"TLC" vs. "No Rest for the Weary!"

Caring for older family members can be extremely challenging and exhausting. Anyone who has ever tried to take care of an Alzheimer's patient will know what I'm talking about. It's difficult to get any rest yourself - and if and when you do sleep, you're probably dreaming about it.

I was the pharmacist in a wonderful long term care facility for 18 years. During my rounds on the floors in this 400-bed skilled care facility, I observed many of these patients over the years. I saw how difficult it was for our entire staff to care for them - even with all of their specialized training and equipment. While it's a noble and loving undertaking, I never understood how families could ever manage this kind of care in a home. It can be totally draining - both physically and financially. At some point it's kinder for all concerned to seriously consider assisted living or long term care - without feeling guilty.

Alzheimer's robs people of their memory in a backward regression. Several patients who had played the piano in their younger days, could still play an entire classical piece from memory, but they could not tell you what they had for lunch 5 minutes ago... or even if they had lunch at all. The older memories seem to be safely embedded in the deepest part of the brain, but recent events just bounce off the surface like water off a duck's back or a little like peeling away layers of an onion. (and both can make you cry...)

Families would often come into the pharmacy asking about some drug that they had seen on TV. These people were desperately looking for something... anything that would help their loved ones. Unfortunately, I had to tell them in all honesty, not to waste their money. True, there are drugs that are promoted for slowing the progress of the disease, but from my observations, they gave the family a little hope but did very little, if anything to help the patient.

To better understand what is happening, I would describe some very basic truths about aging, which seemed to explain a lot - about older people - and especially Alzheimer's patients:

As people age, all of the 5 senses will diminish over time.

"Sight" and "hearing" are usually the first to decline, which can severely limit mobility. If you can't see and you can't hear, it's difficult to get around on your own, and even the simple pastime of watching TV becomes a bother. This lack of freedom increases feelings of isolation and can cause depression and anxiety. It is even more troubling for Alzheimer's patients. When it starts to get dark outside, these patients often realize they're not where they should be (at home or in a familiar place) and they panic because they can't remember where home is. This is called: the Sundown Syndrome. I imagine this is what it would be like having amnesia.

When we lose our sense of "smell", it also affects our sense of "taste", which explains why most older people have lost their appetite. Familiar foods just don't smell or taste good - so why bother? They forget to eat and drink. Poor nutrition will lead to a rapid decline in health, and that's why it's important to provide daily vitamins to supplement the nutritional deficiencies and offer frequent glasses of water to avoid dehydration. These patients simply forget to drink water, because they don't remember what it means to be thirsty or what to do about it.

Interestingly, the sense of "touch" is the last to go. A hug, a kiss, a pat on the hand will still reach patients who may no longer even recognize family members or caregivers.

A gentle touch is the most positive and effective way to connect and provide real "TLC" when little else works. And best of all - both patient and caregiver will benefit from this type of "physical therapy" and everyone can afford it. So dispense it in big doses - as needed.

A smile never goes out of style, so wear one all the time - you may find that they're highly contagious!

Hope this helps a little.

Use Technology - Connect with Patients

Tip #71 in the APhA booklet, "100 Tips for the Pharmacist", describes how pharmacies can use automated email or phone reminders to connect with patients who are having compliance issues. (That's about 50% of all patients, if the stats are right!)

Several major pharmacy chains heavily promote the convenience of their auto-fill service, which sounds good and is supposed to improve compliance - in thoery. However, there is a very real potential backlash effect to these programs.

If patients haven't taken all of their pills consistently, they obviously won't "need" their Rx refilled on a consistent basis either. In fact, when a mail-order auto-refill arrives, and there are still a lot of pills left, the patient may think this is just another "senior rip-off" to sell more drugs. Sure looks that way...

When a patient fails to pick up the auto-fill in the pharmacy, someone will have to put the drugs back in stock, reverse the claim or credit card charge, and fill it all over again, when the patient finally does run out. That's a duplication of effort, and total waste of time and supplies. Medicare pays out enough already without creating stockpiles of medications that aren't being taken and may potentially wind up being shared with others.

Instead of focusing on automating prescription refills , the pharmacy should be more focused on helping the patient to take the pills routinely. Then an auto-fill program makes perfect sense.

A simple automated phone call reminder or two on a daily basis, or automated email/text messages could very effectively remind the patient to take each dose, and everyone would benefit.

We have the technology. It just needs to be utilized and provided to the patient by those who have the most to gain.

So... who benefits?

1. Big pharma!!! Better compliance sells more product and reduces therapy drop-out. Big pharma really has the most to gain and the resources to provide this service.
2. Insurers!!! Better compliance reduces costs by eliminating unnecessary trips to the emergency room.
3. Patients!!! Better compliance improves disease management and keeps patients healthier.
4. Everyone!!! Better compliance would keep costs down and that benefits the entire health care system.

