Dr Michael Steinman Discusses Effective Strategies for Improving Medication Management

Michael Steinman, MD, professor of medicine, University of California, San Diego, discusses effective strategies for improving medication management for patients and how these strategies can improve outcomes, such as medication adherence.

Transcript

What are some strategies that can effectively improve medication management for patients?

There’s a lot of different strategies that can improve medication management, and I think one of the key things is that there’s a huge spectrum. So, one of the challenges is that patients need education, so some strategies can improve education. There’s some strategies of care coordination between physicians, there’s issues of prescribing inappropriate or appropriate medications and how can we disincentivize the inappropriate ones and incentivize the appropriate ones through a systems approach. There’s issues of patient engagement and empowerment, so there’s this huge gamut of issues, and it’s unlikely that any single intervention will affect all of them, but I think the mistake we sometimes make is focusing on just 1 and ignoring the others because it’s only attacking one small piece of the puzzle, and it’s really kind of helping with multiple different elements and having them all line up that’s ultimately going to make the biggest difference. We can’t do it all at once, but we should keep in mind the big picture even while we’re trying to slice off one particular part.

How do these management strategies improve outcomes like medication adherence and, in turn, improve patient outcomes?

The ultimate goal, of course, is improving patient outcomes, and in some cases that could be getting patients to adhere better to their medications, which are helpful and indicated for them. In some cases, it could be getting patients to stop adhering to their medications, stopping medications that are harmful or unnecessary for them. So, it’s really right sizing the medications, and so part of the strategy is really understanding, first of all, where patients are at, what they’re taking, how adherent they are, why they might be adherent or not adherent, what are some of the barriers and facilitators, and addressing those.

And again, it gets back to the issue of being smart about it. So, we shouldn’t be promoting adherence to medications which really are note necessary or may be excessively costly when there’s a cheaper and maybe easier to take alternative. At the same time, we should be thinking about increasing understanding of patients’ experience of medications and the reasons they’re really taking them so we can stop or avoid medications which aren’t necessary. Particularly for older adults, overuse of medication is very common, and we could probably improve outcomes a lot by stopping those meds.

One final point is that we should really be thinking about outcomes in terms of patient-centered outcomes. Hemoglobin A1c is not an outcome. Blood pressure is not an outcome. Strokes, quality of life, death, things like that, those are the outcomes we should be keeping our eyes on.