Farha Dennis | Pharmacists – critical link in healthcare system

Pharmacists are ranked among the top three most trusted health professionals according to Gallup’s 2020 poll in the US. In addition to being trusted, we are usually the most accessible; no appointments required. As readily accessible health professionals, we are in an excellent position to educate, encourage and empower our patients to be better custodians of their health.

Two main ways pharmacists can influence patient health outcomes is by promoting adherence to treatment, and monitoring.

ADHERENCE

Healthcare is moving away from compliance, passively going along with doctor’s orders and more towards adherence, which implies a mutual agreement between prescriber and patient. It also involves taking the right dose at the right time, and in the right way.

In Jamaica, pharmacists can readily detect non-adherence based on the documentation on the prescription. Additionally, patients will tell you, “I don’t need this one”, or “I have some already”, or “I have a lot of it at home.” Statements like these usually indicate non-adherence, as some doses were missed, whether intentionally or not. From my experience, some patients only take their medications when it is almost time for their next doctor’s appointment, with the aim of giving the impression that they had been taking their medication as prescribed all along. Consequently, while the basic tests at the doctor’s office may give a snapshot of seemingly good health, more advanced tests may reveal otherwise. When I see my patients doing this, especially those who drive, I like to ask them, “When your car overheats and the gasket gets damaged, does cooling down the car reverse the damage?” Similarly, only taking the medication prior to your next appointment can be likened to cooling down the car, but the damage from not taking the medication consistently has already been done and may be irreversible.

Another reason for non-adherence is the fear of side effects. However, side effects are what may occur, and not what will definitely happen, and this varies from patient to patient. With continued use, some side effects will dissipate; while others are relatively mild and adjustments can be made to mitigate them. For example, drowsiness can be reduced by taking the medication at nights and dedicating at least seven to eight hours to sleep. However, this strategy is less effective with medications taken more than once daily. On the other hand, if a side effect is particularly bothersome or serious, please get in touch with your healthcare provider right away, who will advise you on your next step. There are usually various medication options for treating the same condition, so do not think that you must suffer through a side effect.

Patients sometimes say a particular medication does not work for them. However, it has also been said that “Medications only work in people who take them.” Thus, while the former may be true in some instances, in others, optimal results are lacking due to not taking the medication as prescribed. This may manifest as taking a lower dose, one tablet instead of two; taking it less frequently, once a day instead of two or three times daily; skipping days altogether; or, if more than one medication is prescribed for the same condition, only taking one. One popular reason given is that they do not want to become dependent on the drug. Contrary to popular belief, it is the state of one’s health that determines dependency on a particular medication, as opposed to the frequency of taking the medication itself. Additionally, one’s health, or lack thereof, is greatly determined by lifestyle choices. Hence, wellness is a result of making and adhering to positive, lifelong habits which may eventually lead to medication reduction.

While adherence is essential, it is like a shot in the dark without monitoring.

MONITORING

“Whatever steps we take ... we will have to monitor those steps in order to know if they’re actually working.” – Naomi Oreskes (American science historian).

This statement is in reference to climate change; however, it can be applied in other areas of life.

How many of us would continue to drive a vehicle without periodically checking the oil and coolant levels? Or, when cooking, just leave the food for the recommended amount of time without looking into or tasting the pot? These checks are even more important if we are driving long distances, or in the case of cooking, using a recipe for the first time, or if we had made changes to the recipe. While expensive and highly inconvenient, a car or meal can be replaced. How much more so, then, do we need to monitor our health parameters such as blood pressure, sugar and cholesterol levels.

Effective monitoring, then, involves knowing what your targets are and then taking the measures necessary to stay on track. Hence, whether you are taking your medications as prescribed or not, and especially if the latter, you need to know if you are reaping the desired results. There are four possible scenarios; two where results are regularly within target range, and two where they are consistently out of range:

1) If within range and taking medications as prescribed, continue doing so.

2) If within range despite not taking medications as prescribed, speak with your doctor about possibly decreasing the dosage or number of medications.

3) If you are not at target but have been consistent with your medication, your dosage may need to be increased, changed completely, or more medication(s) added.

4) If not achieving target but you have not been taking your medication properly, then start doing so immediately.

The effectiveness of the medication can only be evaluated after you have been consistently taking the medication over a period of time. The results will have to be consistent before any adjustments can be made; after all, even a broken clock is right twice per day.

Monitoring also includes recording these results. In addition to the actual reading, the date and time and whether medication or food was taken should also be noted. These results (or the actual monitors) should accompany you on each visit to your healthcare provider. This will assist them in getting a better overall view of your health. Furthermore, it will help you to better understand your disease condition and factors that may affect it, and thus allows you to actively participate in discussions regarding your health and possible treatment options.

As pharmacists, it is our hope that patients are empowered with regard to the need for adherence and effective monitoring to become better gatekeepers of their health. Thus, they will come to view themselves as integral partners in achieving and safeguarding their wellness, and not just casual bystanders.

Farha Dennis is chief pharmacist at The Heart Foundation of Jamaica. Send feedback to columns@gleanerjm.com.