Are You Medicine SmartTM? A New Framework for Addressing Issues

Related to Promoting Safe andAppropriate Medicine Use

Wm. Ray Bullman

Executive Vice President

National Council on Patient

Information and Education (NCPIE)

5th Annual Unused Drug Return Conference

November 10-11, 2008

Portland, ME

ABOUT NCPIE

• Nonprofit Organization -- 501 (c)(3)

• Formed October 1982

• 100+ member organizations - diverse collection of sometimes “strange bedfellows” that coalesce around NCPIE mission.

• Mission: Stimulate / improve communication of information on safe and appropriate medicine use to consumers and healthcare providers.

NCPIE CORE VALUES

• To represent a wide spectrum of organizations serving the public health through educational and advocacy programs.

– To empower consumers to be more informed about and active in decisions affecting their use of medicines.

• To be a catalyst for the development of new, useful, and scientifically accurate information about medicine use that is disseminated in multiple formats to a wide range of audiences.

ABOUT NCPIE

• Healthcare professional organizations

• Businesses (pharmaceutical cos.; trade

associations; drug information publishers)

• Government agencies / non-government

standard-setting organizations

• Consumer and Patient Groups

ABOUT NCPIE

– Produces/ disseminates educational messages & materials to promote improved consumer – provider dialogue about medicines

Some Recent Activities:

• “Talk About Prescriptions” Month (Each October) • “Be MedWise” about OTCs• “Medicines in My Home” partnership with FDA • Not Worth the Risk – Even If It’s Legal• MUST for Seniors Program• Enhancing Prescription Medicine Adherence: A National

Action Plan

MUST for Seniors™

• Medication errors and patients who skip their medications could cost the U.S. $177 billion in medical bills and lost productivity, according to a new report by the nonprofit National Council on Patient Information and Education.

• See www.talkaboutrx.org

Enhancing Prescription Medicine Adherence: A National Action Plan

Americans Taking Rx Medicines in Greater Numbers

• More than 1/2 of insured Americans taking Rx medicines regularly for chronic health problems.

• Most widely used: Medicines to lower high blood pressure & cholesterol;

• In ’07, 51% of children and adults were taking one or more Rx drugs for a chronic condition, up from 50% the previous four years and 47% in ‘01.

• Most are taken daily, although some are needed less often.

Americans Taking Rx Medicines in Greater Numbers

• Medication use for chronic problems was seen in all demographic groups:

*Almost two-thirds of women 20 and older. *One in four children and teenagers. * 52% of adult men. *Three out of four people 65 or older.

• Among seniors, 28% of women & nearly 22% of men take five or more medicines regularly.

(Source: Medco Health Solutions; prescription records from 2001 to 2007 of a representative sample of 2.5 million customers, from newborns to the elderly)

Can You Spare a Pain Pill? Significant Proportion Reports Rx Medication Sharing• Nearly 25% reported loaning their Rx medications to

someone else, and 27 percent reported borrowing Rx medications.

• Medications most frequently shared (loaned or borrowed) were allergy drugs (25%), followed by pain medications (22%); and antibiotics (21%).

• 7% said they shared mood-altering drugs like Paxil, Zoloft, Ritalin and Valium.

• A little more than 6% said they shared the Rx anti-acne drug Accutane and about 5% shared birth control pills.

Can You Spare a Pain Pill? Significant Proportion Reports Rx Medication Sharing

• Whites (23%) and Hispanics (26%) were more apt to share Rx pain medicines than were African Americans (14%). Women were more apt than men to share antibiotics (24% vs. 12%).

• People seemed most willing to share Rx medicine when the medication came from a family member, they had a prescription for a particular medication but ran out of it or did not have it with them, or they had an emergency.

(Source: American Journal of Public Health; Beyond Abuse and Exposure: Framing the Impact of Prescription- Medication Sharing; Richard C. Goldsworthy, PhD, Academic Edge, Inc., Bloomington, IN. (June 2008; One-on-one interviews with 700 Americans)

Depending on Patients’ Recall May Be Dangerous to their Health

• Nearly 50% of pts. taking antihypertensive drugs in 3 community health centers were unable to accurately name a single one of their medications listed in their medical chart. The number climbed to 65% for patients with low health literacy.

• Study looked @ 119 pts, average age 55; from CHCs in Grand Rapids, MI.

