A Series on Medication Safety in the United States: Effective Strategies to Enhance Safety

In the second installment of this series, Dr Munger shares strategies for providers and health systems to improve medication safety. 

Change is needed to address medication safety across the US health care system.

Assigning the responsibility of medication safety to a core clinician group would create a bridge between providers and the drug distribution system.¹ The core clinician group should be responsible for the oversight of starting, monitoring, and discontinuing medications, in collaboration with the primary prescriber, across the health care system.^1-3 

This core clinician group should be pharmacists with expertise in medication management and patient access. This group should also be armed with a recent patient-identified medication reconciliation profile, as well as artificial intelligence that evaluates the patients’ medications using a multi-drug interaction software with a medication safety review approach. This will allow the group to make sure the entire drug regimen is appropriate (including deprescribing) prior to pushing for adherence.

Additionally, published data⁴ shows the feasibility of implementing 3 main interventions to avoid adverse drug events (ADEs):

• change the culture of prescribing by developing a prescriber-pharmacist-patient triad relationship to distance prescribing from the pharmaceutical industry’s influence;
• ensure clinical guidelines and advanced training are put in place for de-prescribing medications; and
• implement a team-based model to incorporate pharmacists into the care team with periodic patient-centered prescription review, analysis, development of precise action plans, coding of proposed interventions and analysis of metrics associated with Economic, Clinical and Humanistic Outcomes.⁴

Comprehensive medication management (CMM) employs these strategies. CMM has shown mixed benefits in reducing the unmet clinical need of medication safety.^5-6 Importantly, studies have shown that pharmacogenomics is a critically important tool to optimize care.⁶ 

An Advanced Therapy Management Strategy is designed to positively impact the unmet need of medication safety. The strategy uses a 5-step approach (underlined):

1. Identify patients at risk using a risk stratification methodology, and through an interview (first encounter), conduct a complete medication reconciliation;
2. Send information to highly trained clinicians who will identify medication-related problems through a comprehensive medication management process with pharmacogenomics, when present, to generate an action plan. The action plan is then reviewed and signed off by a physician advocate;
3. Transmit risk level and action plans in person or virtually to the patient and the patient’s provider;
4. Communicate with the patient on a frequent basis to ensure the patient follows the action plan and to address any changes that may need to be made. This strategy has been shown to improve medication safety.⁷

There are effective published strategies currently in practice around the United States that, if employed, universally would address this important unmet clinical need.

The first part of this series, where Dr Munger defines the problem of medication safety, can be found here.

The third part of this series, where Dr Munger discusses the underutilization of pharmacists, can be found here.

References:

1. Kessler C, Ward MJ, McNaughton CD. Reducing adverse drug events: The need to rethink outpatient prescribing. JAMA. 2016;316(20):2092-2093. doi:10.1001/jama.2016.16392
2. US Department of Health and Human Services. Office of Disease Prevention and Health Promotion. National action plan to improve health literacy. 2010. Accessed July 6, 2022. https://health.gov/our-work/national-health-initiatives/health-literacy/national-action-plan-improve-health-literacy
3. Ratzan SC, Parker RM. Introduction. In: Selden CR, Zorn M, Ratzan SC, Parker RM, eds. National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Bethesda, MD: National Institutes of Health, US Department of Health and Human Services; 2000.
4. Bankes DL, Jin H, Finnel S, et al. Association of a novel medication risk score with adverse drug events and other pertinent outcomes among participants of the programs of all-inclusive care for the elderly. Pharmacy (Basel). 2020;8(2):87. doi:10.3390/pharmacy8020087
5. GTMRx Institute. CMMI project shows how comprehensive mediation management (CMM) improves care for high-risk patients: Initiative has expanded statewide. GTMRx Institute; 2022. Accessed July 6, 2022. https://16bvl028dn7zhgp35k7rzh5c-wpengine.netdna-ssl.com/wp-content/uploads/2022/03/Hochman_Chen_GTMRx-Issue-Brief.pdf
6. Jarvis JP, Peter AP, Keogh M, et al. Real-world impact of a pharmacogenomics-enriched comprehensive medication management program. J Pers Med. 2022;12(3):421. doi:10.3390/jpm12030421
7. Jin H, Yang S, Bankes D, Finnel S, Turgeon J, Stein A. Evaluating the impact of medication risk mitigation services in medically complex older adults. Healthcare (Basel). 2022;10(3):551. doi:10.3390/healthcare10030551