March 25, 2025
Top Medication Tips for Memory with Molly Hinely, PharmD
In this episode of Ask Dr. Mia, pharmacist Molly Hinely talk about medication management for those with memory issues. The conversation covers the impact of certain medications on memory, the use of technology in medication management, and the potential benefits and risks of various supplements. Molly encourages listeners to advocate for themselves and their loved ones in navigating the healthcare system.
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Molly Hinely, PharmD, BCPS is the manager for the Atrium Health Wake Forest Baptist Health pharmacy population health team located in Winston Salem, NC. She leads a pharmacy team who supports the organization’s transitions of care and value-based care programs in collaboration with nurse navigators, social workers, and community health workers. She also is the residency program director for the PGY2 Population Health Management and Data Analytics program at Wake Forest Baptist Health. Molly’s areas of interest include care transitions, post-acute care, value-based care, medication adherence, social determinants of health, progressive care models and health outcomes. She earned her Doctor of
Pharmacy degree from the University of South Carolina, completed a pharmacy practice residency at New Hanover Regional Medical Center in Wilmington, and has been in practice for 13 years.
Links: hero dispenser: https://herohealth.com/
Med Minder pill dispenser: https://medminder.com/
Live Fine med dispenser 28 days with lock https://www.livefineproduct.com/products/automatic-pill-dispenser-with-frosted-lid-and-large-display
Follow Dr. Mia on social media including YouTube and BlueSky @askdrmia
Takeaways
- Community pharmacists are underutilized resources for medication management.
- Simplifying medication regimens can significantly help patients and caregivers.
- Technology can aid in medication adherence but should be used judiciously.
- Certain medications, especially benzodiazepines and opioids, can negatively impact memory.
- Vitamin B12 and omega-3 fatty acids may support cognitive health.
- Alarms for medication reminders can sometimes cause confusion.
- It's essential to understand the purpose of each medication being taken.
Keywords
pharmacy, transitions of care, medication management, community pharmacist, memory loss, supplements, geriatric care, caregiver support, medication technology, patient advocacy
Chapters
00:00 Introduction to Transitions of Care Pharmacy
02:51 Navigating Medication Management for Loved Ones
06:10 The Role of Community Pharmacists
09:06 Simplifying Medication Regimens
11:54 Technology in Medication Management
15:11 Understanding Medications That Affect Memory
20:02 Supplements and Their Impact on Memory
30:11 Advocating for Better Medication Management
Video on Ask Dr. Mia YouTube channel
Transcripts on www.miayangmd.com. Transcripts are automatically generated and may contain minor inaccuracies.
Email: ask@miayangmd.com
Opinions expressed are exclusive of Dr. Mia Yang and not reflective of her or guest speaker's employers or funders.
Transcript
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Welcome back to Ask Dr.
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Mia podcast.
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Today I have a special episode for you from my colleague and friend, Molly Heinle.
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Molly is a pharmacist manager for the HM Health Wake Forest Baptist Health Pharmacy Population Team in North Carolina.
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And she really focuses on transitions of care.
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when patients move from say the hospital to a rehab or to home and works with a group of really dedicated professionals such as nurse navigators, social workers and community health workers.
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She's also training the next generation of pharmacists as the residency program director.
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And so she's quite busy, but she has gotten her pharmacy degree from the University of South Carolina.
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and finished a pharmacy residency at New Hanover Regional Medical Center in Wilmington and has been in practice for more than a decade.
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And so welcome to Ask Dr.
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Mia podcast, Molly.
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Thank you so much, I'm honored to be here.
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Wonderful.
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Well, Molly, tell me a little bit about who are you taking care of in your life right now?
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Yeah, so I am currently a mother of an eight year old and six year old, two sons.
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I also am the sandwich generation and I have two aging parents that I couldn't live my life without because they pick my children up every day from school.
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But I have a father who just turned 78 and my mom who turned 76 as well as my in-laws who are 79 and 77.
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They live in Georgia, but we constantly are getting calls from them to help with medical care.
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And so I tend to be the pharmacist for the whole entire family too.
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I have two brothers and niece and nephews that I tend to ask.
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that get all the medication questions asked for me.
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So you're my perfect audience and and a wonderful guest for this episode because I know we have a lot to talk about in terms of medications and you have not only professional experience but also personal experience.
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So one of the questions that I get asked a lot and I'm curious about your answer is that how do you get your loved ones who might have memory problems to take their medicines?
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Yeah, it's a great question that pharmacists are really well positioned to help with.
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And I have always had a passion for since I became a pharmacist.
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My background was primarily in acute care.
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And I actually saw it from that side where patients were coming in, especially patients with memory loss.
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And the reason why they were admitted was because they just couldn't remember to take their medicines.
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And it seemed like such a simple fix to be able to try to get them to take their medicines.
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And then when I switched into Transitions of Care Pharmacy, and I created the Pharmacy Home Visit Program, and I went into people's homes and actually saw what was happening in real life experience with these patients that have true memory loss.
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It's very, very hard to figure out how to get them to take their medications.
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The most important thing...
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is if there's a caregiver around to have that caregiver support.
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Because there are a lot of unique tools that can help with getting patients to take their medications with memory loss.
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The number one most important underutilized tool in my opinion is the community pharmacist.
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So everybody has to fill their medications somewhere and pharmacists are well positioned to really help with helping people take their medications.
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In most of the community pharmacies, you can find pill boxes that you can buy over the counter.
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A lot of times I try to say, start with a simple pill box, keep it simple as much as possible to try to decrease the burden of the caregiver.
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Some of these fancier medication boxes, especially the electronic dispensing ones, they're so cumbersome to get set up in the home that a lot of times they don't even know where to start.
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And so then especially when you deal with electronics, if it malfunctions, you have to get on the help desk.
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Most of our caregivers are working full time and that's the last thing that they want to do is try to help figure out how to put these medications correctly into these electronic dispensing systems.
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But there is a great place for them.
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I think easy solutions to is setting alarms or trying to remember to take your medicines with your normal routine.
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So taking your medicines with your coffee in the morning, putting it by the coffee maker so you can remember.
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It's okay to have a few different pill boxes because of that.
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You know, we have our single daily pill boxes.
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We have the twice daily, three times daily, four times daily.
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And we also have those pill boxes that have gentle alarms that will alarm in the house too if the patient needs that.
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I know I've gotten feedback though that especially depending on where the patient is in the stage of memory loss, an alarm can make them aggravated and they don't remember what the alarm is for.
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And they've even called 911 and thought that it was a a fire alarm going off.
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we've sort of, you know, there's pros and cons to everything, but I do think really reaching out to your pharmacist to ask for these medication strategies.
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And then one of the biggest things that the community pharmacist can do as well as population health pharmacist, and that's the team that I lead at the Atrium Health Big Forest Baptist is trying to decrease the frequency of the amount of times patients have to take medications.
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So simplifying the medication regimen and that way they don't have to take medicines three to four times a day.
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If we can, some medications, we can't help that.
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Other things is changing patients to the transdermal options if we have that.
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But again, somebody has to remember to remove the old patch and put a new patch on.
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Yeah, and that sometimes can be hard for a caregiver who might not be living with the person with the memory loss to do.
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I do want to ask a clarifying question about the community pharmacist.
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When you say community pharmacist, you mean wherever people pick up their medicines like CVS, Walgreens, or their local pharmacist.
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When you go, how do you ask for a consultation with the pharmacist?
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Do they sit with you and go through your medicines.
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How does that work?
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Every pharmacy is a little different.
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This is where I really encourage patients to use our independent pharmacies in their local communities.
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They tend to have a little bit more time to do exactly what you just said.
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Sit down with the patient, review their medicine.
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Sometimes they'll even fill the pill box for the patient to get them started at the pharmacy.
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after they even shop around and say, this pill box sounds like it would be good for your medications.
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It looks like you take twice a day medications a lot.
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Let's get you on this pill box.
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And then they set it up for you.
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And then they also do the, one of the most important things, telling patients and caregivers why they are on the medication.
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Even in our population health team, we do a lot of telephonic outreach.
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And it is so powerful to even just talk to these patients on the phone because most patients don't know why they're taking their medication.
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Yeah.
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So even as a caregiver, you could potentially make a table.
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And I remember doing this when my mom was on several different medications for her Parkinson's disease that had, you know, with her Parkinson's med, that's like, she was sometimes taking it as frequently as every hour and a half or two hours.
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That, I mean, she obviously knew what that medicine was for, but there were some other medicines where she didn't know which was which, and she got confused kind of.
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Was this for my nausea or was this for my constipation?
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And well, I tried to put a table and say, this is what it's for.
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This is what the pill looks like.
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This is what the bottle looks like.
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that just, know, ideally just doesn't even necessarily need a independent pharmacist to help you with if you just kind of get all the bottles lined up and, you know, take out the as you've taught me actually, Molly, to kind of take the label for the bottle or for the medication and tape one of the actual pills on a piece of paper that says, this little red one is for my cholesterol.
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And I take that to prevent me from having another stroke.
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And I take that at night.
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exactly.
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I'm so glad that you still remember that.
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That is the number one.
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I mean, when we have our pharmacy learners, we have about 27 pharmacy learners rotate through our space.
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And the thing that I love to show them is the the things that are happening in real life with these patients.
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I, especially when we were doing more home visits, I said, get ready to get your arts and crafts out.
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And again, exactly what you said, a caregiver can do this.