100 MTM Tips for the Pharmacist

What is MTM anyway?

MTM is the new "buzzword" in expanded roles for pharmacists. It's shorthand for Medication Therapy Management.

The MTM concept is nothing really new - most of us have been doing this sort of thing for our entire careers. What is new is the fact that Medicare has recognized MTM is reimbursable, and pharmacists can finally get paid for providing this valuable patient care service.

Pharmacists who are just now getting involved in MTM can learn from other practitioners who are reaching their patients and providing needed help managing medications. They can also learn about the kinds of services others have found to be truly effective. Innovative pharmacists are always looking for tips from successful practices and practitioners.

It's only fitting that MTM was one of the hottest of hot topics at the annual meeting of the American Pharmacists Association earlier this month in San Antonio. A new APhA publication, "100 MTM Tips for the Pharmacist", was showcased. I'm especially pleased with the booklet, which was authored by Marsha K Millonig, BPharm, MBA, a registered pharmacist. (I have a 1st edition copy signed by the author!) This booklet is available for sale to anyone - APhA member or not.

Marsha put out a call to the APhA membership for tips and comments on "What Works" in MTM and picked the 100 that she deemed worthy of inclusion. Three of those 100 Tips were mine!

Tip #24 - Provide a Medication Reminder Service for High-Risk NonCompliant Patients.
Obviously, I recommend OnTimeRx Automated Reminder Services. It's "my baby" and I raised it from a seed of an idea to be a valuable service to others. We have worked with professionals at transplant clinics and AIDS specialty pharmacies to provide reminders for those high-risk patients. I know the system works from first hand experience.

The success rate of any transplant facility depends on patient compliance; and if big pharma were inspired to provide a reminder service for organ recipients, it would provide major benefits - some subtle and some not-so-subtle. Better compliance can assure that more organs are available for the thousands on waiting lists. That's not subtle at all!

Newly-transplanted patients have to learn to cope with sudden and drastic changes in their newly "drug dependent" lives. That's not subtle either! But this simple reminder service could help them manage their very complex drug regimens more easily, which is especially critical during the early months after surgery.

I can't think of a more perfect example of a vitally needed MTM service for a high-risk patient. Maybe someday... in a more perfect world!

I'll tell you more about Tip# 71 and #87 in future posts.

Why Doctors Don't Give Patients Credit

We are not talking about a patient getting a "Credit" for unsatisfactory services rendered. I'm talking about patients not receiving credit for being capable of using technology in any of its many forms.

Au Contrare! There are thousands of "ordinary people" with extraordinary medical conditions and physical barriers who use OnTimeRx every day, and tell me they could not live without it.

Ron, a VA patient and long-time user of OnTimeRx software, called me recently to find out the latest news from OnTimeRx HQ. During our conversation, we were bemoaning the fact that most doctors move at a glacial pace when it comes to adopting new technology. He was especially frustrated because the VA has spent a lot of time and money developing the "My HealtheVet" website, but there are many other inexpensive and practical technology tools that could be used by veterans to ease their burdens and simplify their lives even more.

Ron said, " OnTimeRx works really well for me, and I've told all of my VA doctors about OnTimeRx repeatedly." He also wanted to know, "So why don't these doctors order a PDA with OnTimeRx for Traumatic Brain Injury patients - and others - to help them manage their medications and other treatments?"

Here's my theory:
Doctors in general consider themselves to be pretty smart people; and rightly so. IF they are using a PDA, smart phone, or BlackBerry, it's my guess that they probably had a lot of trouble getting it set up and working properly. So, that being the case, they just naturally assume that patients who have less education and compromised mental skills would probably never be able to handle it. This is absolutely not true, but it's probably why the doctors don't even consider an inexpensive laptop, netbook or hand held computer (PDA) as an Assistive Device or Prosthesis for their patients.

Maybe it's time for VA patients with any kind of memory problems to start requesting this OnTimeRx software/hardware adherence solution and save everyone a lot of time, money and heartburn. For $23-$30 worth of software and $100 -$400 (depending on the hardware selected), any patient could improve his or her adherence rate and live better, with less stress, by using the technology that is readily available everywhere.

That's not a theory - that's a fact!

Portable Health Records in a FLASH

...One never knows when an accident may occur and a few seconds could save your life. Would you be ready and able to answer questions about your medical history in an emergency? (That's a hard question to answer right there! You may be dazed - in shock - or worse!) I have trouble filling in all the blanks on a new patient form when I go to a new doctor - and there's no emergency medical team pressing me for answers!

It really pays to plan ahead and be prepared - just in case. Having your personal health record (PHR) with you is very much like buying insurance. You don't wait until you wreck the car to purchase a policy. You can't afford to wait in this case either. It just makes sense to spend a little money and a little time NOW for a whole lot of peace of mind later. Then you can rest easier, knowing you really do have everything "covered".

