At urgent care centers, hospital emergency rooms and physicians’ offices, this scene plays out over and over: The doctor, nurse or tech, pen in hand or laptop at the ready, asks a patient to list every medication. The patient struggles. What’s the name of his latest prescription from the cardiologist? When’s the last time he took that pain pill the orthopedist prescribed for his aching back? Why didn’t he jot down the names and doses of the over-the-counter drugs and vitamin supplements he takes each morning?
While the average American sees a medical provider about four times a year, some see multiple doctors and make many visits. Nearly 6 in 10 American adults take one prescription drug, and 15% take five or more. As the number of providers and prescriptions increase, so does the possibility of confusion. The consequences can be dire.
Recently, for example, a 48-year-old man who was taking flecainide to treat his irregular heartbeat received a prescription from another doctor for fluoxetine, an antidepressant. Taken in tandem, flecainideand fluoxetine can cause sudden cardiac death.
Fortunately, this patient was protected by RationalMed®, an evidence-based safety program from Express Scripts that integrates and evaluates medical, pharmacy and lab data to address safety issues related to prescription drugs and to close gaps in care. RationalMed alerted the second doctor, who discontinued the fluoxetine therapy.
Leveraging Data for Better Outcomes
Across the U.S., fragmented healthcare leads to waste and risk. According to the National Priorities Partnership, 7 million annual medication errors cost the country $4.2 billion in waste. Adverse drug risks – which occur when a patient is prescribed a drug that interacts with another drug previously prescribed or is inappropriate for other reasons – are to blame for 9% of all hospitalizations. Fifty percent of those hospitalizations – one in two – could have been prevented if physicians, pharmacists and other healthcare professionals had access to the actionable alerts sent by RationalMed.
In his state of the industry video series, Express Scripts President Tim Wentworth emphasized that data is a key element to add incremental value to payers and create better outcomes for patients. RationalMed creates integrated patient profiles that include medical claims and prescription drug claims, along with lab test results when provided. The integrated profile contains patient-level, comprehensive data used to analyze and detect therapy-related safety and health risks in three categories: adverse drug risk, coordination of care and omission of essential care. As a result, RationalMed alerts prompted 2 million therapy changes in 2014, providing Express Scripts clients with more than $321 million in pharmacy savings.
RationalMed's Path to Patient Safety
How RationalMed Works
In addition to watching for drugs that are dangerous when prescribed together, RationalMed’s adverse drug risk screening looks for drugs that are inappropriate for patients with specific conditions, including pregnancy; for drugs that are prescribed for too long, at the wrong dosage or to people who are too old or too young to take them safely; and for drugs that duplicate another already prescribed. RationalMed screening also employs pharmacogenomics, where a patient’s gene status may alter the safety and efficacy of a medication prescribed.
When screening for coordination of care, RationalMed looks for patients who have been prescribed a large number of drugs and for signs of misuse or abuse. Omission of care can include a lack of essential therapy, drug-related testing or diagnostics; signs that the patient isn’t taking medication as prescribed; underdosing; or abnormalities in lab tests.
Armed with this knowledge, we can alert physicians, pharmacists, patients and their caregivers that the patient needs to change or stop therapy.
Healthcare in America is complex. Multiple providers, a multitude of payers, an ever-growing array of medications … and at the center, patients doing their best to keep their physicians in the loop. By putting RationalMed in place, we can take that pressure off patients.
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