UW News

January 8, 2009

Combating overmedication one patient at a time

UW Health Sciences/UW Medicine


Do you have an older relative who takes more prescription drugs in one sitting than you take in an entire month? If you’ve ever worried about the implications of this regimen, consider this: Approximately one third of people 65 years or older who are taking at least five medications experience an adverse drug event each year, according to research cited by the American Academy of Family Physicians.

Such adverse events can include falls, hip fractures and delirium. In the most severe cases, drug reactions and interactions can be lethal.

Beyond these more-serious risks, the reality is your loved one might simply be taking too many pills. It is a problem that many faculty members in the UW School of Pharmacy know all too well.

“I get a phone call at least once a month from friends, acquaintances or members of the public with questions and concerns about a family member’s long list of medications,” said Associate Professor of Pharmacy Peggy Odegard.

The issue of overmedication, said Odegard, has complex roots. Many patients see multiple providers and have more than one pharmacy, so communication about medicine use can break down. Or they may be taking vitamins or homeopathic remedies that they forget to mention. Further, people often receive prescriptions to treat ailments that are actually the side effects of another drug. So the regimen just keeps growing.

It’s a cascading effect that can diminish quality of life. The costs add up for individuals and for the entire health care industry.

So late last year, Odegard and colleague Annie Lam, senior lecturer in pharmacy, both UW alumni, set out to be part of the solution for this growing problem. Using endowed-professorship funds, they joined with several colleagues to create a medication-therapy-management (MTM) training and consultation program in the School of Pharmacy.

MTM is a service in which pharmacists meet with patients to review their medication regimens, provide education about medication use and health management, and identify potential safety concerns or red flags that patients should share with their prescribers. They assess whether patients’ health may improve if they scale back on their prescriptions. They also identify potential medication-adherence issues.

Pharmacists have been offering chart-based MTM in nursing facilities since the 1990s. The consultation services became more common in community pharmacies in 2006 when Medicare started providing coverage for qualified beneficiaries. Requests for MTM have continued to grow since that time as more insurers have started covering it for patients of all ages.

This has left many community pharmacies inundated with requests. Which is where the UW’s MTM program comes in — to fill the service gap for pharmacies that would like help.

So, after establishing contracts with insurers this summer, participating faculty — all of whom are licensed pharmacists with experience in conducting medication-regimen reviews — started interviewing qualified MTM patients over the phone and in person (both at the School of Pharmacy and at local collaborating pharmacies). They’ve been offering medication-review consultations and follow-up sessions to patients while mentoring Pharm.D. students.

This School of Pharmacy program, dubbed UW Pharmacy Cares, is licensed by the Washington State Department of Health as a nondispensing, MTM-focused pharmacy. It is the first of its kind in the state. And just this week, it opened an official site for business in the Roosevelt Commons Building,. 4311 Roosevelt Way N.E., to facilitate access for Seattle-based clients, including UW employees covered by Uniform Medical Plan and Aetna.

Ultimately, faculty involved in the program would like community pharmacies throughout the state to see UW Pharmacy Cares as a resource. Although pharmacists are highly trained on medication use, said Odegard, many have found the comprehensive-medication-review consultations to be too time-intensive to offer in a busy pharmacy setting. So faculty members in UW Pharmacy Cares are providing these consultations, then forwarding their recommendations to the patients’ primary pharmacy (and in some cases, to their medical providers).

Bellegrove Pharmacy in Bellevue is one pharmacy that recently called upon UW Pharmacy Cares to form a collaborative relationship.

“I truly believe that MTM is a role that pharmacists are equipped to provide,” said Chief Operating Officer Steve Singer, a UW alumnus, “but the challenge has been actually implementing the program into our businesses.”

Because of this, he believes the UW’s program can not only benefit pharmacies that need guidance, but that it can help move the profession forward by helping pharmacies provide an important service to the public. The School of Pharmacy has been assisting Bellegrove by providing medication-review consultations and helping the business create its own formal MTM program.

Currently, students in the School of Pharmacy’s geriatric-certificate program are receiving training through this program. Eventually, the School seeks to create a permanent MTM curriculum for all Pharm.D.. students and to offer clerkships onsite at UW Pharmacy Cares. And along with other faculty, Odegard and Lam will conduct research into MTM best practices and into health problems associated with overmedication.

For now, the faculty and students involved in UW Pharmacy Cares are thrilled to be providing medication-therapy management to patients in need. In just the few months that they’ve been operating, they’ve already helped patients reach improved health outcomes. This is exactly what they hoped would happen.

“We all feel like we’re making a real contribution to public health in doing this,” said Jackie Gardner, a Department of Pharmacy professor and key player in UW Pharmacy Cares. “We simply couldn’t be more excited.”

To find out whether your insurance covers you for an annual MTM consultation, ask your provider. For general questions about medication-therapy management, to find out if UW Pharmacy Cares works with your insurance provider, or to learn about fee-for-service options, call 866-577-1915 or visit www.uwpharmacycares.com