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Taking Control of Your Medicines: Vol. 1 No. 1

By Dr. Dorothy L. Smith
Patient Advocate, Expert in Safe Medication Use,
and Author of 23 Books for Consumers on How to Take Prescription Drugs.

This newsletter is being launched to address the tremendous need for consumers to better understand how to take their prescription medicines safely. Home medication errors made by patients are linked to hundreds of thousands of deaths a year and cost this country nearly $180 billion in extra medical treatments. Only when people know how to take control of their medicines can they receive the full benefit of their treatment.

Consumers Need Prescription Drug Information They Can Understand

I have always believed that the patient becomes one of the most important players on the health care team once a treatment has been prescribed. After the doctor has diagnosed the medical problem and the pharmacist has dispensed the prescription medicine, the power...and the responsibility...for taking that medicine is shifted to the patient!

Since no medication can ever be safe and effective UNLESS the patient takes it correctly, it is critical that consumers be given the information they need to carry out this responsibility wisely. We know that something is wrong somewhere when all the research statistics report that up to 50% of all prescription medicines are not being taken correctly. This often leads to unnecessary medical complications and health care costs shooting through the roof!

Many of these costs could be avoided if we were more effective at teaching patients how to take their medications correctly. And as the population ages, more and more people will be requiring prescription medicines. These unnecessary costs related to home medication errors are only going to increase.

I was recently invited to address the Drug Information Association and give my opinion on whether consumers can understand the information they receive about prescription medicines from magazines, the Internet, and the patient information materials they are given from their health care providers.

As I reviewed these materials, I found that the ones meeting patient's needs for practical, readable, and understandable information were few and far between. Also, it is very difficult for consumers to identify prescription medication information they can depend on.

One positive note is that a small but growing number of pharmaceutical companies are developing high quality, "patient-friendly" information called Patient Package Inserts for some of their prescription medicines. Not only are these Patient Package Inserts being written in language consumers can understand, but the information is also approved by the U.S. Food and Drug Administration. It's a good idea to ask your doctor or pharmacist if there is a Patient Package Insert for your medicine. It is certainly a source of information you can trust.

Patients have to make decisions about their medicines every day, but they can only make wise decisions if they have the right kind of information. For instance, they need to know what to do if a side effect occurs. Information on side effects needs to be presented in terms that a patient can recognize and understand. It's not enough to say that a medicine can cause a serious liver disease such as hepatitis. A patient needs to know how to recognize the warning symptoms. For example, if they become unusually tired, lose their appetite, have nausea or vomiting, develop a yellow color to the skin or eyes, or have dark-colored urine or pale stools, they should call their doctor.

When a person's health is at stake, they will do all they can to protect it. Each person decides if the benefits of the product are greater than the risks they are personally willing to take. Once consumers and patients receive information they can understand, they will be in a better position to ask questions and determine how to manage their medicines safely and wisely. Medicines will have the chance to work, as they should. Health care costs will go down. People will be healthier.

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Medicine Tip: Patients taking chewable vitamin C tablets should brush their teeth or rinse their mouth after each use. The ascorbic acid in the tablets can stick to the teeth and over time erode the enamel. One patient required 12 crowns after taking high doses of chewable vitamin C.
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STAGGERING COST OF HOME MEDICATION ERRORS:
THE OVERLOOKED COST IN PRESCRIPTION DRUG COVERAGE

Expanding prescription drug coverage for senior citizens is on everybody's mind these days. Everyone seems to be focused on the cost of buying the medicines. However, nobody seems to be addressing the exorbitant costs that result when patients do not know how to take their medicines correctly.

The cost to purchase a prescription medicine is minuscule when compared to the cost of treating the complications that result when people do not know how to take their medicine correctly.

  • In 2000, the estimated total cost to purchase all the prescription medicines in the United States was approximately $111 billion.
  • The estimated cost to treat the complications resulting from home medication errors totaled another $177 billion in extra medical treatments provided by doctors, hospitals, and nursing homes. On top of that, add in at least another $100 billion a year to cover employer costs resulting from absenteeism and loss of productivity from home medication errors. All together, this amounts to at least $277 billion in costs from home medication errors.
  • No dollar value can be put on the most important outcome--the loss in the patient's quality of life.

It doesn't make sense to spend $111 billion to purchase prescription medicines, and then spend an additional $177 billion in medical costs related to medication errors and at least $100 billion in lost productivity because patients were never given the information they needed to manage their treatment correctly.

Research shows that when patients are given the information they need to take a medication safely, home medication errors are cut in half and people have fewer side effects, fewer doctor visits, fewer hospital admissions É and a higher quality of life. Not only do patients get more benefit from their medicines, but health care costs go down!

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Medicine Tip: Patients with asthma should not carry their inhalers in their pockets. Some patients have required surgery because they inhaled coins that had gotten stuck in the inhaler.
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20 STEPS CONSUMERS CAN TAKE TO BE INFORMED ABOUT THEIR MEDICINES

Here are some practical tips I suggested during my presentation at the conference on "Safe Medical Treatments: Everyone Has A Role," sponsored by the U.S. Food and Drug Administration and the National Patient Safety Foundation:

1. Don't be afraid to ask questions!! The only way a person can make informed decisions and use medicines safely is to know what information is important to obtain from health professionals, how to incorporate the medicine into your daily lifestyle, how to manage side effects, when to seek medical help and how to keep track of important information for the doctor and pharmacist.

