Premera Blue Cross Effort With Washington State Medical Association May Reduce Potential for Medication Errors.

News Editors, Health/Medical Writers

MOUNTLAKE TERRACE, Wash.--(BW HealthWire)--Jan. 22, 2002

New Results Reveal One in Four People Taking Multiple Medications

May Need Different Drugs or Dosages

Hundreds of thousands of people in the Northwest take multiple medications for chronic conditions.

If you're one of them, review all of your medications with your doctor. You may be in for a surprise.

That's the conclusion of a successful six-month pilot effort by Premera Blue Cross with assistance from the Washington State Medical Association (WSMA), aimed at reducing medication errors by encouraging people to review their medications with their doctors.

Premera Blue Cross released results today of a voluntary survey among 11,000 Premera Blue Cross members involved in the pilot. The survey revealed that when members' own doctors had a chance to review all medications their patients were taking, doctors found more than one in four patients needed medication changes.

"Thousands of people must juggle many different pills each day," noted Dr. Roki Chauhan, Premera Blue Cross Medical Director for Quality. "These medications are prescribed by different doctors for different conditions, and sometimes filled at different pharmacies. To that, add in self-prescribed over-the-counter drugs and herbal remedies. If you're not careful you can have a formula for trouble. The message here: be sure your doctor knows ALL the medications you're taking."

"This is a great example of common-sense approaches that can help prevent needless adverse medical events from occurring," said Dr. Sam Cullison, President of the WSMA. "This is just one way we're all playing our part in helping the system work better."

Both organizations credit the pilot's success to a decidedly humble instrument: a brown paper bag.

"For all the complexity of health care, this shows once again that the best solutions are often the simple ones," said Dr. Roki Chauhan, Premera Blue Cross Medical Director for Quality.

For its pilot study begun in June 2001, Premera Blue Cross mailed a brown bag labeled "MedCheck" to a carefully targeted list of 11,000 members over age 55 who take five or more "maintenance" medications daily.

The "MedCheck" brown-bag concept was developed by the Washington State Medical Association in the early 1990s.

Premera enclosed the WSMA "MedCheck" brown bag in an oversized brochure advising members to bag up their medications and bring them to their next doctor appointment for review.

The results were remarkable.

Thousands of people -- more than one-third of those receiving the information -- filled up the bag and brought it to their doctors.

After reviewing the contents, their doctors advised more than one in four patients -- 27 percent -- that changes in medications or dosages were necessary.

Based on the study results, 44 percent of the patients received dosage changes after doctors reviewed all drugs they were taking; 36 percent were advised to stop taking at least one existing medication; and 38 percent were advised to begin taking at least one new medication.

"Originally we offered MedCheck bags to our member physicians and encouraged them to ask patients to bring their medications in for review," said Dr. Cullison. "Doctors loved the concept, however, we had know way of tracking how many patients and physicians were using the program. Then Premera Blue Cross approached us with the idea of this joint, targeted effort."

"The value of these results -- and the lesson -- obviously extends far beyond Premera Blue Cross members or people with chronic conditions," noted Premera's Chief Medical Officer, Dr. John Castiglia. "This is another example of how Premera provides information for doctors and consumers to facilitate more informed health-care decisions."

The Premera Blue Cross/WSMA program will be expanded to more Premera members in Washington and Alaska this year, and the Washington State Department of Health Medication Safety Task Force has expressed interest the program.

Premera Blue Cross (also operating in eastern Washington under the name "MSC incorporated as Premera Blue Cross") is a regional health plan serving more than 1 million members in Washington and Alaska. Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. The PREMERA family of companies also offers a health plan in Oregon.

The Washington State Medical Association is a statewide professional association of physicians and physicians assistants with over 8,000 members.

                  PREMERA BLUE CROSS FACT SHEET No.1:
               Multiple Medications -- A Cautionary Tale
   ---------------------------------------------------------------

    --  In 1999, the National Academy of Sciences Institute of
        Medicine (IOM), reported that more than 7,000 people die each
        year from preventable medication errors.

    --  Errors are costly, as well, says the IOM: Preventable
        medication-related errors in U.S. hospitals alone may cost
        society some $2 billion per year.

    --  The IOM suggests this is a very modest estimate of the overall
        problem, since hospital patients are much better monitored and
        inpatient prescriptions represent a tiny fraction all
        prescription drug use.

    --  Patients taking multiple medications are vulnerable to the
        following:
        -   Increased risk of adverse health effects
        -   Increased risk of drug interactions
        -   More difficulty for patients to remember what each drug is
            indicated for;
        -   Increased risk of non-compliance and likelihood that
            patients can't remember to take all their medications;
        -   Increased risk that patients will take discontinued or
            expired medications
        -   Increased cost to patient

    --  In March 2001, Premera Blue Cross analyzed its pharmacy claims
        data and discovered that about 21,000 of its members over age
        45 are taking are taking five or more "maintenance drugs" at
        once for chronic conditions.

    --  Projected statewide, the number of people in Washington taking
        at least five prescription drugs and over-the-counter or
        herbal remedies for chronic conditions easily numbers in the
        hundreds of thousands.

    --  The study found that over two-thirds of patients (68 percent)
        received prescriptions from multiple physicians. One-third of
        patients received prescriptions from three or more doctors.

    --  Following the IOM report and recommendations that the entire
        health care system look for ways to address medication errors,
        Premera Blue Cross undertook a project to support health-care
        industry efforts to:
        -   Reduce potential for duplicate drug combinations
        -   Reduce potential for drug-to-drug interactions
        -   Reduce potential for medication errors
        -   Reduce potential for unnecessary adverse drug events
        -   Reduce use of unnecessary medications

SOURCE: PREMERA BLUE CROSS


                 PREMERA BLUE CROSS FACT SHEET No. 2:
         5 Potential Problems With Multiple Medications -- and
                           How to Avoid Them
    ---------------------------------------------------------------

    --  Problem: It may be hard to remember the purpose of each
        medication
        -   Tip: Keep a list of your medicines. Write down the name,
            dose, how to take it, and why you're using it.
        -   Tip: A free My Medication List chart is available on
            Premera Blue Cross web site at www.premera.com.

    --  Problem: Combined medications may caused unwanted side effects
        -   Tip: Check with your pharmacist or doctor before taking
            any medication.
        -   Tip: Be sure to include herbal supplements,
            over-the-counter cold medicines, etc.
        -   Tip: Consider using only one pharmacy for all prescription
            medications.

    --  Problem: Duplicate medications may be prescribed by different
        doctors
        -   Tip: Tell your doctor whenever you or a different doctor
            starts or stops a medicine, or changes a dose.

    --  Problem: It may be hard to remember to take medications or
        refill them on time
        -   Tip: Put your medicine in a pillbox ahead of time for each
            day of the week (these area available at most pharmacies)
        -   Tip: Mark your calendar for when you need to get a refill.

SOURCE: PREMERA BLUE CROSS