FEATURE
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prescribed dosing as frequency increases from twice a day to three and four times a day . By the same token , if the patient can afford all of the medications , there is a drop in compliance as the number of separate meds increases . Interestingly , there is a U-shaped curve with non-compliance with antihypertensives in the 20-to-39-year age group and in those over age 70 . 5
THE FUTURE
There are hints at forces that currently are just not on the radar screen for ensuring quality of outcomes for the prescriber , let alone the patient . Health equity is still a concept and not a process . Academic articles describe that pure evidence-based guidelines may cause greater health disparities because of the barriers that many patients face . So new directions are being explored that would include concepts of equity in guidelines development . 6 But these are not yet in published and accepted clinical literature . We can expect in the future that clinical practice guidelines will incorporate health equity in formulating directions . These will probably include standardization of direction based upon the patient ’ s socioeconomic status , and the bias of patient , care giver and prescriber .
Measures of quality in medication safety will have to move beyond the broad scope of serious errors and deaths , or medication error associated ER visits , or cost of care . Metrics of health care improvement at the individual and population level will need to be developed . The National Quality Forum reports are sent to the Secretary of Health and Human Services . Efforts to improve medication safety will have to focus on the complex biologic and sociologic portions of the treatment of our patients . Collectively we can have a better safety cap on the prescriptions we write .
PRESCRIPTION PATH :
MD
Medical Decision
MEDICAL ACQUISITION
OTC
RECOMMENDATIONS
• Doctors need to be aware of the wide extent of medication safety issues and that as the prescriber , we must consider opportunities to improve medication safety .
• If the patient has a caregiver , that person should be present at the time the doctor writes the prescription , so questions may be asked .
• Physicians should ask if the patient with multiple medications has been contacted by the hospital or health plan ; and if so , were there any questions the patient may have .
• Simplify the medication list for patients - doctors should try to discontinue drugs when possible .
• Ask patients in a non-judgmental way about barriers they have to taking the prescribed medicines .
• Recognize your own biases when prescribing medications for people who are not like you .
References
1
Center for Disease Control , Medication Safety Basics https :// www . cdc . gov / medicationsafety / basics . html ( last accessed June 2 , 2021 )
2
“ A New Definition Of Health Equity To Guide Future Efforts And Measure Progress , “ Health Affairs Blog , June 22 , 2017 . DOI : 10.1377 / hblog20170622.060710
3
Centers for Medicare and Medicaid Services , Medication Therapy Management , https :// www . cms . gov / Medicare / Prescription-Drug-Coverage / PrescriptionDrug- CovContra / MTM ( last accessed June 20 , 2021 )
4
Medication Reconciliation Process Failures : By Amy Harper , PhD , RN , Elizabeth Kukielka , PharmD , MA , RPh & Rebecca Jones , MBA , RN◊DOI : 10.33940 / data / 2021.3.1Patient Harm Resulting From A Study of Serious Events Reported by Pennsylvania Hospitals10 I PatientSafetyJ . com I Vol . 3 No . 1 I March 2021 https :// patientsafetyj . com / index . php / patientsaf / article / view / medication-reconciliation-process-failures / pdf ( last accessed June 20 , 2021 )
5
Kim SJ , Kwon OD , Han EB , et al . Impact of number of medications and age on adherence to antihypertensive medications : A nationwide population-based study . Medicine ( Baltimore ). 2019 ; 98 ( 49 ): e17825 . doi : 10.1097 / MD . 0000000000017825
6
Javier Eslava-Schmalbach , Paola Mosquera , Juan Pablo Alzate , Kevin Pottie , Vivian Welch , Elie A Akl , Janet Jull , Eddy Lang , Srinivasa Vittal Katikireddi , Rachel Morton , Lehana Thabane , Bev Shea , Airton T Stein , Jasvinder Singh , Ivan D Florez , Gordon Guyatt , Holger Schünemann , Peter Tugwell , Considering health equity when moving from evidence-based guideline recommendations to implementation : a case study from an upper-middle income country on the GRADE approach , Health Policy and Planning , Volume 32 , Issue 10 , December 2017 , Pages 1484 – 1490 , https :// doi . org / 10.1093 / heapol / czx126
Dr . James is the Senior Medical Director , Passport Health Plan by Molina Healthcare .
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