How can you manage complex medication regimens more effectively?

Many case managers face the challenge of helping their clients adhere to complex medication regimens, which may involve multiple drugs, doses, schedules, and instructions. Poor medication management can lead to adverse effects, reduced effectiveness, increased costs, and lower quality of life. How can you manage complex medication regimens more effectively? Here are some tips and strategies to consider.

1 Assess the client's needs

The first step is to assess the client's needs, preferences, and barriers to medication adherence. You can use tools such as the Medication Adherence Questionnaire (MAQ) or the Brief Medication Questionnaire (BMQ) to evaluate the client's knowledge, beliefs, and behaviors regarding their medications. You can also ask about their health literacy, cognitive function, social support, financial situation, and access to pharmacy services. This will help you identify the factors that may affect their medication management and tailor your interventions accordingly.

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Philip Morisky, MBA, Ξ

Chief Optimus at Adherence | ePRO digital AI/ML MMAS-4 MMAS-8 | Morisky Medication Adherence Scales
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Effectively managing complex medication regimens becomes more achievable with the strategic use of the Morisky Medication Adherence Scale-4 (MMAS-4) as a screening tool followed by the Morisky Medication Adherence Scale-8 (MMAS-8) for in-depth evaluation. The MMAS-4 serves as an initial screener, providing a quick yet insightful assessment of adherence behaviors. By identifying individuals at risk of non-adherence, healthcare professionals can efficiently target interventions and allocate resources. The MMAS-8, with its more detailed questionnaire, allows for a thorough examination of adherence patterns and potential barriers.

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Cristina P. Nunez

Resourceful Pharmacist with a talent for business and a passion for the healthcare and the pharmaceutical industry
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You can’t expect to have a positive outcome or get accurate information in order to effectively manage treatments if you are treating your PATIENT as a client. First mistake. I would, before applying any adherence questionnaire or trying to get a score, ask the patient what their expectations are with this new approach, and how other treatments worked in the past.

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2 Educate the client and caregivers

The second step is to educate the client and caregivers about the importance, benefits, and risks of their medication regimen. You can use the teach-back method, which involves asking the client to repeat back what you have explained in their own words, to check their understanding and correct any misconceptions. You can also provide written or visual materials, such as medication lists, calendars, labels, or charts, to reinforce the information and instructions. You can also review the potential side effects, interactions, and precautions of their medications and advise them on what to do if they experience any problems.

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3 Simplify the regimen

The third step is to simplify the regimen as much as possible, without compromising the therapeutic outcomes. You can work with the prescriber and pharmacist to reduce the number of medications, doses, or administration routes, if appropriate. You can also suggest using combination pills, extended-release formulations, or unit-dose packaging, if available. You can also help the client organize their medications by using pill boxes, dispensers, or organizers, and label them clearly with the name, dose, and time of each medication.

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Ats Astover

I have worked on the MAH´s side, I have worked on the manufacturer/wholesaler´s side, now I am managing a pharmacy with one hand and pushing regulatory paper with the other. (Vt ka "Kakuke" / Колобок)
(edited)
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We have to agree on some basic concepts. It is not OK to tell patient to leave 30 minutes between taking each medication just because "it was not studied along with other taken drugs". We should leave time for calcium, for charcoal or any absorbents (2 hours as a rule of thumb) but not for each drug. As much as possible should be taken at the same time to increase adherence. Also, when MAH for drugs or EC representative for Medical Devices or the entity responsible for Food Supplements creates the labeling, it is really quite dubious to suggest any complicated regimens (15 minutes before food; taken on an empty stomach etc.) when there is no solid basis. This is bad for adherence. It is good for marketing (sticks out), though.

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4 Support the client's behavior

The fourth step is to support the client's behavior and motivation to adhere to their medication regimen. You can use techniques such as goal setting, self-monitoring, feedback, rewards, or reminders to encourage and reinforce their medication-taking behavior. You can also use technology, such as apps, text messages, alarms, or electronic pill caps, to provide reminders and alerts for their medications. You can also involve the client's family, friends, or caregivers in their medication management and ask them to provide support, assistance, or supervision, if needed.

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5 Monitor the client's outcomes

The fifth step is to monitor the client's outcomes and evaluate the effectiveness of your interventions. You can use tools such as the Morisky Medication Adherence Scale (MMAS) or the Medication Possession Ratio (MPR) to measure the client's adherence level and identify any gaps or issues. You can also track the client's clinical indicators, such as blood pressure, blood glucose, or cholesterol levels, to assess the impact of their medication regimen on their health status. You can also ask the client for feedback on their satisfaction, challenges, and preferences regarding their medication management and make adjustments as needed.

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Philip Morisky, MBA, Ξ

Chief Optimus at Adherence | ePRO digital AI/ML MMAS-4 MMAS-8 | Morisky Medication Adherence Scales
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The Morisky Medication Adherence Scale-4 (MMAS-4) as a screening tool followed by the Morisky Medication Adherence Scale-8 (MMAS-8) for in-depth evaluation is a perfect 1, 2 combination. The MMAS-4 serves as an initial screener, providing a quick yet insightful assessment of adherence behaviors. By identifying individuals at risk of non-adherence, healthcare professionals can efficiently target interventions and allocate resources. Following that assessment, the MMAS-8, with its more detailed questionnaire, allows for a thorough examination of adherence patterns and potential barriers. This two-step approach not only streamlines the assessment process but also ensures a nuanced understanding of patients' medication adherence challenges.

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6 Communicate and coordinate with the care team

The sixth step is to communicate and coordinate with the care team, including the prescriber, pharmacist, and other health care providers, to ensure the continuity and quality of the client's medication management. You can share the client's medication list, adherence data, outcome measures, and feedback with the care team and update them on any changes or issues. You can also facilitate the reconciliation of the client's medications across different settings and transitions of care and prevent any discrepancies or errors. You can also advocate for the client's needs and preferences and collaborate with the care team to optimize their medication regimen.

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7 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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Cristina P. Nunez

Resourceful Pharmacist with a talent for business and a passion for the healthcare and the pharmaceutical industry
(edited)
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Handling complex medications regimes highly depends on the kind of treatment and the condition being treated. As healthcare practitioner, you can’t expect that a patient that has gone through multiple treatment schedules with little to none success, to have great adherence or have the same expectations and enthusiasm as they did at the beginning, regardless of their knowledge, literacy or income. We need first to help them understand and manage their expectations so they can face any kind of treatment, complex or not. Empower them about their own condition, and prepare them for what comes next and what they should expect in terms of response, side effects, times and outcomes.

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How can you manage complex medication regimens more effectively?

1

2

3

4

5

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1 Assess the client's needs

2 Educate the client and caregivers

3 Simplify the regimen

4 Support the client's behavior

5 Monitor the client's outcomes

6 Communicate and coordinate with the care team

7 Here’s what else to consider

Case Management

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How can you manage complex medication regimens more effectively?

1

2

3

4

5

6

7

1 Assess the client's needs

2 Educate the client and caregivers

3 Simplify the regimen

4 Support the client's behavior

5 Monitor the client's outcomes

6 Communicate and coordinate with the care team

7 Here’s what else to consider

Case Management

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