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All you need is a piece of paper.
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And even if you print out a calendar, we do that a lot where it could be a weekly calendar or a monthly calendar.
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And a lot of times too, it helps to write in your daily tasks of what you do every day.
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gives that patient a sense of purpose for the day to a routine.
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And in that you have those medications.
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Love taping the medications on there because unfortunately these medications sometimes can change in appearance.
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So your statin medication may look different the next time you fill it.
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And that's even more confusing.
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And so being aware of that so you can re tape the new pill on there.
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We get a lot of calls to say like I don't think they filled my medication right.
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It looks different now.
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Yes.
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do they do that?
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Why do they do that to confuse everybody?
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Yes, we need to talk to the drug manufacturers and say, can you please just stick to one color for your medication?
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It would help us a lot.
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really would.
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So diving a little deeper into pros and cons of some of the technologies surrounding pill boxes.
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And I love what you said about keeping things simple, because some of the more fancier medication dispensers, there's pros and cons of each one.
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Well, first of all, where do you encourage people to find them?
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Obviously, you know, in a local pharmacy on the shelves, they're usually just the regular pillboxes that you open manually.
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Yes, that's a great question.
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I think caregivers and or patients and your healthcare team can help find those types of options for you and figure out which one truly fits your lifestyle.
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It's like that philosophy of one size does not fit all and figuring out what really helps.
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your medication regimen.
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so once hopefully we can decrease the frequency of the medications.
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But if you do have to have you on multiple times a day medications, there are a lot of electronic options like the hero pill dispenser or the med minor dispenser.
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You just put it in the Google search and you learn about it from the website.
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and they actually talk to you about different payment options because that's one of the biggest things with these is they can get pricey and that's why a lot of times patients can't afford it.
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There are different options.
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The cheapest option is on Amazon right now and it is a 28 day pill alarm box and you lock the pills in a slot.
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and then it alarms when it's time to take it out and it opens up for you.
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And you simply pay for that one time and then you have it versus some of these more robust types of electronic pill dispensers like the Hill Hero one that's getting a lot of press right now is you have to pay a monthly subscription fee.
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And some of the Medicare plans are actually paying for these.
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options for patients.
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I don't see a lot of benefit.
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I don't see a lot of plans covering them if I'm being honest, but it is a big, it is a sort of a big machine.
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It almost looks like a current coffee machine.
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And the hardest part, like I said before, is just getting it set up.
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The thing I like about Hero though is that they do have that remote monitoring system attached to it.
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So they actually have If you want to buy into the more like Cadillac service option of it and you don't have a caregiver that is reliable per se for every day or every week to check in on you, you can actually do remote monitoring with that system.
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And if the patient doesn't take the medicine and alerts the hero company and then they give that patient a call and they say, Hey, Mr.
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Smith, you really need to take these medicines.
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Can you find your hero pill dispenser?
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They should be dispensing right now.
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And that is a particular machine that I know both you and I have sort of tested it a little bit from the company itself.
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My concern with Hero or any sort of dispenser that relies on a weighted cup that kind of tells the machine whether it's been taken or not is that I know plenty of patients who will just take that little cup, whether it's plastic or metal.
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and take it with them somewhere else.
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So it's off.
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I mean, it looks like it's taken by the machine, but potentially people could, you know, throw it down the trash can or hide it in their bedroom.
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And nobody will know because, you know, unless you go in to actually look for it, it seems like it may be taken.
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Yes.
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Yeah, you have to keep all the components and I agree with you.
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I honestly like that.
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Like I said, keeping it simple.
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I prefer the the best low price dispenser right now is the live fine 28 day automatic pill dispenser that you can find on Amazon.
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You just Google it and yes, and it's it's easy to set up, but it does have that alarm.
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Mm-hmm.
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you know, if you do have a patient that can get easily aggravated or won't remember what the alarm is for, that is the con of it.
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Yeah, and we'll link these in the show notes as well.
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There's one other website that I also recommend to people fairly frequently and that's called alzstore.com, A-L-Z, like in Alzheimer's.
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And that's a slightly more curated list and it doesn't include just pill boxes, but also some other technologies like door switches to prevent people from just unlocking the door and running out into traffic.
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It's slightly more, I find it slightly more manageable to browse because Amazon, it just has so much product that you sometimes don't know like what you need and it takes too long to find what you need.
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Our store kind of just simplifies it.
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So you don't have as much choice, but you do have, you know.
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you can look on there and say, yeah, I wonder if there's something that's similar to this that may be cheaper on Amazon or online, even if you don't necessarily look for it.
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And some of these technologies, I wouldn't even have known that existed, like a fake lock that the caregiver can open because it's a little bit complicated, but it's not like a deadbolt that locks people in from the inside.
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Yeah, I love that.
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Yeah.
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I found another website that it was just like Alzheimer's dot com and it seemed to be pretty user friendly and talked about some good stuff.
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But I will definitely use that website that you just mentioned to.
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Yeah, because Amazon can get cumbersome.
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The other option just really quickly is that's gaining popularity is those pill packaging compliance packaging.
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We have.
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A lot of the outpatient pharmacies do offer these compliance packaging options.
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We call them bubble packs.
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But again, you have to remember to push the meds out of the bubble pack.
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But the other one that's really gaining popularity, it almost looks like a candy dispenser to me, the ones that come out in a sleeve.
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Yeah.
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And it's nice though that it tells you the medications that are in each one.
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The con of that though is if you do have a patient that needs to adjust their medications frequently, it is very challenging to get those fixed and updated.
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So, and again, it's not the most ideal for memory loss, but I did just want to mention those options just to be comprehensive in what's out there.
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Yeah, and those blister packages, I've seen, you know, the downside of some of them is that it's easy to know whether someone has taken their dose, but then it's also hard to adjust, especially if you just need to remove one pill from your morning pack and you're like, crap, now where do I store all these other five pills that I just opened the little blister pack and how do I remember to take that?
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Yes.
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You know, it's almost like, it works well if you have a very stable list of medicines that you're just kind of taking every day without any changes.
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And because otherwise you have to sort of change it at the next month.
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Like the next time the packaging is being delivered, you kind of have to make all the changes at once rather than making one change at a time.
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which is usually how I recommend for people to do it because if you make multiple changes at once, then it's hard to know, you know, is it drug A that made me feel dizzy or is it drug B that made me feel dizzy?
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Because all of that may be implemented at once.
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Yeah.
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Yeah.
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Okay.
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Well, switching gears a little bit, let's talk about the medications that are bad for memory.
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And then I know some of my audience have specifically asked me, what kind of supplements are good for memory.
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Yes.
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Yeah.
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And again, that's a great plug for pharmacists.
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So I'm so excited to be asked to be on your podcast.
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I think pharmacists sometimes can be an underutilized healthcare team member, especially the community pharmacists to talk through which medications you do need to avoid in especially the active drug.
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list that you have with your pharmacy.
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We are big believers in trying to fill medicines at one pharmacy.
00:21:26.468 --> 00:21:35.251
So we have a full comprehensive list of what you're actually taking and then that way we can do good drug-drug interaction checks.
00:21:35.251 --> 00:21:43.256
So that's the number one thing we try to do and then things to try to avoid for patients that do have memory loss.
00:21:43.905 --> 00:21:47.737
I'm actually really excited working in the population health field.
00:21:47.817 --> 00:21:53.528
We focus a lot on quality measures and they're actually coming out with two new quality measures.
00:21:53.528 --> 00:21:55.400
Mia, I don't know if you're aware of them.
00:21:55.400 --> 00:22:09.890
They're calling them the poly CNS measures and they're trying to, you're going to get some flags in the system to try to decrease prescribing opioids and benzos together.
00:22:09.890 --> 00:22:16.759
So those are obviously two medicines that we want to try to avoid for patients that do have memory loss.
00:22:16.759 --> 00:22:17.550
Yeah.
00:22:17.550 --> 00:22:30.259
And the benzodiazepines, just for those who don't understand, these are medicines like Xanax, Valium, Klonopin, and their corollary generic names.
00:22:30.259 --> 00:22:31.940
I call them alcohol and a pill.
00:22:31.940 --> 00:22:50.564
But the danger that Molly was saying about prescribing a pain medicine like morphine, oxycodone, hydrocodone, Percocet, along with these benzodiazepines is that it can actually reduce people's desire to breathe and people can overdose and die.
00:22:50.564 --> 00:22:55.578
Yes, yeah, and it really decreases your cognitive ability.
00:22:55.578 --> 00:22:58.132
So ability to think straight.
00:22:58.132 --> 00:23:01.855
does fog gives you that brain fog.
00:23:01.963 --> 00:23:13.547
Even alone, those benzodiazepines, it's medicines that end in PAM are the benzodiazepine medicines that we think of for generic, that's the generic ones.
00:23:14.166 --> 00:23:21.828
They're commonly prescribed in geriatric patients because they help with agitation or anxiety.
00:23:22.009 --> 00:23:38.912
But there are other options that are better to use to help with anxiety, such as Selexa or Lexapro, or if you have a patient that doesn't want to eat remeron is actually a great option instead of that benzo.
00:23:38.912 --> 00:23:45.667
And then the opioids, like if you do have a patient that's in true pain, we obviously want them to not be in pain.
00:23:45.667 --> 00:23:55.442
So we try to say, try to get them off the opioids, like the norcos or the oxycodones as quickly as possible.
