The Dangers of Mixing Medications

Well known to geriatricians, the dangers of mixing medications are significant with around 21% of the elderly reportedly on a bad combination of drugs. CHOICE seems unsure who to blame citing historical, practice and industry factors. I would say the blame should fall squarely on no one.

We have very little data on real-life interactions of medicines and must therefore go with automated warnings on GP’s desktops and criteria such as Beers. CHOICE suggests pharmacists need to get more involved – particularly as allied health acquire more prescribing rights.

The practical experience of anyone that’s spent more than a few days in any public hospital says that until patients are given better information and control over what medication they are on, why and where they get it from, we will continue to be in the same situation.

The Choice article does offer some great tips (primarily for clinicians), however, that we should apply in the meantime.

Will Patients Appreciate Big-Brother Pharmacists?

The Australian Pharmacy Guild has adapted software from the USA that allows pharmacists to track patient compliance with their medications. It is an attempt to get expand the professional role of pharmacists. And one drug company, Pfizer, has already teamed up with the guild to get pharmacists to coach patients at the point-of-dispensing if they seem to be missing doses of Lipitor.

It is a reality that compliance is an issue with many medications and therefore the software, named Mirixa, could be useful. But I wonder whether the creators considered what patients will think when a pharmacist leans over the counter and says, to their surprise, ‘you haven’t been taking your medication’! I’m sure, of course, they won’t do that because they will have read the guilds ‘motivational interviewing’ document for Mirixa.

It’s a principle in medicine that you never presume such knowledge, even is you think you have a good idea of compliance to a treatment prescribed. Patients hate doctors being paternalistic. So I find it very hard to see how patients will take to this approach unless they somehow ask to be signed up to the program (according to the consumer info this seems to be the case).

In fact, I wonder how this software fits in with our current privacy legislation? Perhaps someone can help me out? Mirixa does have a statement about privacy here.