Issue link: https://www.e-digitaleditions.com/i/316458
ments. As the population skews older, reducing these vis- its and treatments is a simple way to reduce healthcare costs. The "unique physicians" portion of the chart refers to the different physicians and specialists whom a patient with multiple conditions must consult for treatment. Multiple specialists in a variety of fields, including geri- atrics, augment the patients' general practitioners. People with chronic conditions that are not under control visit physicians far more than people who control their conditions. Ongoing continuous treatment is a char- acteristic of chronic conditions that have been untreated or poorly treated. Considering the high cost of untreated or poorly treated chronic conditions, it is surprising that little research and literature address the effects of packaging, doctor-patient counseling, education, pharmacist-patient counseling, and monitoring. Only by offering ongoing treatment and by monitoring the treatment's effect on disease can we maintain these patients, allowing them to lead well functioning lives without the need for high-cost support. Limitations of do-it-yourself management Elderly patients, particularly those who live at home or are alone, are most in need of better treatment, which includes help taking their medicine properly. It is esti- mated that 50 percent or more of all elderly patients take four or more medications for chronic conditions. Furthermore, almost all of these patients are expected to organize and manage the use of these multiple medica- tions by themselves. Many don't cope well. Yet there is still no effective packaging widely available to address the problem. For most elderly patients with multiple chronic condi- tions, the best package is a plastic container that they fill from their prescription bottles. The container typically has seven to 28 compartments divided by day, and/or time of day, to hold a week's worth of tablets and cap- sules. While medicine packaged in blisters is supposed to be managed separately, many patients likely empty the blisters into the compartments as well. The day-and-time container may help patients manage somewhat, but it is less effective in helping people man- age medications that must be taken at different times of the day or with food or after eating. For example, patients may have to juggle a medication that they take twice a day with one that they take four times daily. Even more complicated is combining the schedules of a medication taken on an hourly basis with others that are taken 1 hour before or after meals, which may be consumed at differ- ent times or skipped. The benefits of adherence The cost and the outcome of treating chronic diseases relate directly to patient adherence, meaning how well people follow the directives of their physicians, including taking their medication. Strong programs that promote adherence could reduce healthcare costs by as much as 50 percent. Such programs also reduce the risk of hospi- talization by as much as 50 percent. There are a number of reasons, both intentional and unintentional, why patients don't take their medications correctly. Unintentional reasons include forgetfulness, the need to take multiple medications ("I missed one") 10 May 2014 Tablets & Capsules Figure 3 Activity limitations by number of chronic conditions [4] 0 4 15 28 43 52 67 80 60 40 20 0 1 Number of chronic conditions 2 3 4 5+ Percent with activity limitations Figure 4 Use of physician services by number of chronic conditions (per individual per year) [8] 0 1 Number of chronic conditions 2 3 4 5+ Unique Physicians visits Many elderly people sort their medications into day-and-time organizers, which may help them manage somewhat, but there are better ways. c-Bauerart_8-13_Masters 5/14/14 10:13 AM Page 10