For older patients, developing a relationship with a pharmacist and using one pharmacy can help ensure consistency in care. A consistent pharmacist can help prevent drug-related problems, such as avoidable polypharmacy and drug-drug interactions, which are a particular risk for older adults.
For older patients, pharmacists are sometimes the most accessible health care professional. In addition to dispensing medications, pharmacists provide information on medications to patients and providers, monitor medication use (including adherence), and liaise between physicians or other health care professionals and patients to ensure optimal pharmaceutical care. Pharmacists also provide information about interactions between medications and other substances, including over-the-counter medications, dietary supplements (eg, medicinal herbs), and foods. In many states, pharmacists may also provide some types of clinical care (eg, immunizations, diabetes testing, drug counseling and advising).
Pharmacists are responsible for medication reconciliation, which is a formal process for creating the most complete and accurate list possible of a patient’s current medications and comparing the list to those in the patient record or medication orders. Reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten.
(See also Overview of Geriatric Care.)
Patient adherence
Pharmacists can help improve patient adherence by doing the following:
Assessing the patient’s ability to adhere to a medication regimen by noticing certain impairments (eg, poor dexterity, lack of hand strength, cognitive impairment, loss of vision)
Teaching patients how to take certain medications (eg, inhalers, transdermal patches, injectable drugs, eye or ear drops) or how to measure doses of liquid medications
Supplying medications in ways that are accessible to patients (eg, easy-open bottles, pills without wrappers)
Making sure that medication labels and take-home printed materials are in large type and in the patient’s native language
Teaching patients how to use medication calendar reminders, commercially available medication boxes, electronic medication-dispensing devices, and pill splitters or crushers
Eliminating unnecessary complexity and duplication from the overall medication regimen
Completing a medication reconciliation when patients transition to and from various care settings
Settings
Many pharmacists work in a community pharmacy. But they may also work in any health care setting, including hospitals, long-term care facilities, the home (with a home health care agency), mail service and online pharmacies, organized health care systems, and hospice settings (see table Various Duties of Pharmacists).
Various Duties of Pharmacists
Setting | Duties |
|---|---|
Hospital | Help obtain a detailed drug history from the patient or caregiver Accompany physicians and other health care professionals on patient rounds Make medication recommendations Provide medication information when appropriate When discharge is imminent, provide oral and written medication-related information to the patient or caregiver Conduct medication reconciliation |
Long-term facilities* | May accompany physicians and other health care professionals on rounds Participate in facility quality-improvement committees Assess and interview patients Assess medication effectiveness and monitor patients for drug interactions, adverse drug effects, and therapeutic failures Contact the patient’s nurse or physician directly if a problem or a high risk of medication-related problems is detected Conduct a monthly medication regimen review for all patients as required by federal law Conduct medication reconciliation |
Mail service and online pharmacies | Provide consultation by telephone or video chat to patients and health care professionals (depending on state regulations) Review and validate prescription orders Participate in medication utilization review and formulary management Help ensure quality control Develop education materials for patients and health care professionals |
Organized health care systems | May develop, implement, and manage formularies, computer-based adverse event tracking systems, and performance measurement indicators (to improve quality) May help design therapeutic guidelines and manage medication utilization programs |
Hospice | Make recommendations for appropriate medications to control symptoms Ensure the timeliness of medication delivery Minimize duplicative and interacting medications Help improve cost-effective use of medications Teach patients about the best way to use the prescribed medications Monitor therapeutic responses and recognize medication-related problems Advise hospice team members about appropriate medications and potential interactions between medications and other substances (eg, medicinal herbs) Compound medications or dosage forms extemporaneously as needed Conduct medication reconciliation |
* Pharmacists who work in long-term care facilities are called consultant pharmacists. | |
