Running Head: Medication Management

Medication Management

Gina Antonucci, Polixeni Chirgott, Sarah Patrick, and Brittaney Zupko

Professor Sue Rendano MSN, RN
NURS 3710 – Nursing in the Community
09 November 2016
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Table of Contents

Abstract 3
I. Why Medication Management? 4
II. Vulnerable Populations 4-5
III. Compliance 5-7
IV. Cost Considerations 7-9
V. Medication Management in the Hospital Versus Homecare Setting 9-9
VI. Storage and Disposal of Medications 9-10
VII. Ways to Improve Medication Compliance 10-11
VIII. Conclusion and Nursing Implications 11
References 12
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Abstract

The purpose of this paper is to provide a brief overview of the importance of medication

management. In order to achieve this goal, research has been gathered from various scholarly

resources. As a result, this paper will include a brief background of why medication

management is important, vulnerable populations, compliance issues, cost considerations, and

medication management in the hospital versus in the homecare setting. In addition, the

importance of storing and disposing medications as well as ways to improve medication

compliance will be discussed. Finally, based on this research, nursing implications will be

addressed.
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Why Medication Management?

The health care industry is an arguably diverse sector. In the United States, Western

biomedicine is the predominant health care system. In order to be effective, health promotion

and maintenance are two common strategies stressed as a way to prevent and address illness and

symptoms. According to research “good healthcare has made a significant contribution to

improving longevity and functioning in later life” (Steel, Melzer & Richards, 2013, p. 1).

Unfortunately, due to factors, such as socioeconomic status, everyone does not have access to it

or can afford it. Although a significant amount of progress has been made in healthcare over the

past decade, public health challenges still remain. One such challenge includes getting access to

as well as adhering to correctly taking medication(s). In other words, statistically speaking,

prescription medicines, over-the-counter (OTC) drugs, or dietary supplements are used by 80%

of adults with roughly 33% of them taking at least five medications daily (Steel, Melzer &

Richards, 2013, p.8). However, a number of issues, such as cost and lack of resources getting to

the pharmacy, have caused individuals to not comply with their prescribed drug regimen. As a

result, medication management is important in order to reduce drug related complications and

promote quality of health at the same time.

II. Vulnerable Populations

Two vulnerable populations when it comes to being prescribed medications are the

elderly (age 65 and older) and people of low socioeconomic status. The elderly comprise

approximately 13% of the total U.S. population, and they account for more than one-third of the

total outpatient spending on prescription medications. More than 90% of people ages 60 and

older take at least one medication a week, with 53% for cardiovascular issues, 44% antibiotics,
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and 29% diuretics. Due to physiologic changes of aging and comorbid illnesses, the elderly are

more likely to be prescribed long-term therapy and multiple medications.

Physiologic changes that occur with aging take place in all organ systems, and may lead

to multiple health problems. Arteriosclerosis, or hardening of the arteries occurs, which can lead

to high blood pressure, and decreased cardiac output leads to inadequate tissue perfusion and

heart failure. In the lungs, gas exchange becomes impaired, and this may cause COPD,

hypercapnia, and even confusion in older patients. As far as liver function, it decreases with age,

slowing metabolism. This has a direct effect on medications in the body, because with slower

metabolism, medications will circulate longer and this may cause problems such as drug toxicity

in the patient. There is a progressive elevation of blood glucose with aging, and a decline in

bone mass along with degenerative changes in many of the joints and a loss of muscle mass.

Lastly, cognitive ability and functioning declines and causes much confusion in older adults. All

of these changes that take place in the body lead to many common illnesses in the elderly

including hypertension, cardiovascular disease, Alzheimer’s, diabetes, osteoporosis, and COPD.

People of low socioeconomic status are also at risk for comorbid illnesses medication

prescription. Studies show that this population of people tends to engage in unhealthy behaviors

such as tobacco use, physical inactivity, and poor diet/nutrition. In combination with poor living

and environmental conditions, illnesses and diseases tend to be extremely common. Many

people do not have the funds for many health care resources, so diseases and illnesses are more

advanced due to a lack of treatment and not being able to see a physician regularly. Some

common problems include chronic stress, heart disease, ulcers, type II diabetes, cancer, and

rheumatoid arthritis.

III. Compliance Issues

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Compliance issues are also a major problem when it comes to medication management at

home. One of the most common problems is polypharmacy, or the simultaneous use of multiple

drugs by a single patient for one or more conditions. Approximately 60% of Americans are

taking prescription medications, and overall the US has become an unhealthier population with

bad habits. People often have comorbid illnesses, and see more than one doctor for these

different health issues. This leads to the prescription of more than one medication, and most

people do not want to be taking multiple drugs on a daily basis, so instead, they stop taking them

altogether. Another issue with compliance is when patients begin to feel better or worse.

