chronic diseases.
The health care system does not encourage teamwork for a variety of reasons including the “fee-for-service” payment system, narrow scope of practice limitations, health care “silos,” payor practices, electronic interoperability capabilities, etc.
The solution then is to support team-based approaches to care. To be truly effective, we must include the patient as a full member of the team.
The patient as member of the team
The patient should be recognized as a full member of the integrated team and be a part of developing their own medication plan. As far as I’m concerned, the worst-case scenario is developing a care plan without active patient participation and then presenting it to the patient as a fait accompli. We’re living the worst case scenario: That’s exactly what’s happening now in most care settings.
Individual physicians typically do not have enough time to explain medications to patients. That’s simply not enough. Patients need time and knowledge to digest all the elements of a medication plan. How can one “eat an elephant?” It’s easier to do so in bits and pieces rather than be presented with the entire elephant and be expected to eat it whole. But we expect patients to eat it whole–and not complain about it.
That’s why CMM is so essential. As full members of their team, patients will be engaged to learn and better understand the “whys and wherefores” of each element of their individualized plan, and able to provide input and feedback to the team at every step in the process. They will be better able to buy in to the plan, which increases adherence and health outcomes.
Engage and inform
To be informed team members, patients must be educated and engaged. Patients need to understand and have confidence that their medications will work together and cause them no harm. And that’s on us: providers; health plans; schools of medicine and nursing, professional organizations; continuing education providers; publications, patient advocates, policymakers–among others–all have roles to play.
The integrated team approach to medications is a departure from current practice but offers the hope to patients they will get the medications they need when they need them, at an affordable cost. More people in this country–including patients–need to understand the importance of CMM and the impact it could have on their health care and lives. GTMRx’s newly published Blueprint for Change is the first step in their call for medication management reform. The best proposition for medication value is getting the right medicine to the right patient at the right dosage at the right time.
The Chronic Care Policy Alliance (CCPA) is a network of state and regional advocacy organizations advancing public policy that improves the lives of those living with chronic conditions and diseases. Dedicated to achieving better access to quality, affordable health care, CCPA brings together advocates who share common goals and lends its experience in legislative action and public policy creation to support statewide and regional networking development.
The California Chronic Care Coalition represents more 30 leading consumer health and patient-advocacy organizations, as well as physician and provider groups representing Californians living with chronic conditions. It promotes the collaborative work of policy makers, industry leaders, providers, patients and consumers to improve the health of all Americans with chronic conditions.
 Watanabe, JH, McInnis, T, and Hirsch, JD. “Cost of Prescription Drug–Related Morbidity and Mortality.” Annals of Pharmacotherapy, 2018; 52(9), 829–837