Monday, September 6, 2010

My experiences with teaching medication management

I have found there are a number of factors to consider when trying to help a client learn to manage his or her medications.

The most important factor seems to be: does the person really want to take the medications? Does he or she really feel they will help? If the answer is no, then all the reminders in the world will not help. A little motivational interviewing and education on the illness/condition and on the specific effects of the medication can be helpful. Often the person ends up having to receive his or her medications through injection. Where I live, we can have Home Care come in to provide reminders to take them, which seems to help improve adherence.

Another thing to consider, is that if the medication is good, the person does not experience the symptoms, and it is human nature to want to go off it. I went off my asthma medication – in hind sight it was a really bad idea. In this situation, I encourage my clients to try to negotiate with the prescribing doctor a reduction in medication, or a medically supervised break from it. It is not ideal to be going off medication as it can sometimes cause a loss in functioning that the client may not fully recover from, but it is certainly better to do it in a supervised way than on his or her own. A good thing to do prior to experimenting with decreasing dosages is to complete a Wellness Recovery Action Plan, or something similar.

If the person genuinely wants to work on remembering to take his or her medications, many different kinds of reminders are available. Most pharmacies around here now use bubblepacks, which can be incredibly helpful for remembering if you have already taken your medications or not. They can even include your vitamins, and there is no charge for the service here. Some pharmacies now even have the ability to send a pharmacist to your home to consult with you and your family (a free service here).

Alarms can be helpful, but the trouble with most regular watches or alarm clocks, is that they only ring once a day, and a lot of my clients take their medications 3-4 times per day. I have found a medication reminder watch helpful on several occasions. It can be set to ring several times per day, and the person always has it on him or her. In Manitoba, if people are on Income Assistance, with a letter to medically justify it, they can have the cost covered. The only trouble is that the medications are not always there when it rings if the person has gone out. Little containers to bring pills in when going out, including waterproof ones to hang around the neck, can be helpful. Some women just keep their bubblepacks in their purses.

Another thing I have found helpful is sticky notes. In particular, leaving sticky notes in places that are associated with daily routines. A great place for a morning reminder is the coffeemaker. My clients almost never forget to have their morning cup of coffee (and neither do I). The important thing to remember with sticky notes and signs is to change them (the color, size, or location) at least once a week so the client does not stop seeing them.

Those are my ideas and experiences. Let me know what has worked for you!

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