Medication Therapy Reviews
The Case for Medication Therapy Reviews by Pharmacists
What is a medication review?
Advantage to plan member
An expert assessment to verify medications, dosage, side effect and potential interactions. It also provides the opportunity to ask questions to better understand medications and the proper way they should be taken, reducing the risk for medication-related problems
Advantage to employer
Reduced risk of adverse drug reactions and increased adherence rates translates into lower absenteeism and reduced risk of complications that may result in more costly interventions or increased STD or LTD claims
Advantage to plan
Pharmacists can identify the most cost-effective choice for medications prescribed
Reduced costs to the health plan as a result of reduced risk of complications from drug interactions and adherence issues, reduced risk of hospitalization and lower STD or LTD claims
A medication therapy review is a one-on-one consultation between a pharmacist and a patient during which the pharmacist collects information about the patient’s health conditions and all of the medications he/she takes – whether prescribed, over-the-counter, or a natural health product.
How can pharmacists help?
The pharmacist will check to ensure that each medication is appropriate, effective and safe and there are no adverse effects or interactions. Patient education is also an important part of the review. The pharmacist helps the patient understand what each medication is for and the proper way it should be taken.
Case study example
Here’s how a medication review helped one man better understand and manage his treatment for a healthy outcome (names have been changed to protect privacy).
Michael, a man in his early 50s had a variety of health issues that required he take about 10 different medications each day. He had read somewhere that it wasn’t good to take all the pills at the same time, so he set up his own schedule, spreading his pills throughout the day. With so many pills to take, Michael thought he must be very ill and was frequently absent from work and unproductive when at work out of fear he might miss taking any of his doses of medication.
London-based pharmacist, Elena Dubois, BScPhm, discovered the problem during a medication review. After reviewing his full list of medications, Elena mapped out a new schedule for Michael, explaining which pills to take in the morning and evening. It didn’t take long for Michael to start feeling more confident about managing his medication regime and was able to resume work.
“Patients go home from the hospital or a doctor’s appointment and often feel overwhelmed or confused,” Elena says. “But the coaching and reassurance patients receive from an expert during a medication review can address their anxiety and help them get on with their lives.”
The business case for plan sponsors
According to the Canadian Institute for Health Information (CIHI), Canadians spent an estimated $29.3 billion on prescription drugs in 2013.1 Studies reported by the Health Council of Canada have found that approximately 52% of Canadian adults said they take at least one prescription drug and 15% reported taking four or more.2
The problems addressed by medication reviews
- Adverse drug reactions can result in absenteeism or preventable hospitalization – leading to higher health plan costs and higher STD claims
- Non adherence to medication can lead to a relapse or higher risk of complications that may require more costly medical interventions
- Lack of patient understanding about their medication treatment and how to take medication properly can lead to adverse drug reactions, and increased risk of complications – resulting in increased absenteeism or presenteeism and a more significant healthcare investment
When you combine multiple prescription medications with over-the-counter treatments or natural health products and poor life-style choices, the risk for adverse reactions and other problems can be high.
Medication-related problems and errors are a significant public health issue, with misuse of prescription medications resulting in slower or negative therapeutic outcomes for patients, increased rates of hospitalization, and drug-related morbidity and mortality.
One study published Canadian Medical Association Journal (CMAJ) reported that “adverse drug-related events accounted for 12.0% of emergency department visits, of which 68.0% were considered preventable.”3 The total cost of preventable drug-related hospitalizations in Canada is estimated at $2.6 billion per year, with the most common causes identified as:4
- Adverse drug reactions (35%)
- Improper drug selection (17%)
- Noncompliance (16%)
Research conducted at Vancouver General Hospital compared outcomes of patients visiting the emergency department because of adverse drug events with those visiting for other reasons. The study concluded that patients with adverse drug events “incurred greater health care services utilization and costs during a 6-month follow-up period compared with patients presenting for other reasons.”5
Patient education is the key
Prevention begins with a detailed medication therapy review and patient education. During a review, pharmacists can help identify potential adverse drug reactions and make recommendations for alternate therapies. They can detect errors or discrepancies in labeling, dosage or treatment, and address any adherence issues that the patient may have. Adherence rates are as low as 50% for the average chronic disease patient.6 Pharmacists can be particularly effective at addressing this issue alone. Improving adherence rates to recommended treatments helps prevent risk factors for complications and improves health outcomes.
Through one-on-one consultation and education during the medication review, pharmacists provide patients with essential coaching. Patients gain a better understanding of their medication treatment and learn how to more effectively manage their health. Outcomes include reduced absenteeism and presenteeism, reduced incidences of short-and long-term disability, and ultimately reduced health care costs.
Add your local pharmacy to the wellness team
Encouraging your employees to talk with their pharmacist will enable them to get the full benefit of the expertise they are there to provide. A regular and detailed medication review is a good place to start – and an important step in preventing medication-related problems that could result in higher rates of absenteeism and more costly health interventions. This is particularly important for patients who take multiple prescribed medications. It is essential that patients – plan members – take a far more active role in managing their health by understanding the medications they are taking, knowing how to take them properly and knowing they can speak with their pharmacist when they have questions or concerns.
Medication therapy reviews (MTRs) in action
MTRs can be scheduled in advance or can occur when a patient comes into the pharmacy for a refill or other appointment.
The process begins with the patient completing a form listing all the prescription and non-prescription medications they are taking, including why and how they are taking them.
Once completed, the pharmacist reviews the list drug-by-drug, gathering information on safety and usage. All findings are documented in writing and stored in a patient profile.
Two types of concerns may arise:
- Behavioural concerns (intentional or unintentional non-adherence).
- Therapeutic concerns.
In both cases the pharmacist will make a recommendation to resolve the problem. This can involve notifying or consulting the patient’s primary care provider. Normally it is a decision reached between patient and pharmacist, with the necessary parties being notified of changes.
Any changes are documented in the patients file, and the patient may take home a summary of the changes discussed.
The entire MTR process usually takes around 20-30 minutes.
In conclusion
Pharmacist-led medication therapy review, education and one-on-one consultation (that compliments other healthcare providers) will reduce adverse drug events, improve adherence rates to prescribed treatments and encourage active participation by plan members in their own health recovery.
1. Canadian Institute for Health Information (2012). Prescribed Drug Spending in Canada, 2012: A Focus on Public Drug Programs.
2. Canadian Academy of Health Sciences (2010). Transforming Care for Canadians with Chronic Health Conditions.
3. CMAJ, Inscidence, severity and preventability of medication-related visits to the emergency department: a prospective study; Peter J. Zed PharmD, Riyad B.Abu-Laban MD MHSc, et al, June 3, 2008
4. Samoy, L.J., Zed, P.J., Wilbur, K., et al. (2006). Drug-related hospitalizations in a tertiary care internal medicine service of a Canadian hospital: a prospective study. Pharmacotherapy, 26,1578-86.
5. NCIB, US National Library of Medicine, National Institutes of Health, Outcomes of emergency department patients presenting with adverse drug events, Department of Emergency Medicine, University of British Columbia, Vancouver, Canada, 2011
6. World Health Organization (2003). Adherence to Long-Term Therapies.