00:23:55.442 --> 00:24:00.115
And they actually recommend to try to decrease taking NSAIDs.
00:24:00.115 --> 00:24:10.991
So NSAIDs are your anti-inflammatory inflammatory pain medicines, you can get over the counter like Advil, the generic ibuprofen, Aleve is another common one.
00:24:10.991 --> 00:24:15.305
Those can actually affect how you're thinking as well.
00:24:15.305 --> 00:24:25.040
And so trying to decrease taking those, best medicine for pain in a patient with memory loss is your Tylenol, your acetaminophen.
00:24:25.162 --> 00:24:35.719
And then the other measure that they are actually incorporating is trying to decrease patients on duplicate anticholinergic medications.
00:24:35.940 --> 00:24:41.320
That big word is essentially any medicine that helps you dry up.
00:24:41.362 --> 00:24:49.544
So the number one most common medicine that everyone loves is our lovely pinadryl.
00:24:50.724 --> 00:24:54.596
And it is challenging to figure out which patients are taking those.
00:24:54.596 --> 00:25:06.731
But I have seen, and you probably have too Mia, where I mean, Even my mom, I have had to try to tell her like, you can't take two tablets of Benadryl every single night.
00:25:09.263 --> 00:25:10.079
Yes.
00:25:10.079 --> 00:25:10.580
Yeah.
00:25:10.580 --> 00:25:13.166
Or unisum or sleep aid.
00:25:13.166 --> 00:25:19.140
A lot of those over-the-counter meds actually are benadryl in a slightly different formulation.
00:25:19.140 --> 00:25:21.019
Yes, great call out.
00:25:21.019 --> 00:25:30.015
And then the other anti-cholinergic medication class are the meds that help with bladder control, which do affect our patients.
00:25:30.015 --> 00:25:32.925
And so it's challenging.
00:25:32.926 --> 00:25:44.311
It's always, anytime we think of medicines and as a pharmacist, we look at the medication list, I always say, you have to assess the benefits versus risk for you.
00:25:44.897 --> 00:25:54.179
And so every medication, everything you put in your body has a side effect and everybody has a different side effect.
00:25:54.179 --> 00:26:00.625
And so it's really trying to figure out what medication you best respond to.
00:26:01.134 --> 00:26:01.877
Yeah.
00:26:01.877 --> 00:26:06.972
Another common anti-cholinergic in that is hydroxazine.
00:26:07.314 --> 00:26:09.506
We're seeing that prescribed a little bit more.
00:26:09.506 --> 00:26:20.266
It's almost like a stronger form of Benadryl, but people will put patients on it to help with anxiety because it has more mild side effects.
00:26:20.266 --> 00:26:26.291
It's actually an antihistamine just like Benadryl, but it does calm the body down.
00:26:26.761 --> 00:26:30.833
or if you have like excessive itchiness, it's a good medicine to use.
00:26:30.833 --> 00:26:35.103
But in patients with memory loss, it can increase.
00:26:35.117 --> 00:26:40.732
that memory loss and confusion and drowsiness and dizziness and fatigue.
00:26:40.732 --> 00:26:49.641
So really recommend more of using that natural melatonin that's pretty safe to use for patients that need help with sleep.
00:26:49.641 --> 00:26:57.247
And even like low dose trazodone has been shown to be safe and effective in patients with memory loss.
00:26:57.486 --> 00:26:58.526
Yeah, absolutely.
00:26:58.526 --> 00:27:04.826
For melatonin, my pitch to people is that most of the time people are taking it at the wrong time.
00:27:04.826 --> 00:27:08.306
They're taking it like a sedative right before bed.
00:27:08.306 --> 00:27:16.905
When our natural melatonin is the highest around dinnertime, like that sundowning time, that's actually the time to take it.
00:27:16.905 --> 00:27:23.365
If you're taking it at 10 o'clock, it won't really be peaking until probably two o'clock in the morning.
00:27:24.046 --> 00:27:26.665
So that does not help.
00:27:26.665 --> 00:27:30.568
And then they come back and say, it didn't do anything.
00:27:30.970 --> 00:27:42.058
But there are such a long list of medicines that are what Molly calls anticholinergic that we won't be able to fully review during the podcast today.
00:27:42.058 --> 00:27:51.467
But you can certainly either look online or talk to your local pharmacist to kind of say, which one of these do you think could be affecting my memory?
00:27:51.467 --> 00:27:57.997
And to kind of add to the caveat about paying is that not treating pain can also be bad for memory.
00:27:57.997 --> 00:28:18.678
So it's such a risk benefit, you know, is Tylenol okay in terms of controlling your pain if you take it two or three times a day consistently for arthritis that's kind of constantly there and a little bit, you know, kind of in the background, but could be affecting people's mood and agitation.
00:28:18.890 --> 00:28:29.429
Or do you really need something stronger that technically may fall within the class of an opioid, but not treating that pain can also be detrimental.
00:28:29.429 --> 00:28:33.092
So this is where, you know, I think of it like the Goldilocks phenomenon.
00:28:33.092 --> 00:28:35.765
You don't want too little, but you don't want too much.
00:28:35.765 --> 00:28:37.602
You want it to be just right.
00:28:37.602 --> 00:28:37.932
right.
00:28:37.932 --> 00:28:39.854
And everybody's different.
00:28:39.854 --> 00:28:42.134
I mean, very common.
00:28:42.134 --> 00:28:43.967
We consider it an opioid.
00:28:43.967 --> 00:28:49.621
It's not a controlled substance in some states, but some states it is, but tramadol.
00:28:49.942 --> 00:28:52.705
I don't know if you prescribe that often.
00:28:52.705 --> 00:28:54.303
I'm not a fan of Tramadoll.
00:28:54.303 --> 00:28:59.932
We actually sometimes call it Tramadont because it can have more side effects as well.
00:28:59.932 --> 00:29:01.223
Yeah.
00:29:01.224 --> 00:29:06.589
That's what like it's a it's the pro con and it's being prescribed a lot.
00:29:06.589 --> 00:29:17.619
That's why I just wanted to mention it just because people I think some prescribers, especially primary care providers think that it's well, it's not it's not really an opioid.
00:29:17.619 --> 00:29:18.621
So it's okay.
00:29:18.621 --> 00:29:22.104
But it still has all those side effects as an opioid.
00:29:22.104 --> 00:29:24.057
So right, exactly.
00:29:24.057 --> 00:29:28.397
So what kind of supplements are actually good for memory, if any?
00:29:28.397 --> 00:29:39.269
Yes, so I will say I grew up in a holistic household where I had a mother that didn't necessarily believe in prescription medications.
00:29:39.269 --> 00:29:41.160
So it's ironic that.
00:29:42.541 --> 00:29:48.607
So and that's why I think I'm the type of pharmacist that I am, and I do love geriatric medicine because.
00:29:48.653 --> 00:30:01.029
the amount of polypharmacy that there is, the excessive use of medicines in our culture, and my philosophy is trying to decrease the amount of medications patients take.
00:30:01.050 --> 00:30:10.556
But with that, you go to my mom, she's on about 10 different herbal supplements, but she is very proud that she is on no prescription medicines.
00:30:11.195 --> 00:30:24.022
And the biggest caveat as I went through pharmacy school and I always have to say this is none of our OTCs or herb rolls are approved by the FDA.
00:30:24.084 --> 00:30:31.428
And so they do not, we don't know exactly how safe and effective any of them are.
00:30:31.597 --> 00:30:32.453
Yeah.
00:30:32.703 --> 00:30:36.564
are quite a few over-the-counter that you can get.
00:30:36.564 --> 00:30:41.243
I think one of the most common ones that providers know about is Prevagen.
00:30:41.243 --> 00:30:44.644
I don't know if you ever use that Mia in your practice.
00:30:45.344 --> 00:30:46.029
Good.
00:30:46.029 --> 00:30:47.958
to please save your money.
00:30:47.958 --> 00:30:48.468
is.
00:30:48.468 --> 00:30:52.536
I think that company actually has gotten into trouble for false marketing.
00:30:52.536 --> 00:30:53.757
That's what I was going to mention.
00:30:53.757 --> 00:31:07.582
And I think a lot of primary care providers need to be educated on that because I think it's it's not to bash primary care providers, but it's just, you you try to you Google the first thing that comes up is Prevagen.
00:31:07.582 --> 00:31:10.203
And there's really no great studies.
00:31:10.243 --> 00:31:14.365
It's actually almost like the equivalent of just eating a lot of nuts.
00:31:15.766 --> 00:31:17.074
So my.
00:31:17.074 --> 00:31:18.307
a little nutty.
00:31:20.460 --> 00:31:30.387
Nuts, what are nuts high in that can help with the memory stability is the vitamin E and the omega-3 fatty acids.
00:31:30.387 --> 00:31:34.211
So I'm a believer in taking fish oil.
00:31:34.211 --> 00:31:38.074
I think it helps with multiple parts of your body.
00:31:38.074 --> 00:31:42.737
It helps with your heart and it can help with your brain health.
00:31:43.698 --> 00:31:46.190
And it doesn't have to be.
00:31:46.190 --> 00:31:47.490
that crazy expensive.
00:31:47.490 --> 00:32:02.967
Again, ask your pharmacist for help of which one might be best for you if you want to go that route because there are so many different types of brands and there are a lot of brands out there that are not good because it's all about which active products there are.
00:32:05.140 --> 00:32:10.670
I think Ginkgo Biobla, always, I feel like I always say it mispronounce that.
