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Saturday, October 13, 2007

Medicine and Mishaps

Every time I speak with a client who is using prescription medication prescribed by a medical doctor I find that most don't know the name of the drug, and most have very little understanding of what the drug is for and probably none have been educated about side effects or interactions. It's not only the medical doctors that fall down on this very important task - required by law as part of their work - so do pharmacists and nurse practitioners.

I find this fairly scary. An example might be the client I had who was prescribed Lyrica for peripheral neuropathy secondary to diabetes. She felt very weak and was concerned because of upcoming elective surgery. Upon completion of a drug interaction profile and review of the literature about her prescriptions (something I do for all clients taking Rx to be aware of the medications and related nutrient depletion, as well as any potential side effect with supplements), I provided her with are report to discuss with her doctor. Yes, her platelet count was dropping and a serious side effect of Lyrica is loss of platelets.

Things have changed drastically since the 1970s when I started as a nurse practitioner and worked with three great physicians. A major part of my work was education, including making sure patients understood about their medications. The lack of this is probably a major cause behind the issue covered in this story.
Name that drug: Many patients can't By Julie Steenhuysen
Thu Oct 11, 6:45 PM ET

Most doctors rely on patients to give them an accurate account of what drugs they are taking, but a new U.S. study published on Thursday suggests many patients get it wrong.

About 40 percent of 119 patients taking blood pressure medication in three community health centers could not accurately recall what drugs they were taking.

That number jumped to 60 percent for those with low health literacy, a measure of their ability to read and comprehend health-related materials, researchers at Northwestern University's Feinberg School of Medicine in Chicago found.

This could lead to drug interactions and the undertreatment of chronic diseases, said Dr. Stephen Persell, whose study will appear in the November issue of the Journal of General Internal Medicine.

"I don't think we have a good grasp on how important this problem is in terms of the medical outcomes," he said in a telephone interview.

Persell said the problem was worse than expected and poses challenges for doctors who are trying to understand why a patient's health is not improving with treatment.

"Does it mean the patients are not responding well to the medication or are they not using the medication?" he said.

Persell and colleagues studied 119 patients with high blood pressure and an average age of 55 at three community health centers in Grand Rapids, Michigan.

People were asked to name their blood pressure medications and the researchers compared their answers to the drugs listed in their medical charts.

They found about one-third of patients with adequate health literacy were unable to name their drugs accurately.

Even a look at a patient's medical records may not present an accurate picture of the drugs a patient is actually taking, he said.

Some of his own patients have continued taking prescription drugs even though he prescribed a different drug and told them to stop.

"Patients and doctors have to be in agreement about what drugs patients are actually taking," he said.

One possible solution is for patients to physically bring their medicines to the doctor's office.

"If they have to go to the hospital, they should bring their pill bottles with them. They should know the name of their pharmacy, so if there is a question, the healthcare workers can call the pharmacy," he said.

He also suggested that drugmakers should be encouraged to simplify the names of drugs once they become generic. Currently, generic drugs are sold by their chemical names, which are unpronounceable for the average patient.

"We need a system-wide approach for this," Persell said.

Copyright © 2007 Reuters Limited. All rights reserved

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