Essays

Essays October 2017

From Prescription Pad to Patient: Canada Must Close the Medication Gap

Dr. Chris Hobson

 

I want to discuss the all-too-common breakdown in the process from when a doctor prescribes a medication to the patient taking the medication.

The timing is appropriate for such a discussion, as Canadian Patient Safety Week kicks off October 30 with the theme of medication safety.

Medication safety is an area where the potential for error is high. The discussion extends beyond just how, where or when we take medication – but whether prescriptions are being taken at all. Estimates are that about 50 per cent of Canadians do not take their medications as prescribed. Costs are a major cause of non-adherence to medications, impacting around 10 per cent of all prescriptions. Adherence is even lower among the poor, people with multiple chronic conditions and the uninsured. In 2014, a Canadian Institute of Health Research study found one-in-three new prescriptions goes unfilled.  

The question of whether a patient is really taking their prescribed medications can be quite complex. In fact, I’ve experienced this disconnect in my own practice as a family physician.

In one instance, I had a very conscientious patient who came to see me every month like clockwork to review his hypertension and adjust his medication. When I noticed his elevated blood pressure, we agreed on a medication plan, and for him to return in a week’s time for closer monitoring.

Sadly, my next contact with him came when the police phoned to confirm that I was his physician, and to certify him as deceased. He had suffered a heart attack. When I went to his house, I discovered a medicine cabinet full of unopened medication bottles. As it turns out, he had been going to see me regularly, picking up and filling his prescriptions, but ultimately not taking them.

This problem – when the care plan gets interrupted on the journey from the prescription pad to the patient – is far too common.

A substantial proportion of medications that aren’t taken are avoided for cost reasons. Patients will leave off either the most expensive medication, or the medication they deem the least important. This scenario is especially fraught with peril if the pharmacist does not have access to the patient’s summary of care and care plan.

The Canadian healthcare system and all its stakeholders could usefully focus on one fundamental question – how do we close the medication gap? If the issue is cost, then we need to find ways to better subsidize the cost of medications, or to negotiate lower prices with pharmaceutical companies for instance.

Another important way to bridge the gap is through high quality care coordination, an approach that puts the patient at the center of their care.

Pharmacists, patients, caregivers and families can use online portals, shared electronic health records, and comprehensive shared care plans to view, edit and update each patient’s individual care plan. Leveraging these technologies, they can ensure decisions are made with the best possible knowledge of the most up-to-date care plan. Medication reconciliation is a process of reviewing all the medications a patient is taking to inform any drug-related care decisions moving forward – it can help create a “golden record” of a patient’s drugs.

The best practice approach is threefold:

  • Tracking of the medication from prescription to the point where the patient takes the medication
  • Timely and effective review of all medications, i.e. the full medication reconciliation process, with sharing of the outcome
  • Total inclusion of the patient and their circle of care as full participants in the care team

This approach ensures all points in a patient’s circle of care understand the patient’s clinical situation, have access to the care plan, and can easily communicate amongst the circle of care if something is amiss. While today’s patients are increasingly being treated by multiple providers and stakeholders, lack of medication safety due to lack of information and lack of coordination is taking a toll on our communities. 

Medication can save lives. Let’s ensure Canadian patients, medical professionals, and care providers have the proper resources to make sure that those medications are doing the intended job.

About the Author

Dr. Chris Hobson is a Family Physician with 15 years of experience and the Chief Medical Officer at Orion Health.

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