Treatment of illnesses with medications controls unwanted symptoms, and when patients begin

to feel good again, they stop taking their medications because they feel that they have served

their purpose. What most people do not understand is that this can lead to serious

complications. For example, in patients with hypertension, the sudden discontinuation of

medications can lead to rebound hypertension, and with antibiotics it can lead to antibiotic

resistance. On the other hand, some medications can have adverse side effects. When patients

begin to experience unwanted symptoms, they often times do not notify the physician for

medication adjustments, but take it upon themselves to discontinue the medications themselves.

Again, this can lead to serious consequences as mentioned before.

Lastly, and one of the most important reasons for non-compliance with medications is

cost. Over 54 million Americans are uninsured, and do not benefit from the same services as

many people are fortunate enough to have. Without the proper funds or help to pay for vital

medications, adherence problems become a major issue. It leads to unhealthy behaviors such as

pill-cutting, skipping days and dosages, or not purchasing medications at all. Situations like this

put patients in a hard situation, especially when they have to make a choice between medications
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or paying their monthly utilities. This puts clients at an increased risk for many health problems

and complications.

IV. Cost Considerations

The pharmaceutical industry is considered to be one of the most profitable industries in

the world. For example, in 2007 “the United States spent $286.5 billion on prescription drugs or

$2,600 per household on prescription drugs” (Petrochuk, 2014, para. 1). Presently, it is a sector

that is characterized by a high level of concentration of fifteen multinational companies

dominating the industry (Mennen, et. al., 2006). Pfizer and Johnson & Johnson are a two of the

main pharmaceutical companies that dominate and control the market. As a result, these

companies typically dictate drug prices, which can unfortunately lead to price gouging. One

primary reason for this is that “a patient will not change the demand for a product with a change

in price when there are no close or available substitutes” (“Pharmaceutical Industry,” n.d.).

That being said, in terms of covering prescription drugs, “beginning with the second half

of the twentieth century, health insurance became the major financing mechanism for health

services in the United States” (Pipes, 2008, p. 109). Simply put, insurance is intended to protect

against “unpredictable loss.” In general, there are two types of coverage including private and

public insurance. First, private insurance is considered to be “the main source of health care

coverage for the majority of people in the United States” (“Health Insurance,” 2016, para. 1).

Interestingly, two common types of private insurance include health maintenance organizations

(HMOs) and preferred provider organizations (PPOs). By contrast, public insurance includes

Medicaid and Medicare.

Medicaid and Children’s Health Insurance Program (CHIP) are “two types of low or no-

cost health insurance through the government [in which] eligibility is based upon household size
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and income determined by the government” (“Health Insurance,” 2016, para. 3). Whereas,

Medicare is a type of health insurance coverage for people age 65 or older, or people under 65

with certain disabilities or illnesses. In short, Medicare is further broken down into four parts

including Part A (hospital coverage), Part B (medical coverage), Part C or Medicare Advantage

(a combination of both A and B and sometimes even combined with Part D), and Part D

(prescription drug coverage). Lastly, some individuals also pay out of pocket.

Unfortunately, despite an individual’s age, financial position, and insurance coverage

patients are not always compliant with their drug regimen, as mentioned above. In other words,

in the United States alone, according to the Health Care Cost Institute “over the past decade,

health care costs have risen over three times faster than wages, squeezing family budgets and

imposing a burden on many employers,” (“Health Care Cost,” 2013, p. 8). As a result “people

may be unable to afford the appropriate medicine for their illness […] placing the lives of human

beings at stake” (Michael, 2009, p. 4).

For instance, an individual may not take their full course of medicine as directed in effort

to save the remaining pills for the next time that they become sick as well as to avoid the cost of

another healthcare visit. Unfortunately, if this action occurs with an antibiotic, this can

ultimately lead to resistant bacteria. Additionally, an individual may also be tempted to cut their

pills in half in order to have more in effort to cover a longer period of time. Although some

drugs can be split in half, others can cause the drug to become toxic and ineffective in the body.

As a result, this action alone can lead to medical cost(s) that go beyond the cost of the original

drug.

Finally, in recent years, several individuals have resorted to ordering drugs on the

Internet, especially since they are often cheaper overseas. For example “in Canada, prices can be
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as much as 70 percent lower than in the United States” (Pipes, 2008, p. 53). However, the FDA

so far has found several discrepancies between what is ordered and what is actually in the

product, while checking drugs as they arrive into the United States. Therefore, patient teaching

is essential before discharge in order to promote drug compliance. Furthermore, it is essential to

recognize signs of socioeconomic disadvantages in order to recommend financial assistance

programs offered by some pharmaceutical companies, such as Pfizer’s RxPathways and Johnson

and Johnson’s Patient Assistance Foundation.

