iPad pharmacy checklist could be prescription for better health

February 9, 2012


Matthew Murawski, a Purdue associate professor of pharmacy administration, holds an iPad featuring his Pharmaceutical Therapy-Related Quality of Life tool. The tool presents patients with a five-question survey that catches medication-related side effects. (Purdue University photo/Andrew Hancock)

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WEST LAFAYETTE, Ind. - A quick, interactive survey taken on an iPad could help pharmacists and patients better use their brief time together to catch and eliminate harmful drug side effects.

Matthew Murawski, a Purdue University associate professor of pharmacy administration, created a new tool that presents patients with a five-question checklist that catches up to 60 percent of all known medication side effects.

"Many patients do not mention side effects to their doctor or pharmacist because they either don't recognize that they are connected to the medication or they consider them the cost they must pay to keep from being ill or dying," Murawski said. "In addition, patients who are experiencing side effects are less likely to take the medication as prescribed or may stop taking the medication altogether, which can lead to catastrophic health consequences. Pharmacists can work with patients to eliminate most of these side effects, but they can't help if they don't know what the patient is experiencing."

Exponential growth in the traffic at pharmacies over the past few decades has slashed the time pharmacists have with each patient to an average of two minutes - one third of what the counseling time was 20 years ago - and a system was needed to help make the discovery of adverse reactions easier and more efficient, he said.

"With all of the training and education invested in every pharmacist, I honestly believe they are the most underutilized health-care practitioners," Murawski said. "This tool makes the few minutes available for counseling much more rewarding. The checklist results allow the pharmacist to immediately see side effects the patient is experiencing and target their time to solving these problems and improving the patient's quality of life."

Pharmacists may suggest simple changes like taking a medication after meals or avoiding certain foods, or they can work with a patient's physician to change medications or develop a different therapy plan, he said.

When a patient arrives at a pharmacy they could be handed an iPad with the checklist to fill out while they wait. A list of medications, including both the generic and brand names, is presented on the first screen and the pharmacist selects the medication the patient is taking. A patient is then presented with yes-or-no questions that cover the most common and serious side effect symptoms and the degree to which the problems are experienced. Once the checklist is complete, the iPad is returned to the pharmacist. The results are displayed as colored bars that show which side effects occurred and which are most problematic.

After each consultation, the pharmacist resets the checklist before the next patient uses the iPad. Because the patient does not enter any identifying information and the checklist results are not saved, the same iPad can be used by multiple patients without the risk of revealing private information. Patients would have the option of allowing their anonymous results to be collected for further research into the incidence of adverse reactions and harmful side effects.

Murawski's method, named Pharmaceutical Therapy-Related Quality of Life or PTRQoL, began as paper checklists that took up multiple file folders behind a pharmacist's desk. Mark Sharp, director of Purdue's Hook Teleproduction Center, helped automate the paper checklist and created the user interface and software that is compatible with iPads and other tablet devices and platforms.

Side effects from medication use in the general population are not routinely tracked and reported. The results of clinical trials and the federal government's adverse event notification system were the only sources of such information when Murawski began his research two years ago. These represent the extremes of the best and worst conditions, he said.

"Clinical trials involve ideal conditions in which preselected patients take the drugs exactly according to direction, and the adverse event notification system is used only for really severe problems," Murawski said. "These results do not necessarily translate to the reality of use in the general public. I wanted to know the sharp end of the spear - what was actually happening in the pharmacies and with the average person."

A seed grant from Lilly Endowment Inc. through Purdue's College of Pharmacy funded Murawski's investigation into the side effects being experienced by patients at 10 community pharmacies in Indiana.

Murawski focused his study on the top 200 most-dispensed drugs in the United States, which account for 90 percent of the volume in pharmacies. He sorted these medications by their drug classes and then cataloged all of the potential side effects for each class.

From the 2,000 surveys completed at the sites, Murawski found that approximately 50 percent of patients reported experiencing a symptom that could be a drug-related side effect, and pharmacists were able to confirm 20 percent of these were directly tied to medication use. He extracted the incidence rates of each side effect and created a new checklist weighted by the severity of the problem and the most common problems experienced.

Sometimes side-effect symptoms can be a sign of something more serious, including taking an improper dose of the drug, an interaction with another medication or a harmful drug reaction. The sooner a pharmacist or physician can detect such problems, the better, Murawski said.

In addition to health risks, such problems can be expensive. According to a study published in the Journal of the American Pharmaceutical Association, the cost associated with managing drug-related problems exceeded $177.4 billion in 2000.

The costs to people's health and the health-care system from patients not taking a drug as prescribed or discontinuing a medication without consulting a health-care practitioner have not been well documented. A study by the International Society for Pharmacoeconomics and Outcomes Research that examined drug compliance for patients suffering from diabetes or osteoporosis found that the rate of hospitalization increased as adherence to a medication regimen dropped and overall medical charges were much higher for those who did not take medication as prescribed.

"If someone stops taking a drug as prescribed for a chronic condition there will be health consequences immediately or years down the road," Murawski said. "The detrimental health effects could lead to hospitalizations or the development of another illness, and this can be very expensive for both the individual and the health-care system as whole. It is very important to try to work with someone to solve any issues that could keep them from taking a drug as prescribed."

In addition to the iPad tool, Murawski sees the potential for a kiosk version that could be integrated with a pharmacy's computer system. A patient could swipe an ID card or type in their name and the system would tailor the checklist to their medication records. He also hopes pharmacies could incorporate the results into a patient's record and maintain an ongoing history that would allow for more in-depth questions with each subsequent visit.

"Currently we present a patient with five questions that get about 50 to 60 percent of all side effects," he said. "If we have more time and can continue down the list of questions and get more specific, we could capture all known side effects."

Murawski plans to continue to accumulate checklist results and gather data about the incidence and severity of medication side effects in the general population and to further refine the PTRQoL tool.

PTRQoL is available for licensing through Matt McFarland, associate director of commercialization in the Purdue Office of Technology Commercialization, at 765-588-3487, mjmcfarland@prf.org

Writer: Elizabeth K. Gardner, 765-494-2081, ekgardner@purdue.edu

Source: Matthew Murawski, 765-494-1470, murawski@purdue.edu

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