Medication advantage derived from one-on-one pharmacist-patient counseling

After spending nearly an hour talking one-on-one with a pharmacist, participants in a new study reported using fewer medications and having far fewer drug-related problems.

Instead of having the subjects come to a pharmacy, the pharmacists came to the participants' churches.

Holding the one-on-one discussions at churches allowed people to come to an "emotionally safe, familiar and private environment, instead of the sometimes chaotic setting of a doctor's office or pharmacy," said Gerald Cable, a study co-author and a clinical assistant professor of pharmacy.

"We weren't surprised at the extent of correctable medication problems we found," he said. "However, we were surprised that the participants were so willing to talk with us about these problems."

As part of Gerald Cable's study, pharmacists and patients met in churches for discussions about medications.   By Kevin Fitzsimons

More than half of the participants had kept medication past its expiration date, and nearly half reported that they had experienced adverse drug reactions.

But the intervention sessions seemed to help, as subjects reported using less medication during the six months after the one-on-one meeting than in the six months prior to the session.

"We hope that's a reflection of increased communication between the study participants and their physicians," Cable said. "While we didn't tell the subjects to stop taking their medications, we did suggest that they talk more with their physicians.

"A vital part of medication education is communication between health care practitioners and patients. People always have questions. They want reassurance and accurate information from somebody they can trust."

The study appears in a recent issue of the American Journal of Health-System Pharmacy.

The study involved 187 participants from 20 churches of various denominations in central Ohio. Cable and his colleagues asked the parish nurse at each church to recruit volunteers. Parish nursing is a relatively new -- and growing -- field, one that encompasses spiritual well-being along with physical health.

The study participants met with pharmacists or pharmacy interns -- the latter were student pharmacists -- for an hour-long "brown bag" session. The subjects spent the first 20 minutes of the hour in a group listening to a nurse talk about the perils of taking medication incorrectly as well as the benefits of taking an active role in their health care decisions and outcomes.

Each subject spent the remaining time talking with a pharmacist or pharmacy intern. Prior to each session, participants were given a list indicating the types of medications to bring -- including prescription and nonprescription drugs, vitamins and alternative remedies. Participants were also given a standard brown paper grocery bag in which to carry their medications.

"We wanted to capture the things people don't normally think of as drugs, such as herbs, vitamins and creams," Cable said. "We were looking for outdated medications, duplicates and drugs that could potentially interact with other drugs."

The researchers also gave each subject a questionnaire to fill out before talking with the pharmacist. The forms asked if the participants had any questions about or current problems with their medication regimen; how many times they had visited a physician, a pharmacy or an emergency department or if they had been admitted to a hospital in the past six months; how many drugs they took and how they took those drugs; and also how often they talked with a pharmacist about their medication regimen.

The subject and pharmacist discussed potentially adverse reactions and interactions, medication storage problems and which drugs should have been discarded.

The participants' average age was 70. They took an average of 5.3 medications daily, and brought an average of 10.8 drugs for review. More than half (51 percent) had medications that should have been thrown out, 49 percent reported adverse drug reactions, 29 percent reported drug interactions and 23 percent discovered that they were storing medications improperly.

The parish nurse at each participating church administered a six-month follow-up questionnaire by telephone or in person.

The subjects reported taking fewer medications on a daily basis than they had in the six months before the one-on-one session (4.8 vs. 5.5 medications). The volunteers also had fewer medication-related problems (39 vs. 98 problems).

The opportunity to interact with a pharmacist in a trusted environment also seemed to make participants a bit savvier about their medication regimen -- 44 percent said they had sought more drug information since participating in the program. At the six-month follow-up, 67 percent of these subjects said that they had asked a physician for more information on a particular drug and 72 percent reported feeling more comfortable asking for information. More participants reported talking with their physician, nurse or pharmacist about their medications after the program than before (79 percent vs. 62 percent).

The statistics for using medication incorrectly are grim, according to a variety of studies: Each year in the United States, one out of six hospital admissions, one out of four nursing home admissions, one-quarter of all malpractice lawsuits, one-half of all medication failures and 2.5 million medical emergencies are attributable to incorrect medication use.

Part of the problem, Cable said, is that many patients simply don't know what questions to ask or may feel too intimidated to ask.

"We weren't out to change doctors' orders with this program," Cable said. "We did encourage participants to establish an open dialogue with their pharmacists and doctors and to see them as an advocate."

In 2000, prescription drug-related errors cost more than $177 billion in the United States. Successful medication education could cut this cost by 25 percent, according to a non-Ohio State study.

Part of the reason that drug-related errors cost so much is that more than half of all prescriptions dispensed in the United States are taken incorrectly, Cable said.

While the research is complete, Cable is continuing the brown-bag program in central Ohio. "There are several such new partnerships around the country, mostly on a voluntary basis," he said. "We hope in the future this service becomes part of regular pharmacy practice."

The research was supported by the American Society of Health-System Pharmacists' research and education foundation and by the Pfizer Corp.

Cable co-authored the study with Jon Schommer, associate professor of pharmacy at the University of Minnesota; Sandra Byers, study project director; Linda Pape, parish nurse coordinator at Riverside Methodist Hospital in Columbus; Marcia Worley of the University of New Mexico; and Thomas Sherrin of OhioHealth in Columbus.

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