V. Medication Management in the Hospital Versus in the Homecare Setting

With regard to the difference between medication management in the hospital versus

in the homecare setting, one difference lies primarily with the requirements set forth by the Joint

Commission. In other words, healthcare providers must ensure that they follow the “five-plus-

five” rights of medication administration. Therefore, medication management in the hospital

setting is more tightly controlled ultimately leading to better adherence. In addition, in the

hospital setting, if a medication-related problem occurs, such as nausea, these issues can

sometimes be promptly treated; however, at home, certain types of side effects can cause a

patient to stop taking their medication in its entirety. Other factors that can create a problem

when it comes to taking medicine at home include lack of knowledge regarding the purpose of

the medicine and how often it needs to be taken, interactions between different medications, lack

of resources to get to the pharmacy, cost, and difficulty with opening pill bottles.

VI. Storage and Disposal of Medications

Approximately, 1/3 of medications go unused in the United States every year. This can

result in the need to dispose or store these medications. There are many misconceptions with

proper storage and disposal of medications. Many medications are stored improperly in
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bathrooms, kitchens, and on windowsills, which all allow moisture, light, and heat to damage the

medications. Medications should be stored in a high unreachable place. Children and dogs are

two vulnerable populations that can get into medications that are improperly stored. To ensure

safety, medications can be stored in a lock box with a combination code. Some medications such

as insulin, and nitroglycerin require special storage. Insulin should be kept in the refrigerator

when not using, and nitroglycerin should be stored away from light. Disposal of medications is

very important to ensure safety. Do not flush medications down the toilet as these can go into a

community’s central water supply. A study was completed in 2013 that tested 50 different water

systems and it showed many medications including narcotics and blood pressure medications

were found in drinking water. It is recommended, if you must dispose of your medications at

home, place them in kitty litter or coffee grounds, which will hide the medications and also

destroy them. If disposing of liquid medications, it is best to dilute them first. It is important to

remember to sure identity safety that you destroy all personal information on an empty pill bottle

before disposing of it. There are many prescription drop off programs throughout the community

where you can take expired on unused medications to be proper disposed. There is a drop off

location at some pharmacies, and even one right here on campus at the YSU police department.

Checking expiration date is also vital before taking any medications and should be disposed of if

they are expired. Ultimately, improper storage and disposal of medications can lead to accidents,

disruption in water supply, and many other issues that can all be prevented.

VII. Ways to Improve Medication Compliance

There is a lot of confusion associated with taking medications on a daily basis. These

complications include polypharmacy, the cost of medications, and lack of patient teaching. There

are various ways that medication compliance can be improved, such as using pill dispensers and
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planners to get more organized, certain programs that can help alleviate cost, and providing

effective patient teaching. There are pill dispensers that can organize medications based on the

days of the week, and dispensers that can organize morning and night medications. Medminder,

an electronic pill dispenser, alerts patients visually and with sound that it is time to take their

medications. If medications are not taken at their prescribed time, the Medminder will call the

patient and their caregiver to ensure compliance. Another major issue associated with the elderly

is their lack of transportation. Therefore, it is important to select the closest pharmacy to your

house, and to have all of you medications sent to that location. Pharmacies understand this issue

and have created programs that deliver medications through the mail, which allows patients to

save on prescription copays and receive free shipping.

VIII. Conclusion and Nursing Implications

As nurses, it is our responsibility to ensure that our patients receive thorough and

effective teaching. Many times, patients are sent home from the clinical setting confused and

unsure of their medication regimen. The nurse should ensure that the patient understands the

actions of their medication and when it should be taken, when to follow up with their doctor, and

possible side effects that may occur.

.
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Health care cost Institute. (2013). Retrieved November 08, 2016, from
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insurance.php

Jin, J., Sklar, G. E., Oh, V. M., & Li, S. C. (2008). Factors affecting therapeutic compliance: A
review from the patient’s perspective. Retrieved November 08, 2016, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503662/

Mennen, K., Abayomi, G., Jian, A., Mead, L., & Zhou, J. (2006). Mergers and acquisitions in
the global pharmaceutical industry.

Michael, G. (2009). Catholic thought & intellectual property: Learning from the ethics of
obligation. Journal of Law and Religion, 25(2), 415-451.

Owens, L., & Anand, S. (2009). Medication disposal report. Retrieved November 08, 2016,
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Petrochuk, M. (2014). Top ten myths. Retrieved from

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Top%20Ten%20Myths/player.html
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drop-box

Steel, N., Melzer, D., & Richards, S. (2013, February 01). Quality of health care.
Retrieved from http://www.ingentaconnect.com

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1273316/

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