HEALTHmatters MD

By Miriam Sheinbein, M.D., HPSM Medical Director

In the June 2023 HEALTHmattersMD, we offered simple tips that providers can use to improve patients’ medication adherence. To recap, top takeaways were:

1. Be sure to ask your patients about their medication adherence.
2. Simplify your prescription workflow (“90x4”), which has the added benefit of reducing prescriber burden.  

Now, in part 2 of this article series, we’ll cover another key step to improving medication adherence: performing medication reconciliation.  

Medication reconciliation is especially important for your patients with multiple chronic conditions. It provides dedicated time to:

• Engage patients in managing their chronic conditions.  
• Compare the medications prescribed to your patients with the ones they are taking.
• Check patients’ understanding of their treatment plan.

Medication reconciliation also provides you with a focused opportunity to optimize and simplify your patients’ medication regimens.

Tips for simplifying medication regimens

1. Prescribe combination medications when clinically appropriate to reduce the number of pills that patients have to take each day. Combination pills combine two drugs into one pill, such as:

For hypertension

• Lisinopril-hydrochlorothiazide
• Amlodipine-benazepril
• Bisoprolol-hydrochlorothiazide

For type 2 diabetes

• Glipizide-metformin
• Sitagliptin-metformin (Janumet)
• Empagliflozin-metformin (Synjardy)

2. Deprescribe unnecessary medications. This not only reduces pill burden, but even more importantly, it reduces the risk of adverse drug events. For more information, stay tuned for part 3 of this series on polypharmacy and deprescribing in our December newsletter. In the meantime, take a sneak peek at the Resources section of our medication adherence webpage. 

Steps for medication reconciliation

Step 1: Verification

• Ask patients to bring all their bottles (including vitamins and OTC drugs) to each visit.
• Compare the medications in the bottles to the medications listed in your clinical record (and/or to recent discharge paperwork from the emergency department or hospital).  

Step 2: Clarification

• Consider which pills can be prescribed in combination and/or less frequently and which medicines can be discontinued or tapered.
• Discuss recommendations with patients to determine the best treatment plan.

Step 3: Reconciliation

• Document any changes.
• At the end of the visit, give patients an updated medication list.