Monday, July 22, 2013

Keep taking the pills

Yossi, a doctor in Jerusalem, wrote a prescription for his mother.

She thought he had mixed it up because he had given her a generic medicine. There's no difference at all between them but she looked at the color, shape, saw that they were different – how could they be the same?
So she stopped taking them for a while.

After he explained the difference, she agreed to take them. But what happens if your son isn’t a doctor, and he writes you a prescription? You may think you were cheated, or someone made a mistake, and just not take the medicines.

I had a fascinating meeting at Hadassah hospital recently to learn about a new program for the elderly in Israel that deals with exactly this issue.

Lots of Israel’s seniors receive more than one kind of prescription medication, so you have a high risk of drug interactions, mix-ups, and potential side effects. So JDC-Eshel teamed up with Hadassah Medical Center to create The Center for Medication Safety for the Elderly

The Center is staffed by clinical pharmacology specialists and clinical pharmacists, who answer the medication-related questions of the elderly and review their medications. The aim is to prevent potential dangers, free of charge.  They’ve answered thousands of queries since the program was launched in 2008, in Hebrew and in Russian.

To give you an idea of the challenges … 78% of the callers take 6-10 medicines, and 19% take 11-15 medicines!

The problem is that, usually, every doctor only looks from his or her own perspective of what specific ailment needs to be treated. So the doctor writes down what she sees and only treats the finger, not the whole body.
Older patients can get nervous about these kinds of things. Sometimes there are conflicting medicines, sometimes older patients make their own decisions on what to take and what not to take, on the basis of really unreliable sources. Some may use the internet, but there's a lot of really useless stuff out there (present blog excluded, right fellas?).  The brochure that comes with the medicine is usually intimidating legalese, too.

So there's a problem with the reliability of information. There’s a problem with time and effort, too. A doctor usually has maybe five minutes to spend on a patient, including small-talk, the actual examination, and writing out the prescription. Who has the time to explain?
And how do you reconcile the different medicines once you’ve left the clinic or you're out of the hospital? You should ask the pharmacist, but there are twenty people standing in line behind you, and the pharmacist needs to sell things to everyone. No one has time.

So .. if the patient knows what the medicine is, what the side-effects are and what the interaction is, then (s)he may be compliant.
But the patient isn’t a mouth through which medicines are given, s/he has to be part of the process, otherwise we won't succeed. A patient will take medicines successfully because she understands why, and is part of the process.

So how do we help?

We developed a model to provide information – not instructions – for the patient, that’s personalized and specific. The phone responders help all those who call (it also works by internet, fax, mail and more). 60% of the calls are connected to hypertension, a large percentage of the rest involve diabetes, osteoporosis, hypothyroidism and more.

This program is a step in the right direction.

We’ve achieved a lot, the service is free and designed for 70+ year-olds, though has helped those younger too. They get 2000-2500 calls a year and could easily expand to get more. That means over 9,000 elderly Israelis whose lives have been improved – and some saved – by answering their questions, treating them with respect and helping them with information.

This is a hugely neglected population. And this is a very treatable disease.

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