04 Jun Reducing Medication Related Harm
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Reducing Medication Related Harm
Written by Dr Chris Alderman, Pharmacist
Especially where there is complex multimorbidity, many factors impact upon a person’s overall experience of wellness, quality of life, psychological well-being, and ability to return to meaningful activity, including returning to work. Complex multimorbidity often creates a need for the use of various medications.
Medications are used for the purpose of alleviating symptoms, treating and preventing the progression of chronic disease, the prevention of illness or progression of symptoms, and other purposes. It is quite common for a person to source medications from a variety of providers including General Practitioners (GPs), medical specialists, pharmacies, dentists, health food/supplement stores and alternative medicine practitioners.
It is also common that a unified list of all medications taken by a client is not available to all people who are involved in rendering care for that individual. Moreover, understanding the medication profile for a person involves more than simply understanding which medications are taken. It is also important to clearly establish what the dosage is, how the medication is being administered (route of administration), the duration of treatment, and the intended purpose of treatment. It is also important to understand any history of allergy or intolerance to medication(s), as well as other information such as vaccination history.
These elements need to be interpreted in the context of the results of laboratory and imaging investigations, the clinical history of all medical conditions, and the attitudes and beliefs of the individual in relation to the use of medications (including “adherence”- the extent to which the person uses the medications in alignment with the instructions provided by the prescriber).
The process of bringing together all of this information and synthesising the findings is sometimes referred to as a medication review. The importance of medication review has been recognised around the world, and in advanced healthcare systems has been incorporated into health care in a fashion that is funded by governments and private payers in the interest of achieving best quality use of medicines.
Furthermore, these reviews are funded in a variety of settings including medication reviews that take place in a consumer’s own home (Home Medicines Reviews – HMRs) and in residential aged care facilities (RMMRs), but in Australia there are limited mechanisms that currently exist to fund this service.
This is unfortunate, as there is a considerable body of research that supports the notion that comprehensive medication reviews can lead to improved health outcomes for consumers, resulting in a marked reduction in medication-related harm, a reduction in the cost of care measured both in terms of the overall cost of providing care, the expenses associated with GP visits, hospitalisations and other healthcare utilisation, as well as reducing the costs associated with the acquisition of medications.
Overall, medication reviews have the potential to reduce the extent of polypharmacy (which is the simultaneous use of multiple medications by a person) which in turn is reflected in better overall health outcomes for consumers.
Importantly, optimising the quality use of medicines can help facilitate a return to employment after a compensable injury.
In situations where a person has been involved with an incident that has resulted in a workplace injury, there is considerable potential for extended medication use
to increase rapidly, contributing to polypharmacy. Adding new medications to an already established regimen that has been in place for the management of ongoing chronic disease can create serious potential for drug interactions and other unfavourable outcomes.
It is also well known that as the number of medications a person is required to take increases, their ability to take these medications as prescribed is compromised (adherence decreases): another factor that is well known to be associated with poorer health outcomes. Strategies that can assist in achieving better medication adherence include motivational interviewing, increased health literacy, and adherence coaching.
Through these mechanisms, a medication review can assist in preventing medication-related problems, can improve health outcomes, and may assist with a timely return to work and/or other meaningful activities of daily living.
Ongoing medication management strategies are often delegated to a person’s GP, but this may be a difficult and unrealistic expectation for people with complex multimorbidity and significant polypharmacy. If we consider that during the course of a GP consultation, the doctor must undertake a series of complex tasks such as greeting the patient, taking a history, performing an examination, prescribing medications, ordering new tests and reviewing the results of those already performed, it is clear that the time available to the GP in the context of a standard consultation is often inadequate to allow an in-depth consideration of all of the issues involved. For this reason, if it is possible to arrange support and assistance for the GP in relation to medication-related matters it is not unreasonable to expect that this will assist the doctor in achieving better health outcomes for their patient, as well as simplifying the processes required to provide good medical care.
Given that those who are affected by significant workplace injuries may become involved in compensation proceedings, and these people often have complex multimorbidity and require significant medication treatment, it is logical that a service that helps with medication management might be expected to produce superior outcomes and facilitate a more timely return to work.
A medication review can incorporate several elements to support consumers and their doctors with strategies that are designed to reduce the likelihood of medication related harm as well as optimising medication treatment and associated health outcomes. The components of such a service could include:
- Systematic medication reviews (independent of existing HMR/RMMR arrangements)
- Specialised medicines information and individualised clinical support (including case conferencing)
- GP education
- Patient support and education groups
This service would be a tangible mechanism by which interdisciplinary cooperation can be used to achieve optimal use of medicines for people who have been affected by workplace injury.
Considering the extensive expense associated with adverse health outcomes relating to medications, such a service represents a cost-effective mechanism to minimise medication related harm, optimise health outcomes and facilitate increased capacity to return to work or to attend to activities of daily living.
To find out more about the nature and scope of these services, please email firstname.lastname@example.org
*All views, opinions and conclusions expressed are those of the authors and/or speakers and do not necessarily reflect the view, opinion, conclusion and/or policy of ExamWorks and its affiliates.