00:32:10.670 --> 00:32:12.865
I think that was really popular back in the day.
00:32:12.865 --> 00:32:15.251
I don't know if it's as popular.
00:32:16.203 --> 00:32:28.638
Now and again, I say with caution, like be careful with any of these just because we don't have the, we don't know how they're going to interact with your medicines you're currently on.
00:32:28.638 --> 00:32:33.049
And again, it's that benefit versus risk.
00:32:33.049 --> 00:32:37.805
Just because it's over the counter doesn't mean there aren't risks associated with it.
00:32:37.805 --> 00:32:38.484
right.
00:32:38.484 --> 00:32:42.748
If you take enough Tylenol, you can get liver failure and it is over the counter.
00:32:42.748 --> 00:32:50.612
But Ginkgo actually is one where we are, our center have been involved in a very large study looking at Ginkgo for memory loss.
00:32:50.612 --> 00:32:53.854
And unfortunately it does not help.
00:32:53.913 --> 00:33:00.336
So one of the most common supplements that I prescribe is really vitamin B12.
00:33:00.789 --> 00:33:17.384
And usually I do check for a vitamin B12 level because in people who are on an anti-acid blocker, like your Protonix, your heartburn medication, that can inhibit, prevent the absorption of B12.
00:33:17.384 --> 00:33:30.278
If you're a pure vegetarian and you don't eat any meat, like my son, accidental vegetarian there, he probably is not getting enough B12 because he doesn't even like chicken.
00:33:30.334 --> 00:33:56.365
And that if you are having someone who has been through gastric bypass surgery, parts of your stomach or inflammatory bowel disease where there's things that prevent the absorption of some of these vitamins, especially B12, we do know that low B12 can cause not only memory problems, but also neuropathy where you're tingling in your feet, which then make you more likely to fall.
00:33:56.365 --> 00:34:02.669
So that is one supplement that I guess I believe in because it is actually beneficial.
00:34:02.669 --> 00:34:24.097
But most of the time, I think people are better saving their money and saving the number of pills that they have to take by making sure every medicine does a benefit that you can see or that if it's something that you don't notice a big difference but you want to prevent some future.
00:34:24.097 --> 00:34:28.019
bad outcome like heart disease, heart attacks or strokes.
00:34:28.019 --> 00:34:40.505
Sometimes after people had a heart attack, they suddenly are on six different medicine and that can be hard to reconcile, but they do all have evidence at preventing a second heart attack.
00:34:40.746 --> 00:34:50.329
So that's one of the few situations where I would say, actually you are on more medicines now, but they do help you.
00:34:50.746 --> 00:35:00.900
But most of the time is the opposite where there's usually a couple things that we could take off or just change the frequency from every day to only if you need it.
00:35:00.900 --> 00:35:07.918
And then if you truly need it, then you will notice if there is a benefit at the time that you need it.
00:35:07.918 --> 00:35:09.318
Yeah, absolutely.
00:35:09.318 --> 00:35:13.414
And I will say another plug for vitamin B12, it tastes delicious.
00:35:13.414 --> 00:35:23.443
So I don't know if you've ever taken it Mia, but it's usually under the tug dissolving tablet and it tastes, it has a good flavor to it.
00:35:23.443 --> 00:35:26.967
So my parents love taking their vitamin B12.
00:35:26.967 --> 00:35:29.690
So we are big believers in vitamin B12.
00:35:29.690 --> 00:35:35.425
I would completely buy the wrong brand because I got the pill form that was quite large.
00:35:36.068 --> 00:35:36.467
okay.
00:35:36.467 --> 00:35:37.849
I gotta switch.
00:35:37.990 --> 00:35:40.693
dissolving tablet and it's like a cherry flavor.
00:35:40.693 --> 00:35:44.856
You just put it under your tongue and it actually tastes really good.
00:35:45.097 --> 00:35:46.217
Okay, all right.
00:35:46.217 --> 00:35:50.920
See, now I learned something that I can change as well.
00:35:50.920 --> 00:35:52.731
Yeah, that's right.
00:35:52.731 --> 00:35:57.382
Because my B12 was slightly low for some reason when my doctor checked it.
00:35:57.382 --> 00:36:01.163
Well, thank you so much for joining me today, Molly.
00:36:01.623 --> 00:36:02.943
I'll give you the last words.
00:36:02.943 --> 00:36:08.545
Anything else that you think that we haven't talked about that you want to mention to our audience?
00:36:09.327 --> 00:36:11.168
I think that we've covered it all.
00:36:11.168 --> 00:36:16.228
think that, again, as I stated, lots of different options that can get overwhelming.
00:36:16.447 --> 00:36:31.547
I always tell people, be your best advocate to your care, whether you're the patient or the caregiver, and don't hesitate to truly say what's going on, whether it's to your doctor, your pharmacist.
00:36:31.547 --> 00:36:39.628
On our population health team, we have fabulous community health workers and social workers, and we can really try to wrap around.
00:36:40.432 --> 00:36:53.000
you and your team at home to really make sure that you are set up best to be in the best place to take your medicines and feel the best.
00:36:53.000 --> 00:37:02.264
And I will say lastly, every Mia you know this too, but the best thing too is those non-medication interventions.
00:37:02.264 --> 00:37:04.266
Like are you drinking enough water?
00:37:04.266 --> 00:37:06.958
Are you going outside and getting some light?
00:37:07.000 --> 00:37:10.641
are you doing those types of things to keep your mood up?
00:37:10.641 --> 00:37:29.974
I think that having a really good diet and eating good nutritious foods, big believer in that, because I think that food is the best medicine that we have as well as exercise, even if it's just standing out on your front porch and moving your arms up and down, if that's all you can do.
00:37:31.601 --> 00:37:34.304
Your neighbors might be like, say hi.
00:37:34.445 --> 00:37:36.726
Why are you waving to me?
00:37:38.768 --> 00:37:40.679
Well, thank you so much, Molly.
00:37:40.679 --> 00:37:46.735
And I do want to add for people who might be wondering, how can I find a population health pharmacist?
00:37:46.735 --> 00:37:56.643
And I think usually those are associated with inpatient hospitalization, perhaps at the time that you're about to leave the hospital.
00:37:56.643 --> 00:37:59.266
It may be even helpful to request.
00:37:59.422 --> 00:38:05.985
to talk with a pharmacist or someone on the pharmacy team who can go through your medicines in detail.
00:38:05.985 --> 00:38:36.981
One thing that I actually do think will be really smart and really beneficial before people leave the hospital is to have their family members bring in all of the actual bottles that they take at home because it's more common than not that what is showing up on the hospital list is different from what is at home and it will be ideal if that can be reconciled before you leave the hospital rather than going home and say, I don't know why they listed this medicine twice.
00:38:36.981 --> 00:38:39.380
Am I supposed to take the one I was on before?
00:38:39.380 --> 00:38:41.141
Am I taking this new one?
00:38:41.141 --> 00:38:55.907
But a lot of times it's just because the hospital didn't have your particular brand or formulation on their hospital formulary and your doctor had to substitute for something, but then it causes more confusion later on.
00:38:55.907 --> 00:39:07.739
Definitely, and I will say that definitely ask if you're at discharge, but our population health team does, it doesn't have to be attached to a hospitalization anymore.
00:39:07.739 --> 00:39:17.206
We, you can ask any of your doctors to say, I'd like to talk to a pharmacist and they can send a referral to our team.
00:39:18.208 --> 00:39:21.731
at any time in our electronic health system.
00:39:21.731 --> 00:39:24.855
So it doesn't, and we can do a telephonic outreach.
00:39:24.855 --> 00:39:31.202
We can meet you in person, whether it's in your home or even if it's in collaboration with your clinic visit.
00:39:31.202 --> 00:39:36.833
We really try to meet the patient where they are in their healthcare journey to help them along.
00:39:36.833 --> 00:39:37.494
That's great.
00:39:37.494 --> 00:39:39.557
If you're in Winston-Salem, you're in luck.
00:39:39.557 --> 00:39:44.967
If you're not, then you might have to ask your doctor about what's available in your local community.
00:39:44.967 --> 00:39:48.311
But thank you so much for joining us today, Molly.
00:39:48.311 --> 00:39:50.195
And thank you all for listening.
00:39:50.195 --> 00:39:52.157
We'll talk to you next time.
00:00:02.209 --> 00:00:04.020
Welcome back to Ask Dr.
00:00:04.020 --> 00:00:05.490
Mia podcast.
00:00:05.490 --> 00:00:13.414
Today I have a special episode for you from my colleague and friend, Molly Heinle.
00:00:13.414 --> 00:00:25.519
Molly is a pharmacist manager for the HM Health Wake Forest Baptist Health Pharmacy Population Team in North Carolina.
00:00:25.519 --> 00:00:30.199
And she really focuses on transitions of care.
00:00:30.199 --> 00:00:45.514
when patients move from say the hospital to a rehab or to home and works with a group of really dedicated professionals such as nurse navigators, social workers and community health workers.
00:00:45.514 --> 00:00:52.375
She's also training the next generation of pharmacists as the residency program director.
00:00:52.375 --> 00:00:59.881
And so she's quite busy, but she has gotten her pharmacy degree from the University of South Carolina.
00:00:59.881 --> 00:01:10.290
and finished a pharmacy residency at New Hanover Regional Medical Center in Wilmington and has been in practice for more than a decade.
