Medication therapy is an integral element of healthcare interventions. In 2016, >4 billion prescriptions were dispensed in the United States. Pharmacotherapy is often supported by “hard science” of research evidence; clinical practice often shifts to the “soft science” of medicine, combining patients’ culture and beliefs, their histories, and medication adherence to provide the best possible care.
Of the billions of prescriptions filled, it is estimated that half are taken improperly. Achieving a balance between “hard” and “soft” sciences—providing evidence-based medication therapy that patients will adhere to—becomes paramount. This chapter explores patient adherence; provider considerations, such as evidence, pharmacokinetics/pharmacodynamics, and safety; and healthcare system factors, such as formulary systems/resources.
IMS Institute for Healthcare Informatics. Medicines use and spending in the U.S. http://www.imshealth.com
. Accessed June 12, 2018.
TAKING A MEDICATION HISTORY
Discrepancies among documented medication therapy records and actual patient use of medications are common and occur with all classes of medications. Therefore, the first step for the provider in determining optimal medication therapy is to understand what medications patients are actually taking and how they are taking them. In addition to gathering information regarding prescribed medications, it is important for providers to also ensure they review all over-the-counter products, herbal products, and dietary supplements patients may be using regularly. Over 28% of the population regularly takes herbal supplements on a yearly basis, but only 16% of these patients report this to their physician. A thorough medication history is an important resource to assess for appropriate medication use and to screen for possible medication-related problems. Table 47–1 lists five concise steps to a medication history. To obtain an accurate medication history, the physician should start by asking open-ended questions; for example, “What medications are you taking?” This approach avoids the common mistake of assuming the patient is taking all their medications as prescribed. Conducting an open-ended medication history may take more time up front, but the benefits gained in rapport building and medication optimization are well worth the time and effort, especially when it comes to the risks associated with over- and underprescribing medications. One example of medication optimization is the minimization of polypharmacy; polypharmacy is defined as the concurrent use of multiple medications or the prescribing of more medications than are clinically indicated.
Table 47–1.Reviewing a medication regimen. ||Download (.pdf) Table 47–1. Reviewing a medication regimen.
Match the medication with the diagnosis.
Review the regimen for duplication of therapy.
Elicit from the patient if she or he is taking the medicine.
Review laboratory results and patient history for efficacy/toxicity of the regimen.
Strive to remove any unnecessary agents from the regimen.
et al. Consumer usage and reasons for using dietary supplements: report ...