Jennifer Chen, PharmD, BCPS

Older adults, generally defined as those 65 years or older, are projected to account for a quarter of the US population in the coming years and represent the fastest-growing age group in America.

Pharmacists and pharmacy technicians are well known as some of the most accessible and frequently visited members of the health care industry.

 Evidence suggests pharmacists interact with patients up to 10 times more frequently than primary care physicians.

 With the continued expansion of the older adult population, pharmacists and technicians have the opportunity to play a major role in addressing their health care and medication-related needs. Some of these include medication discrepancies occurring during transitions of care, polypharmacy and the need to deprescribe, and promotion of greater self-efficacy through medication self-management, particularly for those who lack effective social support structures.

Older adults often face multiple chronic health conditions, which increases the likelihood of polypharmacy.

 Polypharmacy, or the concurrent use of multiple chronic medications, has been widely linked to negative health outcomes.

 A survey of 2206 community-dwelling adults of ages
62 to 85 years was conducted by in-home interviews and use of medication logs between 2010 and 2011. At least 1 prescription medication was used by 87% of participants. Five or more prescription medications were used
by 36%, and 38% used OTC medications. Polypharmacy may contribute
to an increase in drug-drug interactions, inappropriate combinations of medications, issues with medication adherence, and prescribing cascades. Technicians in all settings may help identify patients with polypharmacy who may benefit from a comprehensive medication review by their pharmacists. Pharmacists may then conduct a polypharmacy-targeted medication review and make recommendations for deprescribing to the patient’s primary care physician. Deprescribing involves evidence-based systematic decisions in reducing unneeded medications that might contribute to deleterious health outcomes, rather than promoting positive ones.

Older adults are also more than twice as likely to require hospitalization compared with middle-aged adults,

 which not only increases the risk of polypharmacy and medication errors. Transition points in care represent moments of increased risk for medication discrepancies and miscommunication. Seamless transitions of care are especially vital for multimorbidity older adults, who are cared for by multiple specialty providers, seen more frequently in the hospital setting, and often have complex medication regimens.

 Medication reconciliation, a pharmacy-driven process, plays a key step in the identification of medication discrepancies and polypharmacy. Evidence has shown that trained technicians can obtain medication histories with accuracy and completeness.

 A retrospective chart review conducted at a university hospital in New Jersey assessed 200 in-patients who received a technician medication history of prior-to-admission medications, followed by medication reconciliation of electronic health record (EHR) by a pharmacist.

 Medication history–taking conducted by technicians included a brief interview of medication history with the caregiver or patient, which was then verified against objective data, such as prescribing data, prescription refill history, and prescription vials. Overall, 325 total medication discrepancies were identified, with medication omission the most frequently observed (64.7%). This study demonstrated the utility of incorporating technicians into medication reconciliation programs.

In the community setting, there are additional measures that technicians can take to protect older adult patients. If feasible, technicians may encourage periodic so-called brown-bag checkups. They can instruct patients to bring
in all their medications and among other things, check the expiration dates of these drugs. During these reviews, home medications brought in by patients may also be matched to their profiles in the EHR. This process can help identify patients who have medication discrepancies and use multiple pharmacies. A review of each patient’s refill history may also shed light on medication adherence. Available methods to encourage adherence include having patients opt into automatic refills, providing medication charts, and using medication organizers. Because older adults tend to have multiple specialty providers, technicians may also encourage patients to transfer all their prescriptions to 1 health system or pharmacy, as this helps maintain an accurate and updated list of all outpatient medications prescribed to the patient. Finally, cognitive decline is highly prevalent among older adults and has been associated with poor medication self-management skills.

 Technicians play a pivotal role in ensuring that patients leave the pharmacy with adequate resources for successful medication self-management.
This may include printed prescribing information, ensuring patient materials are printed in legible font size, and verbal communication of medication changes to patients and their caregivers.

Technicians are a valuable resource for health systems and play a key role in working with older adult patients to reduce medication errors. In transitions of care, highly trained technicians can positively affect the workflow by conducting medication reconciliation upon admission. This process helps identify discrepancies in medication history and medication list and also identifies patients with polypharmacy. In the community setting, technicians interact with patients more frequently than pharmacists do, which make them the ideal candidates for recognizing difficulties with medication adherence.

 Proactively reviewing patients’ electronic records for dispensing history may help identify patients struggling with medication adherence and reveal an opportunity for technicians to alert and collaborate with pharmacists to share effective medication adherence strategies. Finally, communication of medication changes often falls on technicians when prescriptions are picked up. Ensuring clear, patient-friendly communication maintains an environment of trust and reduces medication errors. Trust is especially important especially for patient outcomes, but it also helps promote customer loyalty.

 candidate at Touro University California College of Pharmacy in Vallejo.

, is a clinical pharmacy practitioner at VA Northern California Health Care System in Sacramento.

, is a professor of social, behavioral pharmacy, and administrative sciences at Touro University California College of Pharmacy in Vallejo.

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Articles

Areas of focus include drug discrepancies during transitions of care, polypharmacy, and promotion of self-management.