00:01:11.311 --> 00:01:13.472
And so welcome to Ask Dr.
00:01:13.472 --> 00:01:15.299
Mia podcast, Molly.
00:01:15.299 --> 00:01:17.766
Thank you so much, I'm honored to be here.
00:01:18.006 --> 00:01:19.129
Wonderful.
00:01:19.129 --> 00:01:25.388
Well, Molly, tell me a little bit about who are you taking care of in your life right now?
00:01:25.421 --> 00:01:33.496
Yeah, so I am currently a mother of an eight year old and six year old, two sons.
00:01:33.496 --> 00:01:45.534
I also am the sandwich generation and I have two aging parents that I couldn't live my life without because they pick my children up every day from school.
00:01:45.534 --> 00:01:59.784
But I have a father who just turned 78 and my mom who turned 76 as well as my in-laws who are 79 and 77.
00:01:59.884 --> 00:02:08.343
They live in Georgia, but we constantly are getting calls from them to help with medical care.
00:02:08.503 --> 00:02:14.003
And so I tend to be the pharmacist for the whole entire family too.
00:02:14.003 --> 00:02:19.449
I have two brothers and niece and nephews that I tend to ask.
00:02:19.449 --> 00:02:22.798
that get all the medication questions asked for me.
00:02:23.912 --> 00:02:39.326
So you're my perfect audience and and a wonderful guest for this episode because I know we have a lot to talk about in terms of medications and you have not only professional experience but also personal experience.
00:02:39.326 --> 00:02:51.530
So one of the questions that I get asked a lot and I'm curious about your answer is that how do you get your loved ones who might have memory problems to take their medicines?
00:02:51.907 --> 00:02:56.429
Yeah, it's a great question that pharmacists are really well positioned to help with.
00:02:56.429 --> 00:03:03.610
And I have always had a passion for since I became a pharmacist.
00:03:03.610 --> 00:03:05.882
My background was primarily in acute care.
00:03:05.882 --> 00:03:11.933
And I actually saw it from that side where patients were coming in, especially patients with memory loss.
00:03:11.933 --> 00:03:16.955
And the reason why they were admitted was because they just couldn't remember to take their medicines.
00:03:17.134 --> 00:03:22.887
And it seemed like such a simple fix to be able to try to get them to take their medicines.
00:03:22.887 --> 00:03:40.002
And then when I switched into Transitions of Care Pharmacy, and I created the Pharmacy Home Visit Program, and I went into people's homes and actually saw what was happening in real life experience with these patients that have true memory loss.
00:03:40.002 --> 00:03:44.923
It's very, very hard to figure out how to get them to take their medications.
00:03:44.943 --> 00:03:46.924
The most important thing...
00:03:47.024 --> 00:03:51.605
is if there's a caregiver around to have that caregiver support.
00:03:51.786 --> 00:04:00.348
Because there are a lot of unique tools that can help with getting patients to take their medications with memory loss.
00:04:01.169 --> 00:04:08.592
The number one most important underutilized tool in my opinion is the community pharmacist.
00:04:08.592 --> 00:04:19.851
So everybody has to fill their medications somewhere and pharmacists are well positioned to really help with helping people take their medications.
00:04:20.610 --> 00:04:27.172
In most of the community pharmacies, you can find pill boxes that you can buy over the counter.
00:04:27.672 --> 00:04:37.411
A lot of times I try to say, start with a simple pill box, keep it simple as much as possible to try to decrease the burden of the caregiver.
00:04:37.812 --> 00:04:52.403
Some of these fancier medication boxes, especially the electronic dispensing ones, they're so cumbersome to get set up in the home that a lot of times they don't even know where to start.
00:04:52.403 --> 00:04:59.269
And so then especially when you deal with electronics, if it malfunctions, you have to get on the help desk.
00:04:59.269 --> 00:05:12.488
Most of our caregivers are working full time and that's the last thing that they want to do is try to help figure out how to put these medications correctly into these electronic dispensing systems.
00:05:12.488 --> 00:05:14.819
But there is a great place for them.
00:05:15.831 --> 00:05:25.735
I think easy solutions to is setting alarms or trying to remember to take your medicines with your normal routine.
00:05:25.735 --> 00:05:32.216
So taking your medicines with your coffee in the morning, putting it by the coffee maker so you can remember.
00:05:32.216 --> 00:05:36.398
It's okay to have a few different pill boxes because of that.
00:05:36.398 --> 00:05:40.009
You know, we have our single daily pill boxes.
00:05:40.009 --> 00:05:43.899
We have the twice daily, three times daily, four times daily.
00:05:44.699 --> 00:05:54.002
And we also have those pill boxes that have gentle alarms that will alarm in the house too if the patient needs that.
00:05:54.322 --> 00:06:07.766
I know I've gotten feedback though that especially depending on where the patient is in the stage of memory loss, an alarm can make them aggravated and they don't remember what the alarm is for.
00:06:07.766 --> 00:06:14.593
And they've even called 911 and thought that it was a a fire alarm going off.
00:06:14.593 --> 00:06:23.958
we've sort of, you know, there's pros and cons to everything, but I do think really reaching out to your pharmacist to ask for these medication strategies.
00:06:24.579 --> 00:06:42.870
And then one of the biggest things that the community pharmacist can do as well as population health pharmacist, and that's the team that I lead at the Atrium Health Big Forest Baptist is trying to decrease the frequency of the amount of times patients have to take medications.
00:06:42.870 --> 00:06:52.017
So simplifying the medication regimen and that way they don't have to take medicines three to four times a day.
00:06:52.017 --> 00:06:56.961
If we can, some medications, we can't help that.
00:06:58.163 --> 00:07:03.867
Other things is changing patients to the transdermal options if we have that.
00:07:03.867 --> 00:07:10.197
But again, somebody has to remember to remove the old patch and put a new patch on.
00:07:10.197 --> 00:07:17.798
Yeah, and that sometimes can be hard for a caregiver who might not be living with the person with the memory loss to do.
00:07:17.798 --> 00:07:22.142
I do want to ask a clarifying question about the community pharmacist.
00:07:22.142 --> 00:07:31.507
When you say community pharmacist, you mean wherever people pick up their medicines like CVS, Walgreens, or their local pharmacist.
00:07:31.507 --> 00:07:36.959
When you go, how do you ask for a consultation with the pharmacist?
00:07:36.959 --> 00:07:41.235
Do they sit with you and go through your medicines.
00:07:41.235 --> 00:07:42.427
How does that work?
00:07:42.593 --> 00:07:44.504
Every pharmacy is a little different.
00:07:44.504 --> 00:07:53.312
This is where I really encourage patients to use our independent pharmacies in their local communities.
00:07:53.492 --> 00:07:58.096
They tend to have a little bit more time to do exactly what you just said.
00:07:58.416 --> 00:08:01.278
Sit down with the patient, review their medicine.
00:08:01.278 --> 00:08:06.723
Sometimes they'll even fill the pill box for the patient to get them started at the pharmacy.
00:08:08.172 --> 00:08:13.915
after they even shop around and say, this pill box sounds like it would be good for your medications.
00:08:13.915 --> 00:08:16.916
It looks like you take twice a day medications a lot.
00:08:16.916 --> 00:08:18.418
Let's get you on this pill box.
00:08:18.418 --> 00:08:20.598
And then they set it up for you.
00:08:20.678 --> 00:08:30.824
And then they also do the, one of the most important things, telling patients and caregivers why they are on the medication.
00:08:32.004 --> 00:08:37.427
Even in our population health team, we do a lot of telephonic outreach.
00:08:37.538 --> 00:08:47.053
And it is so powerful to even just talk to these patients on the phone because most patients don't know why they're taking their medication.
00:08:47.234 --> 00:08:47.734
Yeah.
00:08:47.734 --> 00:08:51.693
So even as a caregiver, you could potentially make a table.
00:08:51.693 --> 00:09:07.668
And I remember doing this when my mom was on several different medications for her Parkinson's disease that had, you know, with her Parkinson's med, that's like, she was sometimes taking it as frequently as every hour and a half or two hours.
00:09:07.847 --> 00:09:16.888
That, I mean, she obviously knew what that medicine was for, but there were some other medicines where she didn't know which was which, and she got confused kind of.
00:09:16.888 --> 00:09:21.831
Was this for my nausea or was this for my constipation?
00:09:21.831 --> 00:09:28.126
And well, I tried to put a table and say, this is what it's for.
00:09:28.126 --> 00:09:29.969
This is what the pill looks like.
00:09:29.969 --> 00:09:31.740
This is what the bottle looks like.
00:09:31.740 --> 00:10:04.331
that just, know, ideally just doesn't even necessarily need a independent pharmacist to help you with if you just kind of get all the bottles lined up and, you know, take out the as you've taught me actually, Molly, to kind of take the label for the bottle or for the medication and tape one of the actual pills on a piece of paper that says, this little red one is for my cholesterol.
00:10:04.331 --> 00:10:08.572
And I take that to prevent me from having another stroke.
00:10:08.572 --> 00:10:10.344
And I take that at night.
00:10:10.524 --> 00:10:11.683
exactly.
00:10:11.703 --> 00:10:14.124
I'm so glad that you still remember that.
00:10:14.124 --> 00:10:16.744
That is the number one.
00:10:16.823 --> 00:10:25.264
I mean, when we have our pharmacy learners, we have about 27 pharmacy learners rotate through our space.
