Article from the Boston Globe’s On Call Magazine, February 2003

By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting

Helping patients understand their medications, whether they are prescription or over-the-counter drugs, is an integral part of healthcare. When medications work well, patients often feel better for taking them. But sometimes medications make patients feel worse. This can be a result of adverse drug interactions or unwanted side effects. But it can also happen simply because a patient does not understand or follow the instructions that come with the medications.

Mr. Green is a 46-year-old man with a long history of acid reflux and a recent history of muscle spasms. As a result, he now takes two prescription medications — an antacid for his stomach and a muscle relaxant for his back. When Mr. Green came into the pharmacy recently for his monthly refill, he told the pharmacist that he was feeling very tired and asked for some multivitamins to help him feel better. However, rather than simply pointing to an over-the-counter medication, the pharmacist asked more about Mr. Green’s symptoms. Based on the answers to those questions, he was able to call Mr. Green’s physician and let her know that the interaction between the two prescribed medications he was taking might be causing Mr. Green’s sense of fatigue. After the physician changed one of Mr. Green’s medications, within a month Mr. Green told the pharmacists he felt much better.

According to Jake Nichols, PharmD, assistant professor of pharmacy practice at the Massachusetts College of Pharmacy and Health Sciences in Boston, pharmacists have a major role to play in ensuring that patients like Mr. Green take their medications safely and correctly. They can alert prescribers (physicians, nurse practitioners, and physician assistants) to adverse drug interactions. They can counsel patients about the side effects of their medications. And they are also ideally situated to know if patients are overusing (taking too many) or underusing (not taking enough of) their medications, since most prescriptions are refilled monthly. Care is improved, Nichols points out, when, in cases like Mr. Green’s, pharmacists collaborate with both prescribers and patients. Such collaboration, studies show, can reduce treatment costs and improve health outcomes.

While this type of collaboration is common in hospital settings, says Nichols, it occurs less often in outpatient settings. Nichols wants to encourage all pharmacists, prescribers, and patients to consistently work together in all patient-care settings for safe and correct medication use. He recently shared some suggestions for ways pharmacists can help make this collaboration standard procedure.

Be alert to drug interactions. Medications, both prescribed and over-the-counter, can interact with one another in unwanted ways. These interactions can range from clinically insignificant ones that cause no physical harm to those that may even be life-threatening. Sometimes, as in the case of Mr. Green, drug interactions can interfere with a person’s quality of life. Prescribers aren’t always aware of potential interactions between the drugs they prescribe. And in some cases, they may not even be aware of all the drugs a patient is taking, especially if the patient is under the care of more than one provider. When you identify the fact that a patient is at risk for a possible adverse drug interaction, let prescribers know. Tell them about alternative medications and inform them about tests to monitor safe use.

Highlight common side effects. Patients need to know about the potential side effects from their medications and what to do if they occur. Package inserts aren’t written for patients. The intended audience for these materials are physicians, government regulators, and pharmacists. Patients often find them hard or even impossible to read because of small print, unfamiliar words, and an overwhelming amount of information. For example, a package insert may mention as many as 20 to 75 possible side effects. To help patients understand what they need to know, Nichols recommends talking with them about the two or three most common side effects.

Make an effort to spot potential problems patients may face. Talk with patients about their medications. Start by asking questions such as:

• Have you started on any other medications in the last few weeks?
• Are you taking any over-the-counter drugs, herbals, or vitamins?
• Have you noticed any difference since you’ve been taking this medication?

Educate patients about OTC medications. Patients shouldn’t think that just because a drug can be purchased over the counter without a prescription it is safe, says Nichols. Let patients know that even OTC medications can have unwanted side effects, can cause adverse drug interactions, and are contraindicated for people with certain medical conditions.

Talk with patients about direct-to-consumer (DTC) advertising. Television, radio, and magazines today have many DTC advertisements for brand-name medications. Patients may ask for a specific drug by name and be disappointed if they cannot get it — either because the drug is not indicated for their condition or their insurance will not pay for it. You can turn this negative experience into a positive one by talking with patients about their symptoms and explaining concepts such as “formulary” and “generic medication” in terms they can understand.

Encourage patients to learn about their insurance benefits. A large part of each pharmacist’s day is spent dealing with insurance issues, says Nichols. Encourage patients, especially those with new insurance policies or benefits plans, to find out the following:

• What drugs their insurance company will, and will not, pay for
• Whether their insurance company has different co-pays for generic and brand-name drugs
• Where, and how often, to refill medications

Teach in ways patients can comprehend. Consider each patient’s specific learning needs when talking about medication:

• Use words patients understand. Be aware of the jargon you are using, like the term “third party payer.” While familiar to you, this term may be unknown to the patient. If the patient looks puzzled, use a more familiar term such as “insurance company.”
• Use an interpreter. When you and a patient speak different languages, it is very difficult to assess whether he or she knows how to take a medication correctly. Just asking “Do you understand?” is not sufficient. The patient may simply nod and smile. In cases like this, Nichols recommends using interpreters to make sure information is truly understood.
• Offer user-friendly products. People with limited vision, memory, or dexterity may benefit from user-friendly products. For example, patients with both diabetes and limited vision may appreciate glucose monitors that have large visual displays. People who are forgetful or easily confused may do well with medication calendars or pill boxes. And people who have difficulty opening child-proof bottles or blister packs may have an easier time when their medication is repackaged in other containers.

Let patients know they can talk with you. Pharmacists are trained to educate and counsel patients about the safe use of medication, says Nichols. He encourages patients to talk with their pharmacists and take advantage of patient care centers in their local drugstores. Just like Mr. Green, everyone benefits when pharmacists make the effort to communicate with patients.

How to Learn More

Jake Nichols, PharmD, is an assistant professor of pharmacy practice at the Massachusetts College of Pharmacy and Health Sciences in Boston. For answers to your questions, and to learn more about careers in pharmacy, you can contact him at jake.nichols@att.net

The U.S. Food and Drug Administration’s Center for Drug Evaluation and Research Web site can be found at www.fda.gov/cder/index.html. This Web site has drug information for both consumers and healthcare providers.