Prepared Patient, is created by the Health Behavior News Service (HBNS), part of the Center for Advancing Health. This monthly series helps Americans participate more fully in their health and health care. For more issues of the Prepared Patient series, visit the archives.
Written By: Lisa Esposito
People with chronic illness often struggle to manage several prescribed drugs at a time. It'??s overwhelming when the vials, bottles and inhalers bulge from your medicine cabinet and you'??re confused about which drug is which, or when to take what.
Also, more medications seem to come with the territory as people get older. '??Prescription drug use is heavily concentrated in people over 55, 65,'?? says Steven Findlay, senior health policy analyst at Consumers Union.
Of older adults, 12 percent use 10 or more medications per week, according to a new report from the Center for Technology and Aging (CTA).
Even though people '??know'?? they should take their pills as directed, for the most part, they don'??t. But so much is at stake when people mix up their medicines or skip or take incorrect doses, study after study has found.
People who stick with their blood pressure medicines and take them as prescribed significantly lower their risk of heart attack and stroke. For people with diabetes, staying on top of their medication means better blood sugar control and fewer long-term complications '?? like serious infections and vision problems.
Medications are powerful tools and also pose powerful risks. Every year, anticoagulant drugs '?? blood '??thinners'?? like Coumadin (warfarin) used to prevent blood dangerous blood clots '?? cause bleeding episodes, a small portion of them fatal, when people mistakenly take too high a dose. So getting your medication routine down is critically important.
When You Have Lots of Meds
Greg Duggins, a medical biller in Garrison, N.Y., developed hepatitis in the early 1990s. His health deteriorated to the point where he underwent a liver transplant in July 2008.
Duggins realized that after the transplant he would have to take a host of medicines '?? including immunosuppressant drugs to prevent his body from rejecting the new liver.
'??When I was in the hospital [taking my meds] the nurses just held my hand while they quizzed me,'?? he recalls. He was able to repeat their instructions, which included complex schedules to allow him to taper dosages safely rather than stopping certain drugs too abruptly. No problem, he thought.
Then it was time to say goodbye to the hospital.
'??The night I got home was the absolute worst,'?? Duggins says. '??I looked into this box of pills and I panicked.'??
Many people find themselves tasked with taking, scheduling and organizing multiple medications '?? for instance people recovering from surgery as well as those with chronic conditions.
As complicated as it can be, taking your medications correctly really matters. Taking medications incorrectly can threaten your very ability to live independently. '??Medication non-adherence contributes '?¦ to 23 percent of all nursing home admissions,'?? the CTA report says.
So, How Do You Sort Out Your Meds?
Don'??t guess when it comes to taking your medication.
Make sure you leave the doctor'??s office knowing the name of the drug, its strength, how much to take and how to take it. Ask WHY you'??re taking the medicine, and not only that, what the drug should do and how long it should be before you see results.
Call your doctor back if you don'??t understand the instructions she gave you along with the prescription. It'??s not unusual to need that kind of reinforcement: '??It'??s been documented that people have a limited memory under stress: their bucket is too full,'?? says Dr. Amy Schiffman, an emergency physician in Rockville, Md.
While you'??re in the doctor'??s office or pharmacy, take notes. Enlist a family member or friend as a second set of ears when you'??re learning about your meds.
Duggins had several resources to keep him on track: '??Before discharge, they asked me to bring a family member. My sister Linda is a stickler. She took copious notes.'?? about all the drugs he would need to take. Of course, you can take your own notes during an appointment as well.
A week or so after he came home, Duggins did an online search and found a program that allows users to create their own drug schedule at home, complete with visual aids to avoid mix-ups. He downloaded a new form and filled in each of his own drugs one by one. Now he has a clear timetable to work from.
'??I created an account; that'??s an option. The first page asked me to list drugs and it showed me pictures and what the drugs are for. The program gives brand names and generic names.'??
You can access the free MyMedSchedule program online, in English or Spanish.
Looking for different choices? A '??talking'?? pill bottle allows you (or your physician or pharmacist) to record how many pills you should take, when to take them and what they'??re for, according to the makers of '??Talking Rx.'??
Behavior changes like people using pillboxes organized by day of the week or time of day '?? -or doctors reducing the number of daily doses or by prescribing multiple medicines with matching time schedules '¬'?? can help people take their medicines as needed, a recent University of Missouri study found.
A variety of online and electronic tools and aids exist to help keep multiple meds straight: see the Making It Easier to Manage Your Meds sidebar for some examples.
For many people, low-tech methods work every bit as well: jotting down instructions on a notepad or checking off drug dosages on the refrigerator calendar. If you can connect your medication-taking to habits you already have '?? like taking daily doses when your brush your teeth in the morning '?? remembering becomes easier.
Whether you use software or pen and paper isn'??t important '?? the issue is educating yourself, getting organized and understanding how and why you take the medications you do.
Do You Still Need This Drug?
Are you supposed to take all these drugs for the rest of your life? Maybe you don'??t need all of them or you and your doctor have fallen into a habit of automatically refilling them. It'??s a good idea to keep your eye on each of the drugs you take and to revisit this with your physician at least once a year.
Greg Duggins still has his big medicine box but it'??s no longer as full: he'??s been weaned off several drugs and now takes '??just'?? six different meds to stay the course.
'??If people are taking multiple medications on a regular basis, they need to have an annual check-up,'?? says Rebecca Snead, executive vice president of the National Alliance of State Pharmacy Associations. In fact, she says, for patients on Medicare, '??Those who are eligible will get a comprehensive medication review on an annual basis, starting [this year]. But even if it'??s not a covered benefit, you need to sit down and have a comprehensive medication review every year.'??
Taking the complete list of your drugs to your appointments offers an opportunity to raise questions and make sure that the medications you'??re taking are still right for you today.
Making It Easier to Manage Your Meds:
MyMedSchedule is free and allows you to manage your meds online, set-up text message reminders and print out checklists that you can take to doctor appointments or the pharmacy.
Advanced Drug Safety is an online tool to '??help you identify, diagnose and resolve drug interactions and combined side effect risks,'?? according to its creator, PharmaSurveyor.
Among other online services, RememberItNow helps people get organized and remember to take their medicines. Some services are free, others involve monthly fees.
'??Intelligent'?? pill bottles use lights and sounds to remind you to take your pills, from manufacturer RxVitality.