New Approach to Pharmacotherapy Aims to Eliminate Medication Mishaps, Cut Costs for Senior Citizens

BUFFALO, N.Y. -- Senior citizens might be a lot happier -- not to say healthier and maybe even a little wealthier -- if health-care providers and insurers stopped focusing exclusively on costs of prescriptions and instead looked closely at why patients take so many medications in the first place.

This approach to managing a patient's drug regimen -- called pharmaceutical therapy management -- could cut health-care costs and lead to seniors living independently for longer periods of time, according to Wayne K. Anderson, Ph.D., dean of the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

Pharmaceutical therapy management is the foundation of a new program in geriatric pharmacotherapy in the UB pharmacy school designed to improve pharmaceutical management of seniors by training new pharmacists who would be involved exclusively in the health care of older patients and conducting research on how pharmacotherapy can enhance and extend the lives of older patients.

"Our goal is to begin to develop programs that allow independent senior citizens to continue to live independently, even though they have a number of medical conditions and as a consequence take a good number of drugs," Anderson said. "The length of time that they can continue to remain independent is very much dependent on the success of their drug therapies."

According to Anderson, senior citizens in the U.S. age 65 and over take an average of six to eight prescription drugs daily.

"That's probably too many," he said. "Proper pharmaceutical therapy management could probably cut in half the number of drugs most senior citizens now are taking," he added, "so the amount of money they are spending is reduced and the quality of their lives is much improved."

Anderson said that most senior citizens see several doctors, each of whom may prescribe a medication based on symptoms the patient is experiencing.

"Different physicians use different drugs to treat different conditions," he said, "and some of these drugs interact, in some cases exacerbating the side effects of other drugs that are being taken for other conditions."

Statistically, a person taking eight drugs can expect at least one drug interaction that will have a negative effect on his or her health, Anderson said.

He explained that the scenario often goes like this: An elderly patient sees a doctor about a particular condition and the physician prescribes a medication. But that drug produces a side effect, so another drug is prescribed, often by another health-care provider, to combat the side effect. That drug makes the patient shaky, so another drug is prescribed, but that drug makes the patient sleepy, so a stimulant is prescribed but then the patient can't sleep at night, so another medication is prescribed to induce sleep.

These outcomes not only compromise the patient's health, but may lead to much higher health-care costs that are entirely avoidable, said Anderson.

He noted that national data from the American Association of Consultant Pharmacists suggest that 25 percent of admissions to nursing homes result from failed drug regimens, noncompliance by patients, drug interactions, inappropriate medications being prescribed for certain conditions and the lack of good therapeutic monitoring.

"There often is no single physician who is looking at the patient's entire health picture and who can ask, 'Why is this person taking so many drugs?'" he explained.

That's where pharmacists can make an invaluable contribution, said Anderson.

"Pharmacists are uniquely positioned to function as a patient's drug advocate," he explained. "With proper pharmaceutical therapy management, the pharmacist, together with the patient and the physician, could re-examine the drug that was prescribed for the initial condition to see if an alternative drug or some combination of other drugs would have a similar therapeutic effect without adversely affecting the patient," said Anderson. "If that's possible, then all but one of the drugs prescribed in that scenario were completely unnecessary."

This type of pharmacy management will be a main principle of the training of pharmacists in the new program in geriatric pharmacotherapy, graduates of which will practice in hospitals, nursing homes or community pharmacies.

An important part of that program involves having pharmacy faculty and students involved in a clinical component with senior citizens at the Weinberg Campus, a facility for senior citizens near the UB North (Amherst) Campus that provides nursing-home care, as well as apartments, for seniors.