Depending on Patients’ Recall May Be Dangerous to their Health

• Although study focused on low-income patients, other patients likely have similar trouble recalling the names and dosages of all their medications, particularly those who take a lot of different drugs and the elderly, who may have cognitive limitations.

• Lead author, Stephen Persell, MD: “The Northwestern study indicates a need for future research to address how patients’ inability to name their medications -- particularly those with limited health literacy -- impacts hypertension control and drug safety.”

(Source: Journal of General Internal Medicine, Nov. 2007).

Many Older ER Dept. Pts. Lack Full Knowledge of their Rx Medicines

• Patients averaged 5.9 Rx medications on presentation to the ED.

• Patients correctly identified 78.4% of these medications.

• Thirty-three (42.8%) pts were able to correctly identify all of their Rx medications.

• Patients correctly identified 65.5% of dosages; 32.5% named all dosages correctly, 91.4% of dosing intervals. 57% of patients named all intervals correctly, and 83% of indications; 63% of patients named all indications correctly.

• Conclusion: Elderly patients presenting to the ED have only a fair knowledge of their Rx meds. (Source:Chung MK, Bartfield JM. Knowledge of prescription medications among elderly emergency department patients. Ann Emerg Med. June 2002;39:605-608.] Patients older than 65 years who presented to the ED of an urban teaching hospital were interviewed about their Rx meds and the indications for their use. Meds/dosages verified through the patients' pharmacies. (Data on 88 patients were collected over a period of 2 months.)

Are You Medicine SmartTM? Considering a A New Framework

Consider:

• Medication error prevention • Adverse drug events • Avoidable Drug Interactions• Preventable side effects • Drug safety as daily news (Vioxx and beyond...)• Useful consumer medicine information • Medication Guides • Health Illiteracy • Cultural competency• Prescription medicine abuse • OTC Medicine Abuse• Proper unused medicine disposal

Are You Medicine SmartTM? Considering a Total Person Framework

Are You “Medicine Smart” poses a simple question with profound implications for good health.

Arriving at a “Yes” response to this question means taking into account action steps that relate to yourself and all the members of your family as well.

Are You Medicine Smart? Considering a Full Response Framework

Being "Medicine Smart" means getting all the information necessary to use your medicine correctly.

-- That means asking questions, and

-- Sharing important information about past medicine use to better ensure that you get the most benefit from your treatment.

If you're not sure what questions to ask about your medicine - see

10 Important Questions to Help You Be “Medicine Smart™”

1. What is the name of the medicine and what is it for? Is this the brand name or the generic name?

2. Is a generic version of this medicine available?

3. How and when do I take it - and for how long?

4. What foods, drinks, other medicines, dietary

supplements, or activities should I avoid while taking this

medicine?

5. When should I expect the medicine to begin to work, and how will I know if it is working? Are there any tests required with this medicine (for example, to check liver or kidney function)?

10 Important Questions to Help You Be “Medicine Smart™”

6. Are there any side effects, what are they, and what do I do if they occur?

7. Will this medicine work safely with the other prescription and nonprescription medicines I am taking? Will it work safely with any dietary / herbal supplements I am taking?

8. Do I need to get a refill? When?

9. How should I store this medicine?

10. Is there any written information available about the medicine? (Is it available in large print or a language other than English?)

Do Tell .... Being “Medicine Smart™”

• And remember, when medicines are prescribed, tell your health professionals:

• All of your medical conditions and the names of doctors providing treatment

• The names of all medicines and other products you are taking, including:– Prescription and nonprescription medicines – Dietary supplements / herbal remedies, vitamins or minerals– Laxatives – Pain relievers – Sleeping aids

• Any problems you are having with your medicines; • The medicines to which you are allergic; • If you are, or might be pregnant.

Sharing – About Your Medicines Being “Medicine Smart™”

Being "Medicine Smart™" also means:

• Knowing several key facts about the medicines you are currently taking - and being able to share that information with the members of your healthcare team @ each visit.

• Keeping track of the names of the medicine(s) you are taking, how much you take, when and how you take it, why you take it, and when you started taking it (for how long), for example.

That’s a Lot to Remember... Being “Medicine Smart™”

• There is help available to make it easy to keep track of personal medicine information.

• NCPIE provides access to nearly a dozen sources where you print out a medicine list for yourself and other members of your family.

• Some can even be filled in, updated, and printed from the computer - making your medicine list just a click away whenever it's needed.

