Making Improved Medication IQ Part of the Treatment

In this era of polypharmacy—where individuals with multiple conditions take multiple medications—the route to safer, more effective care may lie with how a patient answers this question: What are you taking and how are you taking it?

As one New York area hospital found, this was especially true with outpatients at its cancer care clinic where the rising use of oral anti-cancer drugs could lead to more life-threatening complications related to drug interactions or incorrect use.

The idea of reviewing a patient's medications—finding out what they are using, when they are using them, and how they are using them—of course, is not new. The "brown bag" patient safety campaign, which has been around for years, encourages patients to bring their medications and other medical products to check-ups or pharmacy visits so providers can review their dosage and use.

But as times change, treatments and medications are changing as well. What once may have seemed like "a good idea" may be evolving into something that is a critical aspect of a patient's care. This is what sparked an initiative for outpatients at the Montefiore-Einstein Center for Cancer Care.

"Many of our patients have other co-morbid conditions such as diabetes or a heart condition," says Pragna Patel, PharmD, RPh, who is an oncology investigational pharmacy manager at Montefiore. She, along with Una Hopkins, BSN, MSN, FNP BC, a nurse practitioner with the medical oncology department at Montefiore, created the Medication Therapy Management program.

Their goal was to help cancer patients safely take their oral chemotherapy—along with other prescription medications they need for other conditions—to help avoid what could be adverse interactions or life threatening errors. The idea was to create a personalized plan to support safe and effective use and storage of their prescriptions.

The goal is to assist patients to get a better understanding of their medications—including prescribed and over the counter, along with vitamins or herbal supplements they use, according to Patel.

During their treatment, the cancer center patients are referred to the Medication Therapy Management program by the physicians and nurses for a visit with both Patel and Hopkins. During a 30- to 45-minute session, the clinical team discusses possible side effects associated with the potent anti-cancer drugs. They also will look at possible allergies or adverse reactions the patients may experience or possible drug drug or drug food interactions.

They also discuss proper use of the drugs. For instance, Patel notes one patient who misunderstood her instructions and was taking one pill needed for her treatment five times a day instead of taking all five pills at once. Misuse or improper use of the medications may result in their compounds not working as they should as part of the cancer treatment.

Cost issues can be discussed as well, since many anti-cancer drugs are expensive. Patel and Hopkins underscore the importance of taking the drugs at their prescribed intervals even if the prescriptions are expensive and may not be covered by insurance: Skipping anti-cancer medication could be very problematic in effectively fighting the disease.

At the cancer center, those patients considered to be at highest risk for errors include those who are taking more than five medications at the same time, those with multiple co morbid conditions, those taking oral chemotherapeutics, and those taking long term (five years) hormonal therapy.

To assist the patient, the clinical team creates a "medication action plan" that clearly identifies any important symptoms the patient should look out for—some of which should provoke emergency care. The patient can take this action plan home, share it with his or her family, and show it to other specialty healthcare providers including their pharmacist.

The team sees this service as a way to increase patient satisfaction as well, Patel says. Many seemed pleased because no one before had taken the "time to sit with you and talk about your medications and what happens when you take it," Patel says.