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Helping seniors avoid the pitfalls of prescription overload

Connecting vital, underutilized services like medication reviews to the daily lives and routines of older adults is the logical next step in the movement of care to the home

During my training as a geriatrician, my colleagues and I would regularly make house calls. One experience in particular sticks with me to this day. A patient had just been discharged from the hospital. He was having difficulty managing his medications and was worried about making mistakes. Upon entering the home, I quickly understood why: there were clusters of pill bottles in nearly every room.

There were meds from the hospital on the dining room table, pill bottles on the kitchen countertops, in the cabinets, and on the living room coffee table. Upstairs, more prescriptions were scattered around the bedroom and in the bathroom. Pills, capsules, tablets, ointments, lotions, patches, droppers – you name it.  I even found old brown-green glass medication bottles from the 1950s. The pile we eventually made on the dining table was three or four feet wide and a foot and a half tall. Working diligently, we focused on disposing of the expired medications, culling the various med lists he had stacked up, and eventually whittled down the active medication list from 20-odd meds down to the 13 or 14 he actually needed.

This is what polypharmacy looks like when it persists over a lifetime, and the experience is all too common among older adults. The average adult between the ages of 50 and 64 is prescribed 13 medications, with that number increasing to 22 for those age 80 and older. Prescriptions for the average older adult come from multiple providers, and they’re often filled at multiple pharmacies. Currently, medication reconciliation only happens at specific, transitional moments in the healthcare journey. Medication management is in dire need of a wider lens and a broader application to reach more patients.

A recent study published in The Journals of Gerontology: Series A found that fewer than 21 percent of people over the age of 65 have received a comprehensive medication review, with low-income patients among those less likely to have received the service. Even though medication reviews have been covered by Medicare Part D plans for over 15 years, 83% of patients were not even aware that their health plan covered this benefit. Where is the disconnect between the benefit and the member?

It’s all in the delivery. The ways in which most medication reviews are currently conducted prohibit many older adults from being able to take advantage of the benefit. Medication management needs to be convenient, accessible, and connected to daily life.

Convenience and access are key

Older adults shouldn’t have to drive to a pharmacy, with a medication list in-hand, for an in-person medication consultation with a pharmacist. It is inconvenient and, for many older adults, inaccessible. For older adults struggling with multiple chronic conditions, those with limited transportation options, or those who may not have convenient access to a pharmacy in their neighborhood, a trip to the pharmacy can be a difficult endeavor.

Outreach over the phone has its limitations, as well. Pharmacists and techs working in call centers typically do not have a relationship with patients, not to mention the difficulty getting in touch with patients over the phone. A pharmacist – or any other clinician, for that matter – is not able to see all the medications in a household. They have a limited view into that person’s life.

Across the industry, the delivery of services is heading into the home. Covid-19 accelerated the movement of healthcare services to the home through the rapid uptake of telehealth and virtual care. Patient preference and technological advancement have kept the momentum going. Patients want these services because they’re easy to utilize.

The gap between patients and medication management, however, is not one that can be bridged completely with ones and zeros. Computers can’t open medicine cabinets. While telehealth services have become a vital piece of the care delivery puzzle, nothing compares to the value of face-to-face time with a healthcare professional. At its core, healthcare will always be a hands-on, human experience. The most convenient, accessible, effective environment to provide services like medication management is in the home.

The kitchen table medication review 

If the healthcare industry can deliver pills to patients’ homes, we should also be able to sit down with them in their living rooms, at their kitchen tables, and help sort through them.

The home is far more accessible and convenient than a trip to the pharmacy. In my experience doing house calls, I found the home a much more efficient site of service for a medication review than a phone call. Being present in the home allowed me the opportunity to get all of my patients’ prescriptions and supplements out in the open and on the table. Sitting at the kitchen table with my patients, I could catalog what they were actually taking and safely dispose of old, unused medications. I could counsel them on safety concerns and drug interactions. Face-to-face, I could build trust.

As a clinician, I can enter my patient’s home knowing them from limited interactions in facilities, or from their health records. But I can leave with a greater understanding of my patient as a person, of their lived environment, and the barriers they face on a day-to-day basis.

People want to be where they’re most comfortable, and healthcare, in recent years, has followed them there. Connecting vital, underutilized services like medication reviews to the daily lives and routines of older adults is the logical next step in the movement of care to the home, and for finally addressing a problem that has confounded the healthcare system and frustrated patients for far too long.

Photo: bong hyunjung, Getty Images


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Marc Rothman

Marc Rothman, MD has served as Chief Medical Officer of Signify Health since June 2020. Prior to joining Signify, Dr. Rothman served as Deputy Chief Medical Officer at Aspire Healthcare, where he led a nationwide palliative care medical practice and implemented and grew new clinical models and business lines. He also served as Enterprise Chief Medical Officer at Kindred Healthcare, Inc., where he oversaw medical affairs, clinical quality, patient experience and pharmacy services. Additionally, he served as the Chief Medical Officer of Kindred’s Nursing Center Division, leading the medical and pharmacy leadership team. Dr. Rothman holds an MD from New York University School of Medicine and a BA in Philosophy from the University of Wisconsin, Madison. He completed his postgraduate clinical training at Yale New Haven Hospital and is triple boarded in Internal, Geriatric and Hospice & Palliative Medicine.

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