Polypharmacy—the use of multiple drugs to treat a single or several medical issues—is a growing concern for Medicare beneficiaries. According to the Centers for Disease Control and Prevention (CDC), 82 percent of American adults take at least one medication, and 29 percent take five or more. Additionally, adverse drug events (ADEs) cause more than one million emergency department visits and 280,000 hospitalizations each year.
Prescription medications are effective at treating acute symptoms of disease; however, there are few drugs that are completely free of risks or side effects.
Patient advocate Bill Gossard has experienced the burden—and sometimes harm—that multiple medications can place on patients and their families. Gossard’s wife Helen took 18 medications every day toward the end of her life, and four different physicians prescribed those medications.
Over time, the process by which Gossard administered doses to his wife grew increasingly complex. He took it upon himself to ensure that his wife was taking the right pill at the right time, but during this process, he started to wonder if all of the doses were truly necessary.
“I made a spreadsheet listing the prescriptions, the reasons for taking them, amounts, times, manner and any allergies or reactions. It got to where the list was really essential,” Gossard said. “You kind of needed the list to make sure you were filling the medication dispenser correctly. Then it got to the point where you had to check off the pills to make sure you didn’t forget.”
By constructing a list for his own personal reference and sharing it with doctors, he created a holistic view of his wife’s medication regimen. He found that prescribing professionals would review the list and note that some of the drugs had the potential to counteract and cause issues when taken together.
“I think the patient needs to become as knowledgeable as possible about their medications,” Gossard said. “Know what, why, how and when to take your medications. Be alert to the regimen and reactions. Each person is an individual. We may have different effects from the same drug. Ask questions.”
Inspired by Gossard’s story, atom Alliance—the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Alabama, Indiana, Kentucky, Mississippi and Tennessee—initiated a project early in 2016 to address the threat posed by overprescribing.
An initial step was to consult with atom Alliance’s Patient & Family Advisory Council, consisting of 13 individuals from a variety of health care backgrounds. They confirmed that the Gossards’ story was not uncommon among older adults. The council identified a need to empower beneficiaries to have discussions with their physicians and determine the appropriateness of all medicines being taken.
“[A] patient needs to become as knowledgeable as possible about their medications…Know what, why, how and when to take [them].”
atom Alliance developed a patient-friendly tool based on the Medication Regimen Complexity Index (MRCI), a measure that can help identify the likelihood of an ADE or hospital readmission based on a given patient’s medication list. The tool aims to translate the clinical use of evidence-based MRCI measurement into a tool that patients can easily access. To date, atom Alliance’s MRCI tool has undergone two rounds of beneficiary testing, with a third round of testing currently underway.
Data collected from the MRCI tool will inform atom Alliance’s network-wide initiative to reduce overprescribing and adverse drug events by connecting regional providers to beneficiaries interested in reducing unnecessary polypharmacy.
Gossard continues to advocate for patient safety as a member of atom Alliance’s Patient & Family Advisory Council.