Individuals (i.e., patients themselves) make many of their own most important medical decisions. Although none is more important than good lifestyle choices—exercising regularly, eating a healthy diet, not smoking or drinking to excess—adherence to an appropriate medication regimen is a critical aspect of managing chronic diseases. Non-adherence, however, is both strikingly common and consequential. Even clinical trials of treatments for chronic conditions, which devote extraordinary attention and resources to assure that study medications are taken as prescribed, report adherence rates below 80%. Roughly half of all medication-related hospital admissions in the United States are due to non-adherence.[i]
There are many barriers to taking medications as prescribed—undesirable side effects, inconvenient pharmacy hours, cognitive impairment or simple forgetfulness. Upon hospital discharge, a patient is often presented with multiple prescriptions for medications, with the expectation that a regimen started in the hospital will be continued without interruption. This scenario is particularly challenging if one cannot physically go to a pharmacy, does not leave the hospital until after pharmacy hours, or does not have the assistance of family or friends who can deliver needed medications. Managing multiple regimens at once—different medications, each with its own dosing schedule and instructions for storage and consumption—can also be difficult.
These five steps can help assure that you receive your medications as prescribed—the right medications at the right doses, at the right times:
1. Carry a list of the medications you take, their doses, and dosing schedules. Keep it in your wallet, so that you are never without it. When visiting the hospital, it is helpful to have an extra copy, so that both you and your doctors can keep one.
2. If you are admitted to the hospital, make sure that you continue to receive the medications that you take at home—or that you understand why it is best not to take them.
3. When leaving the hospital after an admission, know which medications to take, and when to start taking them. Medications that you take daily may have been given to you already that day. Be certain that you know which ones you have taken, and which you should take later in the day.
4. Make sure that you have prescriptions for any new medications. If possible, ask that they be faxed to your pharmacy. This will give the pharmacist time to prepare your medication before you arrive, and to speak with your doctor about any problems (e.g., it is not available in the pharmacy, or may interact with your other medications).
5. Develop a system to keep track of all of your medications and when you should take them, and record each dose that you take. It is very important for your doctor to know which medications you have taken, when, and how much. It can also be very helpful to remind yourself.
Keeping a notebook and pen next to your medications will make daily management much easier. Internet-based tools such as MyMedSchedule.com also provide pictures of pills (which may look different, depending upon the manufacturer), automatic reminders, and enable you to access the information from various locations. This is especially helpful if you go to the hospital unexpectedly. However you choose to manage your medications, call your doctor before changing your regimen. Many people have difficulty taking their medications as prescribed, but missing a dose can have serious consequences—especially for those with chronic diseases.
[i] Osterberg L, Blaschke T. N Engl J Med 2005; 353:487-97.
Massachusetts doctors believe that home health care can hasten recovery from acute medical care, and improves coordination of health services. In a 2009 survey, 78% of physicians reported that their patients can better adhere to established plans of care when they have the assistance of home care. Seventy-three percent see reduced levels of stress in a patient’s caregivers, and most credit home care with reducing Emergency Department visits.
“Transitions in care” refers to the processes by which immediate oversight of health care responsibilities is transferred. Common examples of transitions in care include the discharge of hospitalized patients to home, and the referral by a primary provider to another for ongoing primary or specialty care. Lapses in communication occur too often during transitions in care, and may cause medical errors and lapses in care plans. Important pieces of information may not be conveyed effectively from one provider to another. Details about one’s living environment, which may challenge an ill or injured person’s ability to care for oneself, may be unknown to a hospital- or office-based provider. In a federally funded evaluation of the Medicare Coordinated Care Demonstration project, researchers reported that, “ . . . seeing the patient and his or her living environment (including aspects that the patient might not tell staff about on the telephone) greatly enhances their ability to understand the patient’s situation and tailor the intervention to it.”[i]
Coordinating care across the continuum—from the hospital to home and between providers—can improve outcomes and expedite recovery from medical events. A weakened or unsteady person who returns to a home with multiple levels or thick carpets is at increased risk for falling. One who does not have family nearby to help with chores may not be able to fill prescriptions or complete necessary household chores. As a result, many experience complications or relapses requiring Emergency Department visits and hospital re-admission—and are entirely avoidable. Such is the impetus for the Patient-Centered Medical Home model of coordinated medical care, which is being adopted in Massachusetts. It is also the reason for the dramatic results seen from the Home-Based Chronic Care Model in Arkansas’ Baptist Health Care system. The importance of care coordination has been recognized for decades. As more is learned about how to achieve it, home care services are proving ever more valuable.
[i] Mathematica Policy Research, Inc. Report to Congress on the Evaluation of the Medicare Coordinated Care Demonstration, January 3, 2008.