Older people often incorrectly assume medicines don't have potential side effects

by Enrique Rivero, University of California, Los Angeles

The findings suggest that physicians should spend more time explaining medication side effects to ensure their older patients are fully informed. Credit: University of California, Los Angeles

Older people correctly ascertained basic information such as dosage and duration of use for more than 70% of the medications they were prescribed, regardless of whether their physician explained it during an office visit. But when physicians failed to verbally provide information about potential side effects, people incorrectly assumed that about 55% of their prescribed medications had none. And even when physicians did discuss possible side effects, their patients incorrectly assumed there were no side effects for 22% of the medications.

24 feb 2021--There is a shortage of data about how well people understand basic information about the medications they are prescribed. This information is important for ensuring that people take their medications safely and properly and adhere to medication regimens.

The researchers examined data from 2009 and 2010 for 81 people age 50 and older who were subjects in a previous study aimed at improving how physicians communicate about newly prescribed medications.

The researchers note that more than half of the people in the study had high levels of health literacy and at least some college education. Also, people were allowed to refer to information that had been provided to them about the medications when they were responding to the survey. These factors may limit the applicability of the findings to the general population.

The findings suggest that although physicians might not need to spend much time conveying information on dosage, the number of pills in a prescription or how frequently medications must be taken, they should spend more time explaining side effects to ensure their older patients are fully informed.

Gaps in knowledge about side effects may put people, particularly older people, at risk for medication nonadherence. Patients may be less likely to take or continue taking medications if they discover the existence of potential adverse effects without having the opportunity to discuss those side effects with their physicians in a timely manner.

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More information: Timothy Ho et al. Post-Visit Patient Understanding About Newly Prescribed Medications, Journal of General Internal Medicine (2021). DOI: 10.1007/s11606-020-06540-4

Provided by University of California, Los Angeles 

Study reveals benefits of clinical medication reviews for improving medication management

Structured and collaborative medication reviews performed by pharmacists and general practitioners are beneficial in improving the quality use of medicines, according to a groundbreaking new review published by Monash University.

18 aug 2015--Researchers from the Faculty of Pharmacy and Pharmaceutical Sciences' Centre for Medicine Use and Safety found that clinical medication reviews (CMRs) resulted in identification of medication-related problems, improved medication adherence and reduced hospitalisations.
Published in respected pharmaceutical research journal Research in Social and Administrative Pharmacy, the comprehensive review titled 'Clinical medication review in Australia: a systematic review' demonstrated the value of medication review models that incorporate inter-professional collaboration.
The Pharmaceutical Society of Australia (PSA) highlighted the importance of the research in a recent announcement, with National President Joe Demarte saying, "This review is landmark in that it provides an overview of the research to date and describes the clinical, humanistic, economic and qualitative benefits of medication reviews." Australia's Chief Medical Officer Professor Chris Baggoley AO also highlighted the research as part of his keynote address at the recent PSA 15 conference in Sydney.
The research team was led by Associate Professor Simon Bell and also included Ms Natali Jokanovic, Dr Edwin Tan, Professor Carl Kirkpatrick, Professor Michael Dooley, and Ms Denise van den Bosch.
"Our research showed that clinical medication reviews are capable of improving the quality use of medicines in older Australians. This is an important finding because up to 30 per cent of unplanned hospital admissions among people aged 75 years and older are medicines related," said Associate Professor Bell.
The review identified a lack of awareness of CMRs among eligible non-recipients, including people from indigenous and linguistically diverse communities, recipients of palliative care, people with poor medication adherence and those in rural and remote areas. Addressing these "access gaps" represents an opportunity to further improve the current model for CMRs in Australia, according to the review.
This was the first systematic review of CMR research undertaken in Australia.
More information: "Clinical medication review in Australia: A systematic review." DOI: dx.doi.org/10.1016/j.sapharm.2015.06.007

Provided by Monash University

Too many drugs for many older patients

Older patients are increasingly prescribed multiple drugs that, when combined, can lead to negative side effects and poor health outcomes.  A new Cochrane Library evidence review reveals that little is known about the best ways to avoid inappropriate prescribing of medications for seniors or how to maximize health benefits while minimizing prescriptions.

According to study author Susan M. Patterson, Ph.D., of Queen’s University in Belfast, U.K., inappropriate polypharmacy contributes to around one in 10 hospital admissions. While many patients appropriately take several drugs to treat the variety of medical problems that can arise with aging, she explains, some are inappropriately prescribed combinations of drugs intended to treat not only the original problem, but side effects from those treatments, and even side effects from side effect drugs.
“It becomes a prescribing cascade,” Patterson said. “Rather than review medications and stop the offending drug, doctors just prescribe an additional drug.”
Patterson and her colleagues gathered research on studies of interventions aiming to cut down on inappropriate drug combinations for aging patients.
One study examined the benefits of using electronic decision support, a computerized program that automatically reviews a doctor’s notes and suggests ways to avoid medical errors or improve care. Other studies researched the effectiveness of complex pharmaceutical care interventions that typically combined medication review, individual patient counseling, group patient education in the community and clinical case conferences.
Patterson and her colleagues reported that the interventions that appeared to work the best involved pharmacists as part of a multidisciplinary team working together to solve this problem.
However, she notes, it was impossible to judge from these studies whether these changes in care resulted in better patient outcomes. For example, only some of the studies reported a reduction in hospital admissions or adverse drug events. Additionally, the studies reviewed gave little insight on when to best implement interventions—for example, whether it’s more effective to counsel patients once when they’re discharged from the hospital, whenever they are prescribed new drugs, or at scheduled times of the year regardless of whether their care has changed.
“We don’t know enough about the process to say what a best scenario for reducing inappropriate polypharmacy should look like,” Patterson said. “That’s where we need further research.”
Bradley Flansbaum, D.O., director of hospitalist services at Lenox Hill Hospital in New York City, agrees. He notes that most doctors would say they’re more interested in how changes in prescribing affect patients’ quality of life, something that these studies didn’t fully examine. Rather than look at whether patients are experiencing problems such as headaches or constipation from the drugs they’re on, he says, the studies instead used a checklist to measure potentially dangerous interactions. “Not to say that a checklist isn’t important, but do you want a proxy of what you’d like to measure, or to know about the adverse event itself?” he said.

