Program helps seniors get SMART about meds

Pharmacists help seniors use meds safely

The misuse of prescribed medications costs an estimated $76.6 billion annually in the United States. Nearly 70% of that amount is spent on drug-related inpatient admissions and emergency department visits. A California coalition has developed a two-year study that combines lay educators and pharmacist counseling in an effort to turn those alarming statistics around.

The study has been expanded recently to 1,000 senior members of a managed care plan and eventually will include about 8,000 senior members of a California managed care organization. It was developed by the Senior Medication Awareness and Training (SMART) coalition, which meets monthly and includes a wide range of health care associations, systems, and pharmaceutical companies, including these:

• University of the Pacific School of Pharmacy in Stockton, CA;

• St. Joseph’s Medical Center of the Catholic Health Care West San Juaquin-Sierra Region in Stockton;

• American Association of Retired Persons (AARP) in Washington, DC;

• California Commission on Aging in Sacramento;

• National Council on Patient Education and Information (NPIE) in Washington, DC.

Tell me how you feel

Health plan members are sent a 12-question health status form and a questionnaire on medication use designed specifically for the study. Questions include:

• Do you ever miss doses of your medications?

• Do you use medication reminder devices?

• Do you know the name of each medication you take?

• Do you know why you take each of your medications?

Returned questionnaires are randomly placed in one of three groups, each receiving a different level of intervention. Group one serves as a control group and receives no further intervention except for reassessment at 12 months using the same questionnaires. Group two takes a medication awareness class taught by senior volunteers from the AARP. In addition, the volunteers screen participants by telephone for potential difficulties and refer them to health care providers, if necessary. Group three receives the same interventions as group two, plus a one-on-one counseling session with a pharmacist.

Before launching the large-scale study, the coalition conducted a pilot program using a captive audience of about 100 retirement home residents, says Randall M. Deal, PharmD, assistant director of pharmacy services for St. Joseph’s Medical Center and adjunct professor at the University of the Pacific School of Pharmacy.

"We knew the outcomes and return rates would be more positive in this captive group than in the community, but we wanted to test some of the program’s logistics," he says.

The pilot study revealed some alarming findings, Deal says:

• About 50% of residents took four or more medications daily.

• Only 42% who took four or more medications knew the names of all their medications.

• Less than 50% of residents taking four or more medications knew why they were taking them.

• No residents taking four or more medications rated their health as "excellent."

• More than 40% of residents taking four or more medications rated their health as only "fair" and 5% as "poor."

Not only did the pilot reveal some disturbing trends, but the coalition learned some valuable lessons about lay education. "We used pharmacy students for the pilot program and learned there were some problems with communication," Deal explains. "The students used slang that made the seniors uncomfortable, and it brought home to us the importance of using peers as lay educators."

Although the lay educators have changed, the format of the medication misuse awareness class has not. The class is casual, Deal says. Volunteers begin by sharing some statistics about medication misuse and then show a video, "To Lead a Better Life" narrated by Walter Cronkite and produced by NPIE. "Another lesson we’ve learned is that turnout for classes is much better when participants are called and reminded the night before their scheduled class," Deal says.

The video is followed by a question and answer session. Then each participant receives a wallet-sized card to help keep track of current medications as well as disease and allergy information. In addition, the card lists six questions adopted from NPIE, which participants are instructed to ask their physicians each time they receive a new medication.

Brown-bagging it

For the one-on-one pharmacy consultations, the pharmacist schedules a block of time to meet with each participant. Participants bring their medications in a bag. The pharmacist reviews each medication and educates participants on its proper use. "When there are problems, we send letters to the participants’ physician suggesting issues that should be addressed during the next office visit," Deal says. "Some very small changes can greatly improve a patient’s quality of life. For example, moving an antihypertensive medication to bedtime can eliminate daytime drowsiness."

In addition to one-on-one counseling sessions, group three receives follow-up phone calls from the pharmacist at three, six, and nine months. "These calls are just to ask whether patients have had any problems, or have any new questions," he says, adding that they have proven quite valuable. "When the pharmacist asked to see the medication card handed out at the end of the class, most participants didn’t have them. Some participants had completely discarded it."

All three groups receive repeat questionnaires by mail at a year. "We hope at the end of two years to have a clear understanding of the impact of each intervention. Did attending the class convince participants in group two to make any changes? Did the participants in group two use their medication cards? Did the one-on-one counseling session really help participants in group three?

"We hope that scheduling an appointment with a pharmacist like they do a physician will empower patients to take control of their lives. We’re hoping that the program will help us be more proactive and less reactionary in terms of proper medication use," he says.

[Editor’s note: The National Council on Patient Education and Information in Washington, DC, has a wide range of consumer education materials about prescription medication use. For details, contact: NPIE, 666 11th St. NW, Suite 810, Washington, DC 20001. Telephone: (202) 347-6711.]