00:10:25.443 --> 00:10:33.504
And the thing that I love to show them is the the things that are happening in real life with these patients.
00:10:33.784 --> 00:10:39.687
I, especially when we were doing more home visits, I said, get ready to get your arts and crafts out.
00:10:39.807 --> 00:10:43.227
And again, exactly what you said, a caregiver can do this.
00:10:43.227 --> 00:10:45.628
All you need is a piece of paper.
00:10:45.744 --> 00:10:53.903
And even if you print out a calendar, we do that a lot where it could be a weekly calendar or a monthly calendar.
00:10:53.903 --> 00:11:01.368
And a lot of times too, it helps to write in your daily tasks of what you do every day.
00:11:01.368 --> 00:11:06.419
gives that patient a sense of purpose for the day to a routine.
00:11:06.443 --> 00:11:09.246
And in that you have those medications.
00:11:09.246 --> 00:11:18.192
Love taping the medications on there because unfortunately these medications sometimes can change in appearance.
00:11:18.274 --> 00:11:23.317
So your statin medication may look different the next time you fill it.
00:11:23.317 --> 00:11:25.320
And that's even more confusing.
00:11:25.320 --> 00:11:31.644
And so being aware of that so you can re tape the new pill on there.
00:11:31.926 --> 00:11:37.169
We get a lot of calls to say like I don't think they filled my medication right.
00:11:37.169 --> 00:11:39.365
It looks different now.
00:11:41.672 --> 00:11:42.274
Yes.
00:11:42.274 --> 00:11:43.285
do they do that?
00:11:43.285 --> 00:11:46.041
Why do they do that to confuse everybody?
00:11:46.114 --> 00:11:52.758
Yes, we need to talk to the drug manufacturers and say, can you please just stick to one color for your medication?
00:11:52.758 --> 00:11:54.549
It would help us a lot.
00:11:54.967 --> 00:11:56.238
really would.
00:11:56.438 --> 00:12:03.783
So diving a little deeper into pros and cons of some of the technologies surrounding pill boxes.
00:12:03.783 --> 00:12:14.448
And I love what you said about keeping things simple, because some of the more fancier medication dispensers, there's pros and cons of each one.
00:12:14.448 --> 00:12:18.451
Well, first of all, where do you encourage people to find them?
00:12:18.850 --> 00:12:26.951
Obviously, you know, in a local pharmacy on the shelves, they're usually just the regular pillboxes that you open manually.
00:12:27.107 --> 00:12:29.489
Yes, that's a great question.
00:12:29.489 --> 00:12:43.833
I think caregivers and or patients and your healthcare team can help find those types of options for you and figure out which one truly fits your lifestyle.
00:12:43.833 --> 00:12:51.600
It's like that philosophy of one size does not fit all and figuring out what really helps.
00:12:51.600 --> 00:12:54.361
your medication regimen.
00:12:54.361 --> 00:12:58.264
so once hopefully we can decrease the frequency of the medications.
00:12:58.264 --> 00:13:11.475
But if you do have to have you on multiple times a day medications, there are a lot of electronic options like the hero pill dispenser or the med minor dispenser.
00:13:11.475 --> 00:13:16.960
You just put it in the Google search and you learn about it from the website.
00:13:18.115 --> 00:13:30.442
and they actually talk to you about different payment options because that's one of the biggest things with these is they can get pricey and that's why a lot of times patients can't afford it.
00:13:30.442 --> 00:13:32.113
There are different options.
00:13:32.113 --> 00:13:44.322
The cheapest option is on Amazon right now and it is a 28 day pill alarm box and you lock the pills in a slot.
00:13:44.322 --> 00:13:49.133
and then it alarms when it's time to take it out and it opens up for you.
00:13:49.133 --> 00:14:08.678
And you simply pay for that one time and then you have it versus some of these more robust types of electronic pill dispensers like the Hill Hero one that's getting a lot of press right now is you have to pay a monthly subscription fee.
00:14:08.879 --> 00:14:12.940
And some of the Medicare plans are actually paying for these.
00:14:13.556 --> 00:14:15.557
options for patients.
00:14:15.937 --> 00:14:18.615
I don't see a lot of benefit.
00:14:18.615 --> 00:14:28.725
I don't see a lot of plans covering them if I'm being honest, but it is a big, it is a sort of a big machine.
00:14:28.725 --> 00:14:32.307
It almost looks like a current coffee machine.
00:14:32.989 --> 00:14:39.111
And the hardest part, like I said before, is just getting it set up.
00:14:39.214 --> 00:14:45.389
The thing I like about Hero though is that they do have that remote monitoring system attached to it.
00:14:45.389 --> 00:15:05.380
So they actually have If you want to buy into the more like Cadillac service option of it and you don't have a caregiver that is reliable per se for every day or every week to check in on you, you can actually do remote monitoring with that system.
00:15:05.461 --> 00:15:16.750
And if the patient doesn't take the medicine and alerts the hero company and then they give that patient a call and they say, Hey, Mr.
00:15:16.750 --> 00:15:18.972
Smith, you really need to take these medicines.
00:15:18.972 --> 00:15:22.025
Can you find your hero pill dispenser?
00:15:22.025 --> 00:15:24.527
They should be dispensing right now.
00:15:25.110 --> 00:15:34.277
And that is a particular machine that I know both you and I have sort of tested it a little bit from the company itself.
00:15:34.277 --> 00:15:51.926
My concern with Hero or any sort of dispenser that relies on a weighted cup that kind of tells the machine whether it's been taken or not is that I know plenty of patients who will just take that little cup, whether it's plastic or metal.
00:15:51.926 --> 00:15:53.736
and take it with them somewhere else.
00:15:53.736 --> 00:15:55.368
So it's off.
00:15:55.405 --> 00:16:04.696
I mean, it looks like it's taken by the machine, but potentially people could, you know, throw it down the trash can or hide it in their bedroom.
00:16:04.696 --> 00:16:12.163
And nobody will know because, you know, unless you go in to actually look for it, it seems like it may be taken.
00:16:12.163 --> 00:16:12.825
Yes.
00:16:12.825 --> 00:16:16.384
Yeah, you have to keep all the components and I agree with you.
00:16:16.384 --> 00:16:17.998
I honestly like that.
00:16:17.998 --> 00:16:19.700
Like I said, keeping it simple.
00:16:19.700 --> 00:16:30.298
I prefer the the best low price dispenser right now is the live fine 28 day automatic pill dispenser that you can find on Amazon.
00:16:30.298 --> 00:16:39.043
You just Google it and yes, and it's it's easy to set up, but it does have that alarm.
00:16:39.086 --> 00:16:39.605
Mm-hmm.
00:16:39.605 --> 00:16:48.181
you know, if you do have a patient that can get easily aggravated or won't remember what the alarm is for, that is the con of it.
00:16:48.235 --> 00:16:51.138
Yeah, and we'll link these in the show notes as well.
00:16:51.138 --> 00:17:02.897
There's one other website that I also recommend to people fairly frequently and that's called alzstore.com, A-L-Z, like in Alzheimer's.
00:17:02.897 --> 00:17:18.919
And that's a slightly more curated list and it doesn't include just pill boxes, but also some other technologies like door switches to prevent people from just unlocking the door and running out into traffic.
00:17:18.980 --> 00:17:32.645
It's slightly more, I find it slightly more manageable to browse because Amazon, it just has so much product that you sometimes don't know like what you need and it takes too long to find what you need.
00:17:32.645 --> 00:17:36.087
Our store kind of just simplifies it.
00:17:36.087 --> 00:17:40.289
So you don't have as much choice, but you do have, you know.
00:17:40.289 --> 00:17:51.363
you can look on there and say, yeah, I wonder if there's something that's similar to this that may be cheaper on Amazon or online, even if you don't necessarily look for it.
00:17:51.363 --> 00:18:06.377
And some of these technologies, I wouldn't even have known that existed, like a fake lock that the caregiver can open because it's a little bit complicated, but it's not like a deadbolt that locks people in from the inside.
00:18:06.696 --> 00:18:08.087
Yeah, I love that.
00:18:08.087 --> 00:18:08.912
Yeah.
00:18:08.912 --> 00:18:18.192
I found another website that it was just like Alzheimer's dot com and it seemed to be pretty user friendly and talked about some good stuff.
00:18:18.192 --> 00:18:24.152
But I will definitely use that website that you just mentioned to.
00:18:24.372 --> 00:18:26.372
Yeah, because Amazon can get cumbersome.
00:18:26.372 --> 00:18:35.872
The other option just really quickly is that's gaining popularity is those pill packaging compliance packaging.
00:18:35.872 --> 00:18:37.471
We have.
00:18:37.913 --> 00:18:43.067
A lot of the outpatient pharmacies do offer these compliance packaging options.
00:18:43.067 --> 00:18:45.559
We call them bubble packs.
00:18:45.621 --> 00:18:49.545
But again, you have to remember to push the meds out of the bubble pack.
00:18:49.545 --> 00:18:57.962
But the other one that's really gaining popularity, it almost looks like a candy dispenser to me, the ones that come out in a sleeve.
00:18:57.962 --> 00:18:58.845
Yeah.
00:18:59.192 --> 00:19:03.776
And it's nice though that it tells you the medications that are in each one.
00:19:03.832 --> 00:19:15.926
The con of that though is if you do have a patient that needs to adjust their medications frequently, it is very challenging to get those fixed and updated.
