Is It Time to Take this Pill or the Other One or…

Did you ever wonder how people who are blind or visually impaired manage to take their medications correctly?

Amanda Wong did. As a student at the USC School of Pharmacy, she understands the importance of taking medications appropriately and the tremendous role it plays in patient outcomes. In fact, nearly 3 out of 4 Americans do not take their medications as directed, and more than 1 out of 3 medication-related hospital admissions are linked to poor adherence. Wong became interested in this issue when she encountered a visually impaired participant at a USC School of Pharmacy health fair.

For example, diabetes, the leading cause of blindness among adults, typically requires a regimen that includes prescription medication. With the CDC estimating that about 3.8 million Americans with diabetes have visual impairment, Wong decided an outreach program targeting this group would assist those with visual impairment in taking their medicine correctly.

“When patients do not take their medicine as directed, it can greatly impact their health,” says Wong who is in her third year of the 4-year, post-graduate Doctor of Pharmacy program. “Just imagine how much more difficult it becomes to take medications if you are blind or have severe vision loss, even when you’re wearing glasses or contact lenses.”

Last spring, Wong was awarded a U.S. Albert Schweitzer Fellowship, based on her proposal addressing an unmet health need in the community. The fellowship provides a stipend, allowing her to develop a series of both medication reviews and educational seminars at Braille Institute, a nonprofit organization headquartered in Los Angeles whose mission is to eliminate barriers to a fulfilling life caused by blindness and severe sight loss. Wong interviewed dozens of clients there, helping her to better understand the difficulties faced by this population.

“Most participants at Braille Institute are elderly and many have lost sight late in life, making adaptations even more challenging,” says Wong. “As a Schweitzer Fellow, I’m addressing how pharmacists can be effective resources for everyone in the community, including those with vision loss, in managing their drug therapy.”

The program was launched last summer, with sessions on asthma, over-the-counter products, hypertension, and the importance of medication adherence and safety. Jason Lieu, also a student in the PharmD program, offered a brief presentation on over-the-counter products and generics.

An exercise to illustrate how easy it is to confuse medications by shape, size, or color had participants hold two different medications or candy tablets in their hands. More than a third of the participants mistook the medication for the candy.

“You can’t rely on your senses alone,” said Lieu. “This could be a potentially lethal mistake, so you have to follow certain guidelines to prevent this kind of confusion.”
The pharmacy students reviewed steps to promote medication safety including asking before taking a medication and talking with your pharmacist to gain assistance; never keeping medications and hazardous products, such as cleaning supplies, in the same cupboard; and the importance of knowing your medications and why you are taking them.

For people with vision loss, knowing their medications goes beyond maintaining a list of medications, their dosage schedule and the reason for use. They must also devise a plan for taking them on time – and identifying them correctly. For Trina Champe, who was born blind and lives with her husband who is also blind, coming up with a system to ensure that she takes her five daily medications correctly was very important.

“Each time I get my medication, I study it with my hands, learning to identify it by touch – shape, texture, indentations – and I talk with my pharmacists about it, asking their help,” says Champe. “Eventually, I’m hoping that Braille labels become standard for people who need them.”

“When blind or elderly patients use only their sense of touch to identify medications, it creates risk for potential mistakes,” says Wong. “During the medication reconciliation process, we really try to emphasize that drug shapes and colors frequently change. We also encourage the use of labeling techniques and the free Braille pill boxes that are given to participants.”

Braille labels do exist but are limited in access. The Food and Drug Administration Safety and Innovation Act, signed by President Obama last July, includes the provision of accessible prescription drug labeling, including medication name, dosage information and side effects for people with vision loss. The act reinforces requirements of the Americans with Disabilities Act which requires effective communication for people with disabilities on all medications. The specifics of how this requirement will be met are not yet known.

Maria Kootsikas, a pharmacist and USC alumnus, is preceptor for the project. “I think the program increases awareness among the visually impaired. I was very encouraged by the number of questions and level of discussion from the group. I think it really gave those who attended some insights on how to address their special needs in correctly taking their medication.”

The project is also precepted by Cecilia Wu and Tatyana Gurvich, both pharmacists and alumni of the School.

Wong is continuing to work with Braille Institute, recently offering a medication review for participants at a September 28 event sponsored by the Fall Prevention Coalition-Los Angeles. This program raised awareness among older adults and their caregivers about the risk of falls and ways to prevent them. Brad Williams, a professor at the School of Pharmacy, and Jacqui Krause-Jacobson, a member of the School’s QSAD board, precepted the event for the pharmacy students on hand to review medications for participants.

Learn more about Amanda Wong’s Schweitzer Fellowship at:
http://pharmacyschool.usc.edu/news/usc-students-awarded-prestigious-schweitzer-fellowships.html.

Learn more about Braille Institute at:
http://brailleinstitute.org