In the aged care environment ensuring residents take all their medication every time is a constant challenge. The World Health Organization (WHO) in their report Adherence to Long-Term Therapies – Evidence for Action claims that in developed countries 50 per cent of patients on long-term treatment plans don’t take their medications as prescribed. These 50 per cent skip their medication regularly or don’t take it altogether, which, according to WHO, can sometimes lead to serious health consequences.
The organisation claims that strategies to help patients stick to their long-term medical plan, “…may have a far greater impact on the health of the population than any improvement in specific medical treatments”. That’s a big call, however with non-compliance as high as 50 per cent that statement may be justified.
One of the biggest barriers to treatment plan compliance, as identified in the WHO report, is the inflexibility of disease therapies, therapies (including medications) that don’t take into consideration lifestyle factors, personal comfort and co-existing health issues. It stands to reason that if you make long term treatment plans simple and non-intrusive to a person’s time, comfort and way of life, compliance will be much higher.
Carers in the aged care field know that residents tire very quickly of taking large numbers of pills, sometimes two or three times a day. And if the resident suffers from dysphagia and the pills are large and hard to swallow, the situation is exacerbated.
Staff at aged care facilities often resort to crushing large pills and dissolving them in juice or water to make administration easier and less anxiety-inducing. You can understand why they would do this, however this practice has been shown in numerous studies to be a problematic at best and dangerous at worst.
A study by the University of Queensland last year found that up to 24 per cent of a medication can be lost when a pill is crushed. Over time, missing out on that quarter of active ingredients could have serious ramifications for a person’s health – it’s essentially the same as skipping a couple of days through the week.
And according to the government’s NPS MedicineWise agency:
“The stability and bioavailability of drugs can be significantly changed by the simple act of crushing a tablet, preparing an oral liquid from a tablet or capsule, or mixing a crushed tablet or capsule powder with food or other thickening agents.”
“Manipulating solid dosage forms remains a significant source of medication error and harm to patients.”
On its website NPS MedicineWise recommends that in cases of dysphagia, if a commercially available liquid version of a drug, or a suitable drug alternative cannot be found, then health care workers should consider, “extemporaneously compounded medicine – this remains off-label use but is produced using an evidence-based approach”.
They refer to a service offered by licensed and regulated compounding pharmacists whereby they make up a person’s medication in the form of a liquid, troche or in some cases a cream. The same ingredients as the prescribed medication are used, just delivered in a different form, a form that’s much easier to swallow or administer. It’s a service often referred to as ‘personalised medicine’.
However, while they’re constantly challenged by treatment plan compliance and understand the seriousness of the issue, many GPs working in the aged care field don’t pursue the option of personalised medicine, assuming it will be prohibitively expensive and difficult to arrange. They would be wrong on both counts.
In most cases personalised medicine is no more expensive than mass-produced drugs and an experienced compounding pharmacist will be fully aware of what the GP is trying to achieve and will work with them to make the change a simple process.
Compounding pharmacies can also, in many situations, combine multiple medications in one capsule. This allows patients to take just the one tablet instead of the three or four (or more) they were previously forced to swallow. I currently provide this service for a number of elderly patients on multiple medications, and their carers report that the anxiety commonly experienced around ‘pill time’ has reduced considerably.
Non-adherence to treatment plans is a serious health issue in the aged care sector, as highlighted by WHO and Australia’s own health officials, however compounding pharmacies can offer solutions, as outlined above, that are safe and highly effective.
Matthew Bellgrove is owner and compounding pharmacist at National Custom Compounding.Do you have an idea for a story?
Email [email protected]