Keep & Share an Updated Medicine List Being “Medicine Smart™”

• Personal Medication Record - Arizona Center for Evaluation and Research in Therapeutics (CERT)

• How to Create a Pill Card - Agency for Healthcare Research and Quality (AHRQ)

Keep & Share an Updated Medicine List Being “Medicine Smart™”

• My Medicine List™ - American Society of Health System Pharmacists -- can be filled out electronically and saved to your computer for printing out as needed.

• Personal Medication Card - Rx ResponseRx Response partners: American Hospital Association; American Red Cross; Biotechnology Industry Organization; Generic Pharmaceutical Association; Healthcare Distribution Management Association; National Association of Chain Drug Stores; National Community Pharmacists Association; Pharmaceutical Research and Manufacturers of America

• Personal Medication Record - AARP; developed by the SOS Rx Coalition. Available in PDF and Word formats.

Medicine List = Life Saver Being “Medicine Smart™”

Being “Medicine Smart”

For your free Medicine List Visit www.talkaboutrx.org

Being “Medicine Smart”

One of the above plays a major role in helping consumers treat disease, control chronic illnesses, and avoid deadly medication errors. The others are just so many words.Find out how to be “MEDICINE SMART™”

Go to www.talkaboutrx.org

Etc. Etc. Yada— Yada—YadaBlah—Blah—Blah—Blah

Being MEDICINE SMART!

Here’s what makes YOU “Medicine Smart™”

Here are 10 important things you can do to make you “Medicine Smart:”

1. Make a list of your medicines; share it at every medical visit.

2. Ask questions whenever a medicine is prescribed for you.

3. Share important information about your medicine use including any medicine allergies or problems taking medicines.

4. Recognize that all medicines have risks as well as benefits and talk about this with your doctor or pharmacist.

5. Know how to talk to / what to say to your kids about medicine abuse.

Here’s what makes YOU “Medicine Smart™”

6. Get the full value of your medicines by following instructions carefully and report any problems if they occur.

7. Read carefully all of the written information that comes with your prescription medicine.

8. Carefully read and follow the information on the Drug Facts Label on OTC medicines.

9. Store your medicine safely and away from children.

10. Properly dispose of any unused medicine. Not sure how? See www.smarxtdisposal.net/

Talk to Your Kids about Rx Medicine Abuse

Here are some ways you can help:• Speak to your teen about prescription medicines – do

not presume that illegal drugs are the only threat.

• Encourage your teen to ask you or a doctorabout the negative side effects of a prescribedmedicine, how to watch for them, and what to doif a negative effect is suspected.

• Alert your family physician that you are concerned and ask him or her to speak to your teen about the importance of proper use of prescription medicines.

Talk to Your Kids about Rx Medicine Abuse

• Avoid stockpiling prescription medicines andkeep them in a safe place.

• Promptly and properly dispose of any unusedRx medicines.

• Provide a safe and open environment for yourteen to talk about abuse issues.

• Monitor your teen’s use of the Internet, especially for any unapproved online purchases.

When Your Medicine is “In the News”

Being “Medicine Smart” 1. Don’t panic. Usually a safety debate about a popular drug relates to

reports of rare effects.

2. Contact your doctor or pharmacist - personally, by phone, or e-mail.

When Your Medicine is “In the News”

Being “Medicine Smart” 3. Have a list of things to ask your doctor or pharmacist.

4. Tell your doctor or pharmacist exactly how you take your medicines.– Be sure to say if you are not following directions,– taking more than you should,– forgetting dosages etc.

5. Ask the following questions.

– Do you think the benefits of my taking this medicine outweigh the risks?

– What risks might I face in taking this medicine?

(Source: CA. Pharmacy Board / UCSF Center for Consumer Self Care; this slide and next)

When Your Medicine is “In the News”Being “Medicine Smart”

•Are there alternative medicines to the one I am taking?

•Are there alternatives to some of my medicines, such as lifestyle changes?

•Should I try these? What do I need to do to be successful with non-drug alternatives?

• If I have to continue to take this medicine, what side effects should I look out for, and when should I call you about them?

•In summary, would you review the best course of action for me?

•Can we set up an appointment in 1-3 months to review what we’ve decided and see how I am doing?

Contact Information

Ray BullmanExecutive Vice President

National Council on Patient Information and Education (NCPIE)4915 Saint Elmo Ave., Suite 505

Bethesda, MD 20814-6082(301) 656-8565 ext. 314

bullman@ncpie.info – email www.talkaboutrx.org

www.mustforseniors.orgwww.bemedwise.org