“Don’t forget to take your medicine!” Improving the use of medicine by elderly patients in the region of Madrid

Change management

The first challenge was to reach out to the patients who were eligible for the programme and to persuade them to get involved. This was achieved through a combination of active, passive and targeted outreach initiatives.

In the first place, medical staff working in health centres approached patients who were visiting the health care centre or who had home visits. Pharmacists also made patients aware of the programme when they picked up medication from the pharmacy. At the same time, a public campaign was launched by putting up posters about the programme in facilities frequented by the elderly. In addition, the Health Agency of Madrid Region identified every patient who was eligible for the programme and requested their GPs to tell them about the new programme.

At the start of the programme patients have an appointment with a nurse to make an assessment of all the medications they are taking. This includes prescribed medications but also those medications available without prescriptions and 'alternative' medicines.

This initial assessment is followed by an in-depth assessment by medical staff in order to:

assure that the medications taken by the patients conform with those prescribed in their medical history - this identifies both gaps, where medicines prescribed are NOT being taken, and also use of medication which was not prescribed;
improve patient's knowledge about the purpose of various medications;
identify the degree to which medications are taken according to the prescription;
identify problems such as lack of regular taking of medications, duplication, and suspected adverse reactions to medication;
agree a set of personalised tools and triggers with the patient which help the patient to achieve a successful outcome (e.g. user-friendly and memorable labels on medicines, and personalised mechanisms for dispensing the daily medications, sometimes in an apparatus which is recyclable, sometimes single use only).

This approach entails a number of tests to enable medical staff to get to know the patients and understand their capacities and attitudes. Then a medication plan is co-designed with each patient taking part in the programme.

Figure 1 provides an overview of the tests carried out with the patient to assess needs and capacities.

Figure 1: Needs and capacity assessments for elderly patients requiring multiple medication

Based on this assessment the GP produces a ‘medication leaf’ which shows the relation of all the medication the patient needs to take with his/her condition as well as the start and end date of the treatment. Particular attention is given to issues of safety in the use of medication by avoiding medication which is not adequate for elderly people or is more likely to produce adverse effects and the prevention of possible medication mistakes. The ‘medication leaf’ needs to be reviewed at least every six months.

In order to ensure compliance with the personalised medication plan health visitors and staff of pharmacies continue to engage with the patient in a number of follow-up activities, including:

a) health education of the patient;

b) checks whether the medication is taken properly to identify problems at an
early stage and jointly discuss possible solutions; and solutions

c) the distribution of tools and materials to achieve a succesful therapy.

The biggest challenge is to ensure that elderly patients with chronic conditions do not stop taking prescribed medication too early. Therefore, the health programme for patients with multiple medication of the region of Madrid foresees three levels of support:

1) Self-sticking labels to stick on medication containers which provide instructions how to use the medication

2) Personalised medication systems which can be reused (weekly medication trays)

3) Personalised medication systems for single use

About this case study

performance indicators

cost and savings

learning points

further information

Main Contact

Encarnación Cruz Martos
Subdirectora de C. de Farmacia y P.S.
D.G. de Gestión Económica y de Compras de Productos Sanitarios y Farmacéuticos
Servicio Madrileño de Salud. Consejería de Sanidad

Email: encarna.cruz@salud.madrid.org

Phone: 00 34 91 426 9917/9902

Fernando Gil and Salvador Parrado wrote this case study for Governance International on 28 August 2012.