Connecting technology and safe drug use among geriatric patients

Up to 76% of older adults deviate from approved medication regimens, leading to medicine-related problems (MRP). Currently, more than 32,000 elders suffer from hip fractures secondary to MRP.

With greater demand for comprehensive, yet timesaving monitoring of medication use among adults, healthcare providers are relying on technology-based devices as more efficient solutions to healthcare management in hospitals and various ambulatory settings. In exploring the use of advanced technology in healthcare management as it relates to creating safer medication use in seniors, the Peter Lamy Center on Drug Therapy & Aging of the School of Pharmacy, University of Maryland, in collaboration with the National Council on Patient Information and Education, recently hosted a conference in Bethesda, Md. This is a conference held annually by the school.

According to Carolyn Clancy, acting director of the Agency for Healthcare Research and Quality, unsafe medication use–which currently accounts for more than $104 billion in direct cost to the healthcare industry–is a silent epidemic that generally results in MRPs. Unsafe medication use involves any act of divergence from an agreed schedule between a provider and a patient, such as ingesting drugs in doses other than those approved, using other peoples’ medications, and receiving multiple prescriptions for the same ailment.

Coexisting alcohol problems have also been linked to medication misuse. Some patients combine alcohol and prescription drugs for sleep, pain, and anxiety, unknowingly increasing their chances of adverse drug events. Stephen Bartels, associate professor of psychiatry at Dartmouth Medical School, related that alcohol misuse currently affects up to 19% of older American adults leading to increased morbidity, disability, and mortality. More than 15% of older alcoholics are also dependent on other drugs.

Bartels recommended that people over 60 should be screened for alcohol and prescription drug abuse as part of a regular physical examination and for the purpose of an alcohol intervention program. Older adults should be advised not to exceed one standard drink per day, with quantities even lower in females.

Various speakers offered recommendations for unsafe medication use intervention, including identifying at-risk patients for greater monitoring, educating patients on their disease and drugs, creating medication use plans, anticipating and correcting for missed doses, informing patients of the consequences of inappropriate use of drugs, and offering alternatives to unsafe medication uses.

Increased counseling about therapy and disease will significantly reduce hospitalizations. However, according to a recent survey conducted by the FDA, only about 14% of pharmacists and 24% of prescribers provide verbal counseling to patients about the appropriate use and potential risks of medications. A program developed by the FDA–Healthy People 2010–has as a goal to increase the levels to 95% by 2010.

According to Nancy Smith, director of the Office of Training & Communications, Center for Drug Evaluation & Research, FDA, Healthy People 2010 also focuses on integrating technology with health management. That will be accomplished by "increasing the use of linked automated systems to share information" and "increasing the proportion of healthcare organizations linked in an integrated system that monitors and reports adverse events."

The conference also highlighted the shifting focus toward technology for many clinical solutions. Many healthcare providers now rely on devices such as handheld personal digital assistants and Web technology as therapeutic and adverse reaction monitoring aids. Stephen Feldman, president-elect of the American Society of Consultant Pharmacists, said that vast selections of software programs are available to offer more efficient solutions to management. Many clinical pharmacy programs can track and monitor medication use for drugs such as antidepressants, cholinesterase inhibitors, antipsychotics, and anticoagulants. This eliminates rigorous calculations and provides instant individualized results for quicker interventions in cases of medication misuse.

James Bradley, CEO of RxHub, noted that there is a growing need for advanced technology-based clinical practice due to an increasing number of prescriptions and continuing pharmacy shortage (8,500 unfilled openings in 2002). The number of prescriptions has increased by more than 50% from 1992 (about two billion) to 2000 (2.9 billion) and is estimated to go up to more than four billion in 2005.

Bradley acknowledged that a reliance on high technology in one network to connect all providers and patients would reduce medication errors and costs while still maintaining quality of patient care.

Adaeze Atuegwu, Pharm.D., B.Sc.

The author is a writer in the Washington, D.C., area.

Adaeze Atuegwu. Connecting technology and safe drug use among geriatric patients.

Drug Topics

2003;2.