clinical focus
Compound interest
For patients who don’t stick to
treatment plans, the answer
may be personalised medicine.
By Matthew Bellgrove
I
n the aged care environment, ensuring
residents take all their medication
every time is a constant challenge.
The World Health Organization (WHO)
in its report, Adherence to Long-Term
Therapies – Evidence for Action, claims
that in developed countries 50 per cent
of patients on long-term treatment plans
don’t take their medications as prescribed.
These patients skip their medication
regularly or don’t take it altogether, which,
according to WHO, can sometimes lead to
serious health consequences.
The organisation claims that strategies
to help patients stick to their long-term
medical plan “may have a far greater
impact on the health of the population
than any improvement in specific medical
treatments”. That’s a big call, but with
non‑compliance as high as 50 per cent,
that statement may be justified.
Some of the biggest barriers to treatment
plan compliance, as identified in the WHO
report, include the inflexibility of disease
therapies, therapies (including medications)
that don’t take into consideration lifestyle
factors, personal comfort, and co-existing
health issues.
It stands to reason that if you make
long-term treatment plans simple and
non‑intrusive to a person’s time, comfort
and way of life, compliance will be
much higher.
Carers in the aged care field know that
residents tire very quickly of taking large
numbers of pills, sometimes two or three
times a day. And if the resident suffers from
dysphagia and the pills are large and hard
to swallow, the situation is exacerbated.
Staff at aged care facilities often resort
to crushing large pills and dissolving them
in juice or water to make administration
easier and less anxiety-inducing. You
can understand why they would do this,
however this practice has been shown in
numerous studies to be a problematic at
best and dangerous at worst.
A study by the University of Queensland
last year found that up to 24 per cent of
a medication can be lost when a pill is
crushed. Over time, missing out on that
quarter of active ingredients could have
serious ramifications for a person’s health
– it’s essentially the same as skipping a
couple of days through the week.
And according to the government’s NPS
MedicineWise agency: “The stability and
bioavailability of drugs can be significantly
changed by the simple act of crushing
a tablet, preparing an oral liquid from a
tablet or capsule, or mixing a crushed
tablet or capsule powder with food or
other thickening agents. Manipulating solid
dosage forms remains a significant source
of medication error and harm to patients.”
On its website, NPS MedicineWise
recommends that in cases of dysphagia,
if a commercially available liquid version
of a drug, or a suitable drug alternative
cannot be found, then healthcare workers
should consider “extemporaneously
compounded medicine – this remains
off-label use but is produced using an
evidence-based approach”.
This refers to a service offered by
licensed and regulated compounding
pharmacists whereby they make up a
person’s medication in the form of a liquid,
troche or in some cases a cream. The same
ingredients as the prescribed medication
are used, just delivered in a different form,
a form that’s much easier to swallow or
administer. It’s a service often referred to as
‘personalised medicine’.
However, while they’re constantly
challenged by treatment plan compliance
and understand the seriousness of the
issue, many GPs in the aged care field
don’t pursue the option of personalised
medicine, assuming it will be prohibitively
expensive and difficult to arrange. They
would be wrong on both counts.
In most cases, personalised medicine is
no more expensive than mass-produced
drugs, and an experienced compounding
pharmacist will be fully aware of what
the GP is trying to achieve and will
work with them to make the change a
simple process.
Compounding pharmacies can also,
in many situations, combine multiple
medications in one capsule. This allows
patients to take just the one tablet instead
of the three or four (or more) they were
previously forced to swallow.
I currently provide this service for a
number of elderly patients on multiple
medications, and their carers report that
the anxiety commonly experienced around
‘pill time’ has reduced considerably.
Non-adherence to treatment plans
is a serious health issue in the aged
care sector, as highlighted by WHO
and Australia’s own health officials.
However, compounding pharmacies
can offer solutions that are safe and
highly effective. ■
Matthew Bellgrove is owner and
compounding pharmacist at National
Custom Compounding.
agedcareinsite.com.au 27