Pharmacists uniquely poised to reduce unnecessary prescriptions

Two recent articles, one by Jane E. Brody in The New York Times and another by Erin Allday in the San Francisco Chronicle, highlight the problems associated with polypharmacy, the term for taking many different medications daily. Research points to almost 90 percent of Medicare beneficiaries 65 years of age and older taking a prescription drug, and of those taking at least one prescription drug a day, almost half reported taking five or more different drugs a day. Brody’s article says people in their 60s take an average of 15 prescription drugs a year. These are a lot of drugs, by whatever measure.

The numbers underscore a disturbing fact that I’ve written about before: In today’s health care system, no one person knows exactly what drugs you’re taking. No single, up-to-date record consistently displays all of this important information.

As a result, many prescribed drugs—in addition to over-the-counter medications, herbals, and dietary supplements—may do more harm than good. Consider the potential side effects of just one prescription drug, let alone 5, or 15, or more. Consider the potential interactions among 5-plus medications and among those 5-plus medications and the foods you eat. And don’t forget the unnecessary expense of drugs, herbs, and supplements with no positive health value.

As highlighted in the Chronicle article, Michael Steinman, MD, faculty member in geriatrics at the School of Medicine, UC San Francisco, is working on one part of the problem, co-leading the U.S. Deprescribing Research Network with the goal of taking patients off unnecessary drugs. It’s an important goal and one the entire health care team should be addressing, especially the pharmacist, who can play a critical role in curbing the costs and health issues that come with polypharmacy.

As a first step to the problem, each patient (or each patient’s advocate) needs an accurate, up-to-date medication list to share with the patient’s health care provider at each visit. Yet while medication misadventures are clearly linked to inaccurate, dated medication lists, these lists still do not fully solve the polypharmacy dilemma. Patients also need a health care professional who consistently reviews their medication lists for accuracy and ensures their drugs are safe, effective, and affordable.

Pharmacists are uniquely positioned—with doctoral degrees and clinical training—to ensure patients receive the right drugs at the right time. Unfortunately, the current community pharmacy business model, which focuses on the volume of drugs dispensed, limits the ability of pharmacists to apply their expertise by managing their patients’ medications. With a different business model, pharmacists are perfectly poised to address, if not eliminate, unnecessary and unneeded medications from patients’ lives.

B. Joseph Guglielmo, PharmD
Dean
Troy C. Daniels Distinguished Professor of Pharmaceutical Sciences
School of Pharmacy
University of California, San Francisco