PCPs should talk to patients about OTC pain relievers, drug reconciliation

When choosing an OTC pain reliever, 37% of those with cardiovascular disease, and 43% of those with high BP, fail to consider their current health conditions in their decision making process, according to a new national survey from the U.S. Pain Foundation.

The survey, conducted online and via telephone with the support of McNeil Consumer Healthcare, polled 1,292 U.S. adults and found that 45% do not consider the prescription medications they are currently taking when choosing an OTC pain reliever. In addition, 58% fail to consider pre-existing health conditions, 65% do not consider other OTC medicines they are taking, and 73% of those 60 years and older do not consider their age.

According to Charles Vega, MD, clinical professor of family medicine at the University of California, Irvine, these figures highlight the fact that, in primary care, it is important for PCPs to fully consider a patient’s medications, in general and analgesics specifically, and to conduct medication reconciliation in a meaningful way.

“That means having the patients bring in all of their medication and understand all the different things they are taking, whether it’s prescription medications, or OTC drugs, which they might be using for pain, or for itches or for sleep, as well as their various supplements and vitamins,” Vega told Healio Family Medicine. “And then it’s our task to interpret it, and see potential synergies and benefits, but also potential consequences, particularly in high-risk patients. Those with cardiovascular disease are a high-risk group.”

In particularly challenging cases, in which patients are not bringing in their various prescription and OTC medications, that may include home visits. According to Vega, visiting a patient’s home can be a “wonderful opportunity” to increase the quality of care in multiple ways, including safety.

However, he acknowledged that not all practices have to resources necessary to dedicate to home visits.

“Directly looking at how patients store their medications, and use their medication, is a very meaningful experience, and of course patients really appreciate this,” Vega said. “I don’t think that most practices have the ability to perform home visits on a routine basis, but maybe there are other home health services that can be employed, particularly in places where there has been a complication.”

According to Vega, that is particularly true of patients with a history of cardiovascular disease.

“Think about a patient with a history of cardiovascular disease who comes in with acute kidney failure or gastrointestinal bleeding, or a recurring cardiovascular event,” he said. “Maybe there was something at home, related to adherence, or related to interactions between drugs that can be discovered with a home visit.”

In patients with cardiovascular disease, there are many potential drug interactions that could potentially harmful effects, including a recurrent cardiovascular event, Vega said. Such “red flags” include NSAIDs, particularly ibuprofen when used with aspirin, which can be associated with the risk for repeat myocardial infarction. In addition, hypertension and BP can also be an issue with NSAIDs.

“Many patients who are on aspirin and or other blood thinners get nervous about bleeding risk, particularly gastrointestinal bleeding risk,” Vega said. “And finally, many have, if not chronic kidney disease, at least conditions that predispose them to kidney disease, so kidneys are a worry, too. Between heart, brain, stomach and kidneys, those reasons are why it’s so important to pay attention to that full health profile and the full medication list that the patient is using.”

According to Vega, these complications can be avoidable in many cases, if PCPs use smart recommendations and guidelines regarding the use of OTC pain relievers.

However, that does not mean scolding patients. Instead, Vega recommended viewing drug reconciliation as an opportunity to support patients in a positive way.

“What that means is, if a patient is having difficulties, I identify those barriers and work through them in a patient-centered way, providing a conversation where we can talk about issues that they may have, their practices, their beliefs and their values, and try to find solutions,” he said. “Those solutions will be much more effective, and certainly much more durable, than just chiding patients or giving the same message over and over again when it’s clearly not working.”

That relationship between patient and PCP, according to Vega, will ultimately mean the difference between successful medication reconciliation, and failure.

“Fill in medications in electronic health record,” Vega said. “But you also need the patient’s assistance first and foremost. That means that the simple technology that I want from my patients is just a brown paper bag. I tell them to just put everything that you might be taking in there, and bring it to us to make sure that we have the right data when we’re putting all this information into our electronic health record. It does take a cooperation and commitment from both sides to make this work.” – by Jason Laday

Additional reading:

https://www.uspainfoundation.org/awareness/choosing-otc-safely/