As a card-carrying" Organ Donor, I certainly intend for my wishes to be known and respected if the worst happened. I have made arrangements with my family and my primary physician, but those people may not be with me at "crunch time". So I now carry a MedFlash Personal Health Record on a flash drive.

Every EMT uses a laptop these days, and it's a simple thing to pop my MedFlash device into any USB drive and read all about my medical condition, such as: the medications I'm taking, my I.C.E. contact(who to call In Case of Emergency), my doctors' phone numbers, etc. Very simple - very easy.

It's also critically important to keep your information up to date. You can easily schedule an OnTimeRx phone or email reminder to tell yourself to access your online MedFlash account and review and update the information monthly.

Accidents happen in a flash! I strongly urge everyone to "Be Prepared"!

Put Your Old PDA to GOOD Use

A caregiver contacted me recently and asked if OnTimeRx software would work on an old Palm devices. This person had an old M515 Palm PDA lying around and thought it might be useful for his elderly mother to remember to take her pills.

Not only will it work... That's a PERFECT USE for IT!! (It certainly isn't doing ANYONE any good stuck in a desk drawer storing dead batteries. )

I've been advocating the use of PDAs for older people for years. We can document that they work well by the results of a small compliance study that was conducted at PennState, using Palm devices. Dr. William Curry wanted to see if older patients in his Family Practice setting could handle the technology. Much to his delight and mine, they did very well. In fact the oldest participant in the study was 87 and she had a 97% compliance rate. It was almost too good to be believable, but it was true.

"In a pilot study in the fall of 2005, 10 individuals aged 36 to 87 years participated in a one month trial of the PDA and OnTimeRx software. Adherence improved by using the device and exceeded 95% in almost all participants, with a 97% rate in the eldest participant."

So... What's AGE got to do with it? Really!!!
Technology comes in many forms and can help people of all ages if they're willing to try new things.

One of the biggest barriers to more people using OnTimeRx software these days is the fact that Palm has stopped producing the Palm OS hardware. So about the only way that "Boomers and beyond" can utilize the PDA medication reminder approach is by borrowing old devices from their children or grandchildren.

This should not pose a problem for anyone concerned, because as each new device comes along, a person upgrades and rarely disposes of the old "obsolete" device. They're around somewhere, just aching to be put back into service for a "Good Cause"... and what better "cause" is there if Grandma needs to be gently reminded to take her pills.

Some older Palm and Windows Mobile devices can also still be found on eBay at really good prices - if you act fast. I would LOVE to see old PDAs collected and recycled for use by seniors - just like they do old cell phones.

Why not repurpose YOUR old hand held devices and turn them into excellent pill reminders for the grandparents in your life. Who knows? It may be just what the doctor ordered!... and he didn't even know it existed. Give it a try.

Phone Calls for all Occasions

What types of people use automated phone reminders?

1. "Granddad" insists on living alone or has finally moved into assisted living. How do you make sure he's doing OK in either case? Like many older folks, he may be napping all afternoon and getting his "days and nights mixed up". Staying up all hours of the night can add a level of confusion that certainly isn't needed. Confusion can be caused by some medications as well and it all lumps together to make it even more difficult for him to remember all the things he should do - including taking his all important medications. So what's a family to do?

You may live in a different city or simply can't keep running over to check on him, but an automated phone call will wake him from his nap time at a reasonable hour each afternoon, and he won't miss out on dinner at his assisted living facility. It's a non-judgmental call, so he won't mind the wake-up call reminder.

2. "Grandmom" has been a widow for several years and insists she can manage just fine on her own. You aren't so sure, but you still don't want to insult her by questioning her capabilities. What can you do?

Maybe it's time to have the "Get-A-Call" discussion. Tell her there are ways to use the phone that will help her stay in the old homestead by herself and give you the peace of mind that she's taking her medications properly or waking up in time for her favorite TV shows, etc. Automated calls help maintain her treasured independence, and they take a bit of stress and pressure off of the family.

3. "Junior" doesn't like to stop playing video games to do homework. Mom and Dad are simply tired of nagging about it every afternoon. The confrontations are counter-productive and stressful. Why not schedule an automated phone call especially to remind "Junior" that it's time to put down the game controls and hit the books. Again, automated calls are non-judgmental and the request or directive is coming from a "third party" that "Junior" can't argue with.

4. "Auntie May" lives alone and is very independent, even though she's nearly blind and a bit hard-of-hearing. She needs to take very important medications at the same time every day for best results. She's tried several normal reminder alarms, but they aren't loud enough so they don't work. However, she has the volume turned way up on the phone ringer and hears it just fine. With an automated call, when the phone rings and she answers it, a special voice message will tell her that it's time to take her pills.

You can listen to an audio sample of a basic phone reminder. And you can also change any of your custom messages every day or every week if you want - just to keep it interesting and maybe even fun. Will it help? We think so. And it doesn't cost a thing to try it out.