Med Reviews

Sep 30, 2014

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I can resist anything..except temptation. Oscar Wilde may have hit the nail on the head when it comes to how important self control is. I was dismayed when I heard how important it was that children be able to resist marshmallows. There were these series of experiments done in the 1960s by Walter Mischel. Four year old children were offered a marshmallow. They were told they could eat the one marshmallow whenever they wanted, but if they waited 15 minutes, they would get 2 marshmallows. About 2/3s of the kids ate the marshmallow right away and about 1/3 waited. These kids have been followed for years. They were checked on at age 13, at 18 and are still being followed today. The 4 year olds who could delay gratification the longest were more successful in life than those who ate the marshmallow right away. The kids with self control were thinner, had better grades, had better relationships, and were overall doing better at life. This experiment concerned me so much because Ive seen my son Eric eat 5 marshmallows at a friends bonfire before any of the other kids had choked down one. When it comes to marshmallows, Eric resists temptation like Oscar Wilde.

It may seem counter intuitive that a four year old resisting marshmallows is a strong indicator of their future success. Our society doesnt celebrate self control, but when you think about it, self control is a very useful attribute. It may also not be immediately obvious, but sitting down with your pharmacist to discuss your medications for 30-60 minutes can be very good for your health. We call these extended interactions with a pharmacist a medication review. In a community pharmacy, pharmacists spend most of our time making sure the right medication is in the right bottle for the right patient. Then we explain how a patient can get the most use out of that medication. I might tell them to take it with food, or to be careful because it might make them sleepy. That is an over-simplification, but in general that is what I get paid to do. In other provinces, pharmacists get paid to do more services for patients such as medication reviews. And patients find these other services very valuable. But you don't have to take my word for it. The Canadian Association of Retired People or CARP did a study.

Let's take a step back. What problems in the health care system did CARP think pharmacists could help with? As the Canadian population ages, Canadians are living with multiple complex chronic illnesses like diabetes, heart disease and arthritis. Multiple illnesses in one person often means multiple medications prescribed that person. When a person has multiple medications, that increases the chances of medication non-adherence. Medication non-adherence includes things like not taking medications properly, not filling prescriptions at all, missing refills, and skipping doses. Non-adherence statistics in Canada are alarming. It is estimated that 50% of patients with a chronic disease are non-adherent with their medications. Medication non-adherence leads to an estimated $7-9 billion of annual health care cost in Canada. Even more frightening, it is estimated that 125.000 people die unnecessarily every year due to medication non-adherence. One tool available to combat medication non-adherence is a medication review done by a pharmacist.

CARP and Shopper's Drug Mart looked at Medication Reviews across Canada. A medication review is an individualized, in-person meeting between a patient and a pharmacist. It usually takes 30-60 minutes to perform. During a medication review a pharmacist will discuss how to take each medication. They will make sure each medication the patient is taking still matches up with a disease/condition the patient has. For example a patient might not need a stomach acid medication for an ulcer that was healed last year. The pharmacist will review what each medication is for including over the counter medications, vitamins and herbs. If the patient is experiencing side effects the pharmacist will give them information about how to minimize them. If any serious problems with the medications come up during the review, the pharmacist will consult with the patients doctor to solve them.

When CARP interviewed Canadians from BC, Alberta and Ontario who recently completed a medication review with their pharmacist, 85% of them were likely to make medication reviews a regular part of their health routine. The main benefits cited were: preventing and managing adverse drug reactions, ensuring medications were being taken properly, improving medication effectiveness, improving pharmacist-patient-physician communication and having the pharmacist identifying additional clinical services that might benefit the patient.

The CARP study found medication reviews by pharmacists were paid for differently in different provinces. Alberta had one of the most comprehensive medication review programs. To have a medication review by a pharmacist paid for, an Albertan must have at least one chronic medical condition and be taking 3 or more prescription medications or be taking insulin. Most other provinces pay at least something for patients to receive a medication review. However 2 provinces don't pay for medication reviews by pharmacists at all. Those provinces are Manitoba and Quebec.

Recently I was listening to an interview with Walter Mischel, the marshmallow guy. He said I interpreted the marshmallow results all wrong. Just because Eric cant resist a marshmallow (or five) he isnt doomed. The important thing is self control can be taught. Mischel remembered a little girl in his test that ate the marshmallow right away. He told her next time imagine the marshmallow was a picture. Then she was able to resist the marshmallow for 15 minutes because in her words, You cant eat a picture. Maybe we can teach Eric to resist marshmallows. Right after I learn how to resist beer and donuts. Oscar Wilde was right. Maybe Ill just try to resist something other than temptation.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

As always if you have any questions or concerns about these or other products, ask your pharmacist.

CARP Study on Medication Reviews - www.carp.ca/2014/08/26/carp-member-study-calls-enhanced-role-pharmacists-meds-reviews-good-first-step/

CBCs The Current Interview with Walter Mischel - www.cbc.ca/thecurrent/episode/2014/09/23/the-marshmallow-test-of-almost-50-years-challenging-will-power-shows-self-control-can-be-learned/

 


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