More information: Patterson SM, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD008165. DOI: 10.1002/14651858.CD008165.pub2

Provided by Health Behavior News Service

Older adults can take medicines more safely and effectively by charting their daily routines

Collaborating with providers can foster problem-solving about dates, times, conditions, drug interactions

WASHINGTON, 10 sept 2008 — Older adults may be better able to comply with medication regimens by working with providers to fill out simple paper tables that track what they take and when they take it. Recent experiments found that use of a "medtable" may help to prevent medication-related problems. A report appears in the September issue of Journal of Experimental Psychology: Applied, published by the American Psychological Association.
As they age, people often take several different prescription medications. Yet about half of older adults are found to take medicine incorrectly and up to one in three of their hospital admissions is blamed on faulty medication use. Weak collaboration with health-care providers, along with cognitive problems and lower health literacy, are viewed as contributors.
Psychologists at the University of Illinois at Urbana-Champaign led by Daniel Morrow, PhD, found that when pairs of older adults filled out a written matrix listing medications and instructions by days and times to take them, they solved medication-related problems more efficiently and accurately, especially for the complex medication schedules increasingly common among older adults.
In Experiment 1, 96 participants averaging 69 years in age were randomly assigned to the role of patient or provider. These pairs were randomly assigned to use a pre-designed medtable, a blank piece of paper or no aid. To simulate real life, the researchers varied information about both medication and patient.
In a complex-medication condition, the researchers provided information about four medications commonly used by older adults (for example, for high blood pressure, high cholesterol and osteoporosis), including purpose, number of pills and times per day to take them, dose spacing, and special instructions or warnings. In a simple-medication condition, there were two medications with fewer constraints on when they could be taken together.
In a complex patient-information condition, patients were described as having a strict daily work routine that only let them take their medicine at lunchtime or after work. In a simple patient-information condition, there were no daily restrictions; patients could adjust wake-up times and meal times.
The "patient-provider" pairs completed four problems, one from each of the four conditions created by combining medication and patient complexity. The pairs had one minute to review each simple-medication problem and two minutes to review each complex-medication problem. The researchers told the pairs to share information verbally but not look at each other's information sheets.
Next, the pairs collaborated on schedules that reflected medication and patient constraints. To simulate the limited patient contact time in routine primary-care visits, collaborators had up to four minutes to work out simple medication problems and 10 minutes to work out complex problems. After they agreed on the schedule and filled out the matrices, patients described them to an experimenter (reported schedules were audiotaped for later scoring).
The researchers assessed problem-solving accuracy, completion time and efficiency. Accuracy was reflected by total points awarded for meeting medication requirements (name, number of pills, times/day, dose spacing, etc.). Problem-solving time started when provider and patient began talking and ended when patients said they were ready to describe the schedule (or until time was up). Efficiency divided solution time by accuracy, indicating the time needed to achieve the same level of accuracy across participants.
Compared to the no-aid condition, the use of both blank paper and the medtable increased collaborative problem-solving accuracy and efficiency while reducing subjective workload, primarily for the complex medication problems. Researchers noticed that participants found it hard to use that particular design of the medtable, probably because it was too rigid about meal times.
Experiment 2 included 64 older adults who also averaged 69 years old, but used a redesigned medtable and raised the maximum time for complex problems from 10 to 15 minutes. With these changes, the authors found that the medtable compared with blank paper supported significantly more accurate and efficient collaborative problem-solving. These benefits occurred primarily for the complex-schedule problems.
The medtable and blank paper may have made it easier to solve problems by reducing demands on working memory, with the medtable the more effective of the two because it was designed to support problem-solving processes. The authors said the medtable also may help by integrating provider knowledge of medicine with patient knowledge of daily routines.
The authors see this tool as most suitable for pharmacists or nurses who help chronically ill older adults manage complex medication regimens. They wrote that the medtable may also be suitable when time is less of a barrier, such as when nurses or caregivers work with older patients at home. In the future, electronic medtables could possibly expedite the updating of comprehensive medication lists. The authors wrote, "It would be important for patients to take home a copy of their medtable schedule to guide adherence."
The research team is investigating medtable use by pharmacists and nurses who work with patients with low health literacy, defined by the U.S. Dept. of Health and Human Services as "The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."
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Article: "External Support for Collaborative Problem Solving in a Simulated Provider/Patient Medication Scheduling Task," Daniel Morrow, PhD, Liza Raquel, MS, Angela Schriver, MS, Seth Redenbo, MS, David Rozovski, MS, and Gillian Weiss, BS; Journal of Experimental Psychology: Applied, Vol. 14, No. 3.
(Full text of the article is available from the APA Public Affairs Office and at http://www.apa.org/journals/releases/xap143288.pdf)