How Medication Decision Support Can Enhance Drug Optimization and Compatibility

Optimizing medication compatibility among health plan participants is about more than attempting to review a long list of potential one-to-one drug interactions using antiquated methods. It’s about evaluating whether an individual’s medication regimen is compatible through a comprehensive analysis of simultaneous, multi-drug interactions, as well as genetic composition. By using more modern and advanced tools, we can better assess and mitigate the potential risk of medication-related harm.

Orsula Knowlton

The risk stratification systems that many healthcare organizations use assess the probability of harm solely on diseases. However, people with the same disease may be on different drug regimens to treat that ailment and other conditions. Those different drug combinations may present distinct risks. For example, certain medications may contribute to a prolonged heart rhythm, which can be dangerous and even fatal. Knowing exactly which medications a person takes can help gauge and monitor such risk.

An accurate medication list can involve many moving parts. Individuals may receive prescriptions from more than one healthcare provider, including an internist, cardiologist, endocrinologist, and so on. It’s vital to incorporate medications from all providers in the comprehensive analysis because a new prescription might interact with various other drugs.

Participant- or patient-reported data can shed some light on an individual’s level of medication adherence and any mitigating factors driving their behaviors (e.g., side effects). We know that pharmacy systems’ tracking of adherence using refill data may not reflect how patients actually take their medications. If an individual is not fully adherent, a discussion with a clinical pharmacist or healthcare provider can go a long way in helping them understand their medications. These conversations are grounded in motivational interviewing and educating patients on the reasons they were prescribed certain medications as well as the often-long-term benefits.

For help in stratifying risk, tracking medications and adherence, and ultimately enhancing medication optimization, health plans and healthcare providers can leverage tools and services. But not all support is alike. The more impactful options provide comprehensive medication reviews that analyze the drugs an individual actually takes and the interactions that could arise as they work together in the body.

Pharmacogenomic analysis can further enhance medication optimization, as it can help determine how an individual might metabolize different medications based on their genetic composition. A study published in the Journal of Palliative Medicine in February employed pharmacogenomic analysis for patients with advanced illness — all of whom were taking at least one opioid and at least four other drugs.

Participating clinicians received pharmacogenomic information, including recommended guidance surrounding the potential for multi-drug and drug-gene interactions. In particular, the recommendations specified an interaction, highlighted the potential for a resulting change in a drug’s effects, and discussed the path forward (e.g., communicated the importance of monitoring during therapy, suggested dose reduction). According to the clinicians, more than half of the patients enrolled in the study received one or more changes in treatment due to the pharmacogenomic information.

Advanced medication decision support can make all the difference in optimizing drug regimens, helping to evaluate whether the medications an individual takes are compatible with one another and with the individual’s genetic composition. More specifically, by stratifying a population to assess risk based on accurate medication lists, using patient-reported adherence data, collectively analyzing potential multi-drug interactions, and employing pharmacogenomic analysis, such support can greatly strengthen the safe use of medication amongst health plan participants.

Orsula Knowlton, Pharm.D., MBA, is founder and president of Tabula Rasa HealthCare, a healthcare technology company.