2. Ask your doctor WHY you need the medicine being prescribed and how it is going to help you. Discuss any concerns you have about taking the medicine so that you have all the information you need to decide whether you want to take it. If you do not want to take the medicine, discuss this with your doctor so that a treatment more acceptable to you can be prescribed.

3. Ask your doctor or pharmacist if there is an FDA-approved Patient Package Insert (PPI) for the medicine you are taking.

4. Since the average person forgets 50% of what the doctor tells them by the time they arrive at the pharmacy, ask the pharmacist to go over all the instructions again.

5. If you would feel more comfortable speaking with the pharmacist in a private area, ask for it. More and more pharmacies have private counseling areas to ensure confidentiality and better learning.

6. Ask the pharmacist to show you the actual medicine so that you know which medicine is used to treat which symptom(s).

7. Many people stop taking a medicine because they think they are allergic to it. Actually they may have had a minor side effect. Some allergic reactions can be very serious and require immediate medical treatment. If you have any questions about whether a symptom is an allergy or a side effect, always ask your doctor and pharmacist.

8. Be sure you know how to administer the medicine correctly. Some medicines, such as inhalers to treat asthma, require complicated steps. Your doctor and pharmacist can show you the steps to follow when using an inhaler so that the medicine will reach your lungs and not get sprayed on the back of your throat where it will not work. You may want to ask the pharmacist to let you practice using the inhaler in the pharmacy.

9. A prescription label that states "Take 1 tablet 3 times a day" does not give you enough information. Ask your doctor or pharmacist to help you determine the best times to take the medication so you can easily work the dosage schedule into your daily activities, meal times and work. You will find it easier to remember to take your medicine if it fits in with your normal lifestyle.

10. Try not to adjust your medicine or skip doses without discussing this first with your doctor or pharmacist. Some medicines can have very serious side effects if they are stopped suddenly.

11. Many prescription medicines can interact with each other as well as with over-the-counter products and herbal remedies. Your doctor and pharmacist should review all of your medicines at each visit and make sure that you are not taking any prescription medicines that can interact. It is important that you tell them if you are self-treating with any over-the-counter product or herbal remedies. Even better, ask them before you start self-treating!

12. If you receive written instructions that just list side effects that could occur, ask for more information. You need to know how to recognize the early symptoms of common side effects and how to manage side effects that may be annoying but are minor. You also need to know when you should contact your doctor because of a side effect. If you do not understand a medical term, do not be embarrassed to ask what that term means. Keep asking until you understand it!

13. If you think you are having a side effect and don't know what to do, call your doctor or pharmacist. You also need to tell them if you have done anything to try to treat it -- such as skipping a dose, stopping the medicine, or taking an over-the-counter or herbal remedy. This information is important for them to include in both your medical and pharmacy records.

14. Some people find it helpful to keep a "medicine diary" they can take with them to their next doctor and pharmacy visit. This diary can help you remember important information to tell your doctor so the doctor can decide if you really had a side effect or if the symptom may have been caused by something else. Your diary can also help remind you of important questions you want to ask.

15. Some medicines must be stored away from heat, light or moisture in order to keep their strength. Transdermal patches should not be thrown away where children can find them and put them on like Band-Aids. If you are traveling in a car during hot weather, don't store your medicines in the glove compartment of the car. The heat can destroy the medicine and it may not work.

16. Select your pharmacist with the same care that you select your doctor. You want a pharmacist who will take the time to counsel you at every visit and answer your questions.

17. You should expect to receive written information from the pharmacy that you can take home. Keep this written information in a handy place where you can find it if you need it. However, the written instructions should NEVER take the place of personal counseling. You need your questions answered so you can manage your medicines safely!

18. Find out how many days in advance you should order your refills. Ask your pharmacist to develop a program to help remind you to get your refills.

19. If you are having trouble remembering to take your medicine, it is important to let your doctor know this. Otherwise, your doctor may think that the medicine is not working and may prescribe another medicine that is less effective or has more side effects. All that really may be needed is to work out a more convenient dosage schedule for you.

20. Be sure at each pharmacy visit to tell the pharmacist if you have had any problems with any of your medicines. Your pharmacist can often provide helpful advice.

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Medicine Tip: Do you know which direction to pull the ear when administering eardrops? For children younger than 3 years, pull the top of the ear down and back. For children over 3 years and adults, pull the ear up and back. This helps straighten the ear canal so that the drops can reach the eardrum.
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Dr. Dorothy L. Smith is an internationally recognized expert in patient education, patient compliance, and behavior modification programs. She has devoted her career to helping people make informed decisions about health care and use of medications. Dr. Smith is the author of 23 books and has appeared on radio and television programs across the country to increase awareness of the important role consumers play in their prescription drug therapy. In 1983, she founded Consumer Health Information Corporation, a company internationally recognized for its innovative patient information programs. The organization has produced a broad range of print and audiovisual programs that have helped millions of people learn to make wise decisions about their health and medications.

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