With Complex Prescription Routines, Fewer Filled

Patients on heart drugs are less likely to fill their prescriptions if they have to make more trips to a pharmacy or have multiple doctors prescribing them drugs, according to a new study.

"The problem of complexity has just increased over the years as Americans are prescribed more and more medication," Dr. Sunil Kripalani of Vanderbilt University, who wrote a commentary accompanying the study, told Reuters Health.

While the finding is not surprising, it highlights the importance of doctors and patients discussing the best way to simplify each patient's medication regimen, the authors report in Archives of Internal Medicine.

It also shows that health insurers and pharmacies can do a better job of making things simpler for patients, they added.

Dr. Niteesh Choudhry of Brigham and Women's Hospital and Harvard Medical School and his colleagues analyzed a database of about 2.5 million patients who were prescribed a heart medication, including cholesterol-fighting stations, in 2006 and 2007.

For three months, the authors tracked each of those patients to see how many medications they were prescribed -- both for heart disease and other conditions -- as well as how many doctors prescribed their medications, how many pharmacies they used to fill those medications, and how often they visited a pharmacy.

Next, the researchers kept track of how frequently those patients filled their heart medication prescriptions over the following year.

Over those first three months, patients filled an average of eleven prescriptions for six different medications, and made five visits to a pharmacy. And during the following year, they filled an average of two-thirds of their heart drug prescriptions.

Patients who had to make more pharmacy visits and fill prescriptions from more doctors were less likely to get their heart drugs filled.

However, patients who were taking more medications actually appeared to be better about filling their heart drugs that those taking fewer -- especially when they could fill all of their prescriptions during just a few pharmacy visits.

It's not completely clear why that is, Kripalani said. However, he added, "my own suspicion is that the people who end up being prescribed more medications have little choice but to develop mechanisms for managing those medications (and they) integrate them more into their daily lives."

To show just how complicated some patients' medication routines can get, the authors reported that the 10 percent of patients with the most complex routines filled 23 or more prescriptions over the three months and made eleven or more pharmacy visits. They also had at least four doctors prescribing them medication.

Simplifying Routines
While there's no proof that helping patients consolidate their prescriptions means they will be better about filling them, Kripalani said that it was "reasonable for health care providers to recommend that patients try to simplify and streamline their prescription filling practices as much as possible," as suggested by the researchers.

However, "this is a tough problem for doctors to solve themselves," Choudhry told Reuters Health. He said the study was a "call to action" for pharmacies and health insurance companies, who may be able to make a bigger difference in simplifying patients' medication routines.

And with more people being able to pay for their medications under health care reform, and many of them having to manage multiple prescriptions, "it means that the issues that we highlight might actually become more and more relevant," he said.

Prescribing in the Hospital 
Having a better handle on patients' medications may also help hospitals make fewer errors when they are admitted and need a change in those drugs.

Another research letter from the same issue of Archives of Internal Medicine found that when a Veterans Affairs medical center began phasing in a computerized tool that displayed what medications patients were currently taking or had taken recently, those patients had fewer drug-related complications due to hospital doctors' prescribing errors.

The "medication reconciliation" process also involved talking to the patient, or calling their pharmacy or doctor's office to get a more complete picture of drug use, said Dr. Kenneth Boockvar, the study's lead author from the James J. Peters VA Medical Center in Bronx, New York.

Drugs that patients are taking long-term are especially important to keep tabs on, he said.

Patients "often have medications they're taking at home," Boockvar told Reuters Health, and doctors have to determine "what those medications are, whether the patients are adherent or take the medications as prescribed, if they don't, why they don't take those medications as prescribed."

He said that as these systems get implemented more fully and doctors get on board, drug-related complications -- whether or not they are caused by errors -- should decline.