In today’s health care system, no one person – maybe not even you – knows exactly what drugs you’re taking. What’s more, no one health care provider knows how you, the patient, take your medications and at what doses. No single, up-to-date record consistently displays all of this important information.
The lack of an accurate medication list, and the associated lack of centralized and expert management of your full drug regimen, has serious consequences.
A 2016 study at the Johns Hopkins University School of Medicine suggested that medical errors are the third leading cause of death in the United States. Many of these deaths are directly related to errors associated with medications. The Centers for Disease Control and Prevention estimates 1 million visits to emergency rooms each year stem from adverse medication events.
In addition, thousands of people are harmed by suboptimal medication management, or because they don’t take their medications as directed. And millions of health care dollars are wasted each year in the form of duplicated or unneeded drugs and medication-related hospital readmissions.
As dean of the UCSF School of Pharmacy, a school defined by science, as well as a researcher who has strived to improve the effectiveness and safety of medications, I think the key to solving these problems is to expand the role of pharmacists. My position on this point is based on accumulating evidence.
Investigating the problem
In a 2015-2016 project, UCSF School of Pharmacy pharmacists compared the accuracy of the medication lists of 135 newly discharged patients with the medications the patients actually ended up taking. Not one of these lists completely reflected medication use at home, despite the fact that each patient had been recently discharged from a controlled hospital environment.
Common errors included:
- Duplication of therapy (either getting two of the same medication or two drugs in the same class)
- Omitted but necessary medications
- Unreported use of herbals or dietary supplements
In a previous project in 2014, as part of a new transition of care program, patients received an automated phone call 48 hours after leaving the hospital. Any reported issues resulted in an immediate phone call by a nurse and pharmacists addressed any medication issues.
An unpublished study of these post-discharge phone calls by the School of Pharmacy revealed medication issues were common. Forty percent of the pharmacy calls during the study period involved access, such as insurance coverage or transportation to a pharmacy, while 60 percent involved clinical issues, including medication side effects, interactions or medication use instructions.
As a result of these findings, a voluntary program was offered to allow patients to receive their discharge medications at the bedside before going home in a meds-to-beds program. No meds-to-beds patients reported being without their discharge prescriptions at the 48-hour discharge phone call. The School of Pharmacy continues to study the outcomes associated with this program.
In 2016, the UCSF School of Pharmacy initiated another pilot project, teaming with the UCSF School of Dentistry in the Oral Medicine Clinical Center. This clinic manages the most serious mouth diseases, including soft tissue infections and cancers. Many drug treatments are associated with side effects, including bleeding, dry mouth and other systemic adverse events that affect oral health.
Our pharmacy faculty members and pharmacy students mentored and collaborated with their dental colleagues to complete a comprehensive medication review for patients prior to clinic visits. The team, in close collaboration with their patients, created an accurate medication list and placed the list in the patients‘ electronic records on the day of the clinic visit.
When their providers took the time to discuss the importance of their medication lists, the patients routinely began bringing these lists to their clinic visits. Similarly, clinic health care providers began taking responsibility for updating patients‘ electronic health records with new medications. The success of the experiment is underscored by the fact that the dental school has continued to fund this novel model of care.
The path forward
I am hopeful the results of our pilots suggest a way forward.
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