Helping patients orchestrate their medications for maximum simplicity and efficacy

Abstract

Objective: This study aimed to: (1) analyze prior patient experience and desire for dose administration assistance and (2) evaluate an intervention service's impact on patient regimen schedule simplicity, potential for optimum drug efficacy, and risk of adverse drug toxicity. Methods: A pre-post design was used to evaluate the impact of a community pharmacy service assignment for 132 fourth-year doctor of pharmacy (PharmD) students with 210 patients during advanced pharmacy practice experience (APPE) rotations in community pharmacies. The assignment required each student to optimize the daily timing of medication doses for two patients with ≥5 prescription medications. A structured grid was used to record medication timing before and after the student-pharmacist consultation. The PharmD students wrote out the patient's baseline and revised medication schedules by time of day. The students also interviewed patients about their desire and experience with dose administration consults. Results: A dose administration consultation was provided for 210 patients. The average number of medications per patient was 12.26. Dose administration consult results were: 82% of patients said no health professional has ever written out when to take all of their medications; 82% of patients wanted an easier administration schedule; only 14% of patients were taking medications 1-2 times per day prior to student intervention and 25% after student intervention. Students responded that they improved potential drug efficacy for 75% of the patients and reduced the risk of adverse events for 57% of the patients. Conclusion: In the chronic care model, the patient's self-efficacy and ability to manage complex medication regimens is central. However, clinicians rarely help patients orchestrate dose administration of the regimen as a whole for maximum simplicity and efficacy. Students reviewing patient medication administration times were able to maximize dosing times and potentially improve drug efficacy.