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A Call to Help Elderly Patients

Dec 18, 2009

I SPENT MY CHILDHOOD with my grandparents. Watching them age and suffer the limitations of chronic disease made a huge impression on me. Little did I know that this experience was to become invaluable to my career in understanding the medical challenges that geriatric patients face each day.

Demetra Antimisiaris, Pharm.D., CGP, FASCP, is assistant professor, University of Louisville, Department of Family and Geriatric Medicine.

After pharmacy school, I interviewed for an internal medicine residency at a hospital known for its treatment of celebrities as well as a geriatric residency at a Department of Veterans Affairs hospital. Although the internal medicine residency seemed glamorous, the preceptors of the geriatrics program promised me that I would “see everything in internal medicine and more” because the elderly often have multiple chronic diseases.

I owe these preceptors a debtof gratitude because they were spot on. I did see everything and found my true calling along the way. Today, I teach medical students, staff physicians, and others about medication management in the frail elderly. I use my Pharm.D. training to address a critical part of the patient-care equation: detailed medication therapy management (MTM).

Advocating for Pharmacists’ Role

For patients who are taking up to 18 drugs concurrently, medication management is essential. The question is simple: Who on the medical team is best positioned to do this important work?

Physicians can typically spend seven to 15 minutes per patient. If the patient is on multiple medications, how long does that physician have to assess each drug? Likewise, the training nurses, social workers, and pharmacologists undergo focuses on other areas.

This is why it is critical that hospitals and health systems begin to rely more on pharmacists to manage medications.

Educating Patients on Medication Regimens

I recall how my grandparents blithely took their medicines without any knowledge or understanding of what could happen in terms of interactions or other adverse consequences. In retrospect—and with the knowledge that I have now—I’ve come to realize that the number and types of medications they took caused them harm.

So, to help other elderly patients avoid these medication-related problems, I regularly conduct volunteer community seminars to increase awareness. The demand for medication consults after each community session is so immense that I recently opened a medication management clinic. I offer office hours and appointments, and patients pay in cash. My faculty members bill for the consults using their medication management codes.

A New Focus on Patient-Centered Care

The new Medicare Part D codes are the first official recognition that MTM is serious business. I am committed to helping position pharmacists as the medical professionals who are paid to manage drug regimens.

Pharmacists are adept at assessing costs and managing drugs, over-the-counter use, and patient diet. Once a clinical patient-centered focus is added to that mix, it is clear that pharmacists are perfect therapy managers. Regularly studying current medical literature and listening carefully to your patients will foster patient centeredness.

I believe that the ability for pharmacists to practice this kind of high-touch, high-tech approach is the very future of our profession.

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