00:19:15.926 --> 00:19:26.055
So, and again, it's not the most ideal for memory loss, but I did just want to mention those options just to be comprehensive in what's out there.
00:19:26.102 --> 00:19:55.140
Yeah, and those blister packages, I've seen, you know, the downside of some of them is that it's easy to know whether someone has taken their dose, but then it's also hard to adjust, especially if you just need to remove one pill from your morning pack and you're like, crap, now where do I store all these other five pills that I just opened the little blister pack and how do I remember to take that?
00:19:55.140 --> 00:19:55.596
Yes.
00:19:55.596 --> 00:20:09.396
You know, it's almost like, it works well if you have a very stable list of medicines that you're just kind of taking every day without any changes.
00:20:09.645 --> 00:20:13.181
And because otherwise you have to sort of change it at the next month.
00:20:13.181 --> 00:20:23.690
Like the next time the packaging is being delivered, you kind of have to make all the changes at once rather than making one change at a time.
00:20:23.705 --> 00:20:36.530
which is usually how I recommend for people to do it because if you make multiple changes at once, then it's hard to know, you know, is it drug A that made me feel dizzy or is it drug B that made me feel dizzy?
00:20:36.971 --> 00:20:40.272
Because all of that may be implemented at once.
00:20:40.272 --> 00:20:41.173
Yeah.
00:20:41.173 --> 00:20:41.853
Yeah.
00:20:41.853 --> 00:20:42.284
Okay.
00:20:42.284 --> 00:20:49.185
Well, switching gears a little bit, let's talk about the medications that are bad for memory.
00:20:49.185 --> 00:20:56.259
And then I know some of my audience have specifically asked me, what kind of supplements are good for memory.
00:20:56.259 --> 00:20:57.200
Yes.
00:20:57.560 --> 00:20:57.951
Yeah.
00:20:57.951 --> 00:21:00.832
And again, that's a great plug for pharmacists.
00:21:00.832 --> 00:21:05.545
So I'm so excited to be asked to be on your podcast.
00:21:05.545 --> 00:21:19.403
I think pharmacists sometimes can be an underutilized healthcare team member, especially the community pharmacists to talk through which medications you do need to avoid in especially the active drug.
00:21:19.403 --> 00:21:21.404
list that you have with your pharmacy.
00:21:21.404 --> 00:21:26.366
We are big believers in trying to fill medicines at one pharmacy.
00:21:26.468 --> 00:21:35.251
So we have a full comprehensive list of what you're actually taking and then that way we can do good drug-drug interaction checks.
00:21:35.251 --> 00:21:43.256
So that's the number one thing we try to do and then things to try to avoid for patients that do have memory loss.
00:21:43.905 --> 00:21:47.737
I'm actually really excited working in the population health field.
00:21:47.817 --> 00:21:53.528
We focus a lot on quality measures and they're actually coming out with two new quality measures.
00:21:53.528 --> 00:21:55.400
Mia, I don't know if you're aware of them.
00:21:55.400 --> 00:22:09.890
They're calling them the poly CNS measures and they're trying to, you're going to get some flags in the system to try to decrease prescribing opioids and benzos together.
00:22:09.890 --> 00:22:16.759
So those are obviously two medicines that we want to try to avoid for patients that do have memory loss.
00:22:16.759 --> 00:22:17.550
Yeah.
00:22:17.550 --> 00:22:30.259
And the benzodiazepines, just for those who don't understand, these are medicines like Xanax, Valium, Klonopin, and their corollary generic names.
00:22:30.259 --> 00:22:31.940
I call them alcohol and a pill.
00:22:31.940 --> 00:22:50.564
But the danger that Molly was saying about prescribing a pain medicine like morphine, oxycodone, hydrocodone, Percocet, along with these benzodiazepines is that it can actually reduce people's desire to breathe and people can overdose and die.
00:22:50.564 --> 00:22:55.578
Yes, yeah, and it really decreases your cognitive ability.
00:22:55.578 --> 00:22:58.132
So ability to think straight.
00:22:58.132 --> 00:23:01.855
does fog gives you that brain fog.
00:23:01.963 --> 00:23:13.547
Even alone, those benzodiazepines, it's medicines that end in PAM are the benzodiazepine medicines that we think of for generic, that's the generic ones.
00:23:14.166 --> 00:23:21.828
They're commonly prescribed in geriatric patients because they help with agitation or anxiety.
00:23:22.009 --> 00:23:38.912
But there are other options that are better to use to help with anxiety, such as Selexa or Lexapro, or if you have a patient that doesn't want to eat remeron is actually a great option instead of that benzo.
00:23:38.912 --> 00:23:45.667
And then the opioids, like if you do have a patient that's in true pain, we obviously want them to not be in pain.
00:23:45.667 --> 00:23:55.442
So we try to say, try to get them off the opioids, like the norcos or the oxycodones as quickly as possible.
00:23:55.442 --> 00:24:00.115
And they actually recommend to try to decrease taking NSAIDs.
00:24:00.115 --> 00:24:10.991
So NSAIDs are your anti-inflammatory inflammatory pain medicines, you can get over the counter like Advil, the generic ibuprofen, Aleve is another common one.
00:24:10.991 --> 00:24:15.305
Those can actually affect how you're thinking as well.
00:24:15.305 --> 00:24:25.040
And so trying to decrease taking those, best medicine for pain in a patient with memory loss is your Tylenol, your acetaminophen.
00:24:25.162 --> 00:24:35.719
And then the other measure that they are actually incorporating is trying to decrease patients on duplicate anticholinergic medications.
00:24:35.940 --> 00:24:41.320
That big word is essentially any medicine that helps you dry up.
00:24:41.362 --> 00:24:49.544
So the number one most common medicine that everyone loves is our lovely pinadryl.
00:24:50.724 --> 00:24:54.596
And it is challenging to figure out which patients are taking those.
00:24:54.596 --> 00:25:06.731
But I have seen, and you probably have too Mia, where I mean, Even my mom, I have had to try to tell her like, you can't take two tablets of Benadryl every single night.
00:25:09.263 --> 00:25:10.079
Yes.
00:25:10.079 --> 00:25:10.580
Yeah.
00:25:10.580 --> 00:25:13.166
Or unisum or sleep aid.
00:25:13.166 --> 00:25:19.140
A lot of those over-the-counter meds actually are benadryl in a slightly different formulation.
00:25:19.140 --> 00:25:21.019
Yes, great call out.
00:25:21.019 --> 00:25:30.015
And then the other anti-cholinergic medication class are the meds that help with bladder control, which do affect our patients.
00:25:30.015 --> 00:25:32.925
And so it's challenging.
00:25:32.926 --> 00:25:44.311
It's always, anytime we think of medicines and as a pharmacist, we look at the medication list, I always say, you have to assess the benefits versus risk for you.
00:25:44.897 --> 00:25:54.179
And so every medication, everything you put in your body has a side effect and everybody has a different side effect.
00:25:54.179 --> 00:26:00.625
And so it's really trying to figure out what medication you best respond to.
00:26:01.134 --> 00:26:01.877
Yeah.
00:26:01.877 --> 00:26:06.972
Another common anti-cholinergic in that is hydroxazine.
00:26:07.314 --> 00:26:09.506
We're seeing that prescribed a little bit more.
00:26:09.506 --> 00:26:20.266
It's almost like a stronger form of Benadryl, but people will put patients on it to help with anxiety because it has more mild side effects.
00:26:20.266 --> 00:26:26.291
It's actually an antihistamine just like Benadryl, but it does calm the body down.
00:26:26.761 --> 00:26:30.833
or if you have like excessive itchiness, it's a good medicine to use.
00:26:30.833 --> 00:26:35.103
But in patients with memory loss, it can increase.
00:26:35.117 --> 00:26:40.732
that memory loss and confusion and drowsiness and dizziness and fatigue.
00:26:40.732 --> 00:26:49.641
So really recommend more of using that natural melatonin that's pretty safe to use for patients that need help with sleep.
00:26:49.641 --> 00:26:57.247
And even like low dose trazodone has been shown to be safe and effective in patients with memory loss.
00:26:57.486 --> 00:26:58.526
Yeah, absolutely.
00:26:58.526 --> 00:27:04.826
For melatonin, my pitch to people is that most of the time people are taking it at the wrong time.
00:27:04.826 --> 00:27:08.306
They're taking it like a sedative right before bed.
00:27:08.306 --> 00:27:16.905
When our natural melatonin is the highest around dinnertime, like that sundowning time, that's actually the time to take it.
00:27:16.905 --> 00:27:23.365
If you're taking it at 10 o'clock, it won't really be peaking until probably two o'clock in the morning.
00:27:24.046 --> 00:27:26.665
So that does not help.
00:27:26.665 --> 00:27:30.568
And then they come back and say, it didn't do anything.
00:27:30.970 --> 00:27:42.058
But there are such a long list of medicines that are what Molly calls anticholinergic that we won't be able to fully review during the podcast today.
00:27:42.058 --> 00:27:51.467
But you can certainly either look online or talk to your local pharmacist to kind of say, which one of these do you think could be affecting my memory?
00:27:51.467 --> 00:27:57.997
And to kind of add to the caveat about paying is that not treating pain can also be bad for memory.
00:27:57.997 --> 00:28:18.678
So it's such a risk benefit, you know, is Tylenol okay in terms of controlling your pain if you take it two or three times a day consistently for arthritis that's kind of constantly there and a little bit, you know, kind of in the background, but could be affecting people's mood and agitation.
