An 84-year-old patient of mine came in recently with a large shopping bag of vitamins and a small handful of prescription bottles.

“Do any of these cause problems with my medicines?” she asked, holding up bag of supplements. “I don’t know,” I replied, “have you checked with your pharmacist?”

“I can’t. I get my pills through a mail order service, and I don’t know if they have anyone I can talk to about it.”

I had to be honest, I didn’t know either. My staff have called the mainland mail order companies, and are often stuck in a maze of telephone prompts and forced to leave a message. But I do know that every time I pick up a prescription at the local pharmacy near my house, they always ask me if I have any questions. I have overheard a few people say yes, and they are brought to a separate area so the pharmacist can talk to them personally.

“Let’s take a look at these bottles,” I said as I emptied the bag onto the exam table.

Calcium, vitamin D, multivitamins, glucosamine chondroitin and a few less common ones. Tumeric and something labeled “memory support,” and another called “bladder support.” The ingredients were unpronounceable, and also were in such tiny print I had to get a magnifying glass to read it.

If I was having  problems reading the fine print, how could I expect my octogenarian patient to be able to see it, let alone decipher what the ingredients were and if they would cause a problem with her standard medications?

Losing The Personal Touch

This all highlighted a growing problem with the loss of the community pharmacy connection. In years gone past, people would ask their neighborhood pharmacist for suggestions on what types of medications to take for a cold, or if their vitamins had to be taken on an empty stomach.

Whenever a doctor prescribed medication, the pills were dispensed by a pharmacist who would be able to suggest what to do if a dose was missed, or if there were certain types of pills that might interfere with one another.

Prescriptions could be tracked and if someone like my patient hadn’t picked up her pills, she would be notified that her refill was ready. If she had a large amount of leftover medication at the end of the month, the pharmacy would notify me or my office of the potential for skipped pills.

But that was then. Now, many of my patients are given incentives to get their medications via mail order delivery services. Often it’s financial, with a lower copay for three months of medications at the same cost as two at a local pharmacy.

The pills are often on automatic reorder, with new pills sent to time with the previous ones running out. That sounds like a great way to improve compliance, lower cost, and for some patients it probably works. But for the high-risk elderly, the ones who might not know which medications to take and when, the loss of the personal touch puts them at a greater risk of mixing up their pills, with potentially disastrous results.

It’s time that pharmacists are recognized as part of the health care team and reimbursed for consultations with patients about all of their prescription medications and supplements.

Adverse drug events are monitored nationally, and in a recent study, there were an estimated 700,000 emergency room visits and 100,000 hospitalizations due to ADEs.

The elderly are most at risk. Not only are they more likely to be on multiple medications, they are also prescribed certain medications that have more side effects due to slower metabolism or other age-related changes. On average, almost 30 percent of people over 80 are taking at least seven prescriptions daily.

Mixing mail-order and local prescriptions can further complicate things. Neither supplier has a comprehensive list of what patients are taking, increasing the chance of bad interactions between medicines.

Electronic medical records are supposed to tracking all prescribed medicines, but not all doctors use the same system and lots of people have more than one physician.

If the patient picked up all their medications at one location, the pharmacist would know. Their database would be complete, and not only would they be able to advise patients about their medications, they would also be able to cross-reference all of the supplements as well.

This would potentially save the patients thousands of dollars in unnecessary costs for supplements they shouldn’t be taking, and save the entire medical system from unintentional adverse drug events that can lead to serious consequences.

Pay Pharmacists For Consultations

This is not to say that all mainland mail-order companies should be abandoned, or that every prescription has to come from the same place.

Rather, it’s time that pharmacists are recognized as part of the health care team and reimbursed for consultations with patients about all of their prescription medications and supplements.

Yearly exams by physicians are considered an essential health benefit provided by medical insurance, including all Medicare plans. It’s time that yearly reviews by pharmacists be considered essential as well. Anyone on more than five prescription medications, or who is over 65, should have consultation with a pharmacist covered by their medical insurance.

This one-on-one personal interaction can save thousands of dollars by lowering overall medical costs via streamlining prescriptions, avoiding potential deadly interactions, and making it easier for patients to know who they can turn to if they have questions about their medications.

It could save my 84-year-old patient hundreds of dollars a month by eliminating unneeded supplements, and potentially save her life.