Drug Study Taps Counseling To Cut Harmful Interactions

Employers who have succeeded in getting their employees to manage a chronic illness by taking necessary prescription medicine now face a new dilemma: harmful drug cocktails consumed by patients who are treating several chronic conditions simultaneously.

The University of Michigan is set to announce today that it will study whether counseling with pharmacists reduces the incidence of adverse reactions that occur when its employees take multiple drugs for unrelated con­ditions. Such harmful effects can occur between prescription drugs, over-the-counter medicines and dietary and herbal supplements. The university is among a handful of employers trying to learn how best to manage the use of multiple medications.

“We ought to have someone looking at the overall picture here to make sure things work well,” says Leslie Shimp, the professor at the university’s College of Pharmacy who is leading the project.

Researchers at the pharmacy school will begin a pilot program next month to provide counseling to 3,000 employees, dependents and retirees who regularly take at least nine medications. The goal will be to see what kinds of counseling best help individuals safely adhere to their drug regimens. Another goal is to encourage people to use cheaper generic drugs.

Every day, 85 percent of adults take one or more prescription drugs, over-the-counter medicines, herbal medications or supplements, while nearly one-third of adults take five or more every day, according to the Institute of Medicine in Washington.

Despite the prominent role medicine plays in people’s everyday lives, patients are not necessarily using drugs correctly or with awareness of how they interact with other medicines. The inappropriate use of medications leads to more than 1.5 million serious medical events each year, all of which are considered preventable, according to the Institute of Medicine.

“We know that adverse reactions go up almost exponentially depending on the number of drugs you take,” says Dale Christensen, a professor emeritus at the University of North Carolina’s School of Pharmacy.

Some disease management programs have focused on managing chronic illness, like the program begun 10 years ago in the city of Asheville, North Carolina, to manage diabetes.

But programs that look at the entirety of a person’s medical therapies are more recent and less studied. Federal law governing Medicare Part D, the prescription drug benefit that was introduced last year, mandates that individuals with several chronic conditions who take multiple medicines receive what is called “medical therapy management.” Since then, employer groups have taken a closer look at better managing the regimens of employees who have high health care costs associated with chronic illnesses.

“The way you get value for your dollar is to make sure that medical therapies are used properly,” Christensen says. “If not, it’s waste of money at the very least.”

The issue is one that affects more than just retired people. At the University of Michigan, the patients in the pilot program, more than half of whom are 18 to 65 years old, take an average of 12 medications daily, not including non-prescription medications. The goal of the program is to improve the management of chronic diseases, reduce side effects and harmful drug interactions, and simplify the pill-taking process, Shimp says.

The university also expects to save money by moving people to generics, eliminating redundant medications and avoiding medical errors that result in expensive hospitalizations and lost productivity. Exact savings, however, have not been adequately measured, according to the Institute of Medicine.

In order for other employers to reproduce the program, they must contract with local pharmacists who can provide a clinical setting where one-on-one counseling can take place and persuade their population to use the counseling. Other employers, like Pitney Bowes, are using on-site clinics or on-site pharmacies managed by pharmacy benefit managers to provide similar counseling.

“I think that patients are often interested in talking to somebody about their medicine,” Shimp says, “especially if they are taking a lot of them.”

—Jeremy Smerd