Across the nation, the inability of patients to properly follow their medication regimens is a major issue. The cause can be anything from difficult financial circumstances to lack of knowledge about certain medications and/or their illnesses.
At the University of Rhode Island’s College of Pharmacy, Pharmacy Outreach Program Coordinators Nancy J. Tortolani and Noemi Ramos-DeSimone said the solution to problems with medication compliance is education.
“We travel throughout Rhode Island anywhere from Westerly to Woonsocket visiting senior centers, senior housing, and community centers,” Ramos-DeSimone said. In 2009, the program completed 216 presentations for 3,381 individuals. It also offered 13 health fairs that had 1,045 participants.
“Right now the economy makes it difficult,” Tortolani said. “People do not have the money to spend on all of their medical expenses and they may be unaware of the harm they can cause themselves. For some, even the co-pays are too much, and people on fixed incomes do not have the extra money to spend.”
The two coordinators said a patient who tries to save money by skipping a day of their medication or by cutting their pills in two may actually cost themselves and society more money. An untreated or improperly treated condition can often lead to expensive hospitalizations and follow-up treatments, they said.
All outreach services, including URI’s Medication Information Line at 1-800-215-9001, are free and open to all Rhode Island residents. Patients who cannot afford their prescriptions can call this number for help. Staffed by pharmacists, this confidential service provides Rhode Islanders with answers concerning medications, drug therapy, and health issues. A list of all the outreach services can be found at http://www.uri.edu/pharmacy/outreach/.
“Besides money issues, people may misuse medications because they are not fully educated about their disease state,” Tortolani said. “They may not believe they have a certain diagnosis, people may not remember to take their medicines every day, or they believe that they’re cured. They’ll say, ‘My cholesterol is better or my blood pressure is lower, so I don’t have to take my medicine anymore.’ It’s our job to say ‘Yes, you are better, but that’s because of the medications that you are currently taking.’”
The statewide-traveling resource program offers educational presentations, counseling, and provides resource information. URI pharmacy teams visit different senior centers, senior housing community centers, and those for people with disabilities and the needy to discuss medication questions and concerns.
The pharmacists and sixth-year pharmacy students involved in the program educate people at all different levels. Ramos-DeSimone was a consultant with the program for three years before she was hired full time in the spring. “Our goal is to expand The Pharmacy Outreach Program to Rhode Island’s Spanish-speaking population. We understand that language and cultural beliefs are a huge barrier for medication compliance. We are aiming to educate and empower this population to fully take advantage of the health care services available to them.”
“Many of the people that we counsel through the Outreach Program are not computer literate. They don’t know ways to access medication information, and they aren’t familiar with the fact that within a therapeutic class of medications, there may be an alternative drug that is available as a generic, and therefore less costly. We help them understand that they can get a medication that works the same for less money. Educating our seniors about therapeutic drug substitution is a huge part of our Brown Bag program,” Tortolani said.
The Brown Bag initiative, from which all of the pharmacy college’s outreach programs originated, provides patients with further explanations of the medications that they are taking. As a result, the participants have seen an increase in medical compliance. Patients bring all of their medications in a brown bag, including prescription, over-the-counter and herbals, to their senior center or common areas of their residential complexes. Pharmacists and pharmacy students then review every medication, discuss the purpose of the medication, any side effects, how to organize their medications, if they can afford them, and also answer any other questions the participant may have.
“Many seniors are on multiple prescriptions and over-the-counter medicines and supplements. There are adverse effects of under- or over-treating yourself and everything can be harmful if not used correctly,” Tortolani said.
Tortolani and Ramos-DeSimone agreed that pain medications and sedative sleeping aides are the most commonly misused drugs.
“There are unspecified guidelines for pain management. Doctors differ in their instructions and most seniors are on some type of pain medication for arthritis. They need to know proper drug use in addition to the other medications that they already take,” Tortolani said.
As Tortolani explained, education is the best way to help patients comply with medication instructions. “We’re trying to keep people compliant with their medical regimens. We find out why someone isn’t compliant and serve as a resource center to support them.”