00:28:18.890 --> 00:28:29.429
Or do you really need something stronger that technically may fall within the class of an opioid, but not treating that pain can also be detrimental.
00:28:29.429 --> 00:28:33.092
So this is where, you know, I think of it like the Goldilocks phenomenon.
00:28:33.092 --> 00:28:35.765
You don't want too little, but you don't want too much.
00:28:35.765 --> 00:28:37.602
You want it to be just right.
00:28:37.602 --> 00:28:37.932
right.
00:28:37.932 --> 00:28:39.854
And everybody's different.
00:28:39.854 --> 00:28:42.134
I mean, very common.
00:28:42.134 --> 00:28:43.967
We consider it an opioid.
00:28:43.967 --> 00:28:49.621
It's not a controlled substance in some states, but some states it is, but tramadol.
00:28:49.942 --> 00:28:52.705
I don't know if you prescribe that often.
00:28:52.705 --> 00:28:54.303
I'm not a fan of Tramadoll.
00:28:54.303 --> 00:28:59.932
We actually sometimes call it Tramadont because it can have more side effects as well.
00:28:59.932 --> 00:29:01.223
Yeah.
00:29:01.224 --> 00:29:06.589
That's what like it's a it's the pro con and it's being prescribed a lot.
00:29:06.589 --> 00:29:17.619
That's why I just wanted to mention it just because people I think some prescribers, especially primary care providers think that it's well, it's not it's not really an opioid.
00:29:17.619 --> 00:29:18.621
So it's okay.
00:29:18.621 --> 00:29:22.104
But it still has all those side effects as an opioid.
00:29:22.104 --> 00:29:24.057
So right, exactly.
00:29:24.057 --> 00:29:28.397
So what kind of supplements are actually good for memory, if any?
00:29:28.397 --> 00:29:39.269
Yes, so I will say I grew up in a holistic household where I had a mother that didn't necessarily believe in prescription medications.
00:29:39.269 --> 00:29:41.160
So it's ironic that.
00:29:42.541 --> 00:29:48.607
So and that's why I think I'm the type of pharmacist that I am, and I do love geriatric medicine because.
00:29:48.653 --> 00:30:01.029
the amount of polypharmacy that there is, the excessive use of medicines in our culture, and my philosophy is trying to decrease the amount of medications patients take.
00:30:01.050 --> 00:30:10.556
But with that, you go to my mom, she's on about 10 different herbal supplements, but she is very proud that she is on no prescription medicines.
00:30:11.195 --> 00:30:24.022
And the biggest caveat as I went through pharmacy school and I always have to say this is none of our OTCs or herb rolls are approved by the FDA.
00:30:24.084 --> 00:30:31.428
And so they do not, we don't know exactly how safe and effective any of them are.
00:30:31.597 --> 00:30:32.453
Yeah.
00:30:32.703 --> 00:30:36.564
are quite a few over-the-counter that you can get.
00:30:36.564 --> 00:30:41.243
I think one of the most common ones that providers know about is Prevagen.
00:30:41.243 --> 00:30:44.644
I don't know if you ever use that Mia in your practice.
00:30:45.344 --> 00:30:46.029
Good.
00:30:46.029 --> 00:30:47.958
to please save your money.
00:30:47.958 --> 00:30:48.468
is.
00:30:48.468 --> 00:30:52.536
I think that company actually has gotten into trouble for false marketing.
00:30:52.536 --> 00:30:53.757
That's what I was going to mention.
00:30:53.757 --> 00:31:07.582
And I think a lot of primary care providers need to be educated on that because I think it's it's not to bash primary care providers, but it's just, you you try to you Google the first thing that comes up is Prevagen.
00:31:07.582 --> 00:31:10.203
And there's really no great studies.
00:31:10.243 --> 00:31:14.365
It's actually almost like the equivalent of just eating a lot of nuts.
00:31:15.766 --> 00:31:17.074
So my.
00:31:17.074 --> 00:31:18.307
a little nutty.
00:31:20.460 --> 00:31:30.387
Nuts, what are nuts high in that can help with the memory stability is the vitamin E and the omega-3 fatty acids.
00:31:30.387 --> 00:31:34.211
So I'm a believer in taking fish oil.
00:31:34.211 --> 00:31:38.074
I think it helps with multiple parts of your body.
00:31:38.074 --> 00:31:42.737
It helps with your heart and it can help with your brain health.
00:31:43.698 --> 00:31:46.190
And it doesn't have to be.
00:31:46.190 --> 00:31:47.490
that crazy expensive.
00:31:47.490 --> 00:32:02.967
Again, ask your pharmacist for help of which one might be best for you if you want to go that route because there are so many different types of brands and there are a lot of brands out there that are not good because it's all about which active products there are.
00:32:05.140 --> 00:32:10.670
I think Ginkgo Biobla, always, I feel like I always say it mispronounce that.
00:32:10.670 --> 00:32:12.865
I think that was really popular back in the day.
00:32:12.865 --> 00:32:15.251
I don't know if it's as popular.
00:32:16.203 --> 00:32:28.638
Now and again, I say with caution, like be careful with any of these just because we don't have the, we don't know how they're going to interact with your medicines you're currently on.
00:32:28.638 --> 00:32:33.049
And again, it's that benefit versus risk.
00:32:33.049 --> 00:32:37.805
Just because it's over the counter doesn't mean there aren't risks associated with it.
00:32:37.805 --> 00:32:38.484
right.
00:32:38.484 --> 00:32:42.748
If you take enough Tylenol, you can get liver failure and it is over the counter.
00:32:42.748 --> 00:32:50.612
But Ginkgo actually is one where we are, our center have been involved in a very large study looking at Ginkgo for memory loss.
00:32:50.612 --> 00:32:53.854
And unfortunately it does not help.
00:32:53.913 --> 00:33:00.336
So one of the most common supplements that I prescribe is really vitamin B12.
00:33:00.789 --> 00:33:17.384
And usually I do check for a vitamin B12 level because in people who are on an anti-acid blocker, like your Protonix, your heartburn medication, that can inhibit, prevent the absorption of B12.
00:33:17.384 --> 00:33:30.278
If you're a pure vegetarian and you don't eat any meat, like my son, accidental vegetarian there, he probably is not getting enough B12 because he doesn't even like chicken.
00:33:30.334 --> 00:33:56.365
And that if you are having someone who has been through gastric bypass surgery, parts of your stomach or inflammatory bowel disease where there's things that prevent the absorption of some of these vitamins, especially B12, we do know that low B12 can cause not only memory problems, but also neuropathy where you're tingling in your feet, which then make you more likely to fall.
00:33:56.365 --> 00:34:02.669
So that is one supplement that I guess I believe in because it is actually beneficial.
00:34:02.669 --> 00:34:24.097
But most of the time, I think people are better saving their money and saving the number of pills that they have to take by making sure every medicine does a benefit that you can see or that if it's something that you don't notice a big difference but you want to prevent some future.
00:34:24.097 --> 00:34:28.019
bad outcome like heart disease, heart attacks or strokes.
00:34:28.019 --> 00:34:40.505
Sometimes after people had a heart attack, they suddenly are on six different medicine and that can be hard to reconcile, but they do all have evidence at preventing a second heart attack.
00:34:40.746 --> 00:34:50.329
So that's one of the few situations where I would say, actually you are on more medicines now, but they do help you.
00:34:50.746 --> 00:35:00.900
But most of the time is the opposite where there's usually a couple things that we could take off or just change the frequency from every day to only if you need it.
00:35:00.900 --> 00:35:07.918
And then if you truly need it, then you will notice if there is a benefit at the time that you need it.
00:35:07.918 --> 00:35:09.318
Yeah, absolutely.
00:35:09.318 --> 00:35:13.414
And I will say another plug for vitamin B12, it tastes delicious.
00:35:13.414 --> 00:35:23.443
So I don't know if you've ever taken it Mia, but it's usually under the tug dissolving tablet and it tastes, it has a good flavor to it.
00:35:23.443 --> 00:35:26.967
So my parents love taking their vitamin B12.
00:35:26.967 --> 00:35:29.690
So we are big believers in vitamin B12.
00:35:29.690 --> 00:35:35.425
I would completely buy the wrong brand because I got the pill form that was quite large.
00:35:36.068 --> 00:35:36.467
okay.
00:35:36.467 --> 00:35:37.849
I gotta switch.
00:35:37.990 --> 00:35:40.693
dissolving tablet and it's like a cherry flavor.
00:35:40.693 --> 00:35:44.856
You just put it under your tongue and it actually tastes really good.
00:35:45.097 --> 00:35:46.217
Okay, all right.
00:35:46.217 --> 00:35:50.920
See, now I learned something that I can change as well.
00:35:50.920 --> 00:35:52.731
Yeah, that's right.
00:35:52.731 --> 00:35:57.382
Because my B12 was slightly low for some reason when my doctor checked it.
00:35:57.382 --> 00:36:01.163
Well, thank you so much for joining me today, Molly.
00:36:01.623 --> 00:36:02.943
I'll give you the last words.
00:36:02.943 --> 00:36:08.545
Anything else that you think that we haven't talked about that you want to mention to our audience?
00:36:09.327 --> 00:36:11.168
I think that we've covered it all.
00:36:11.168 --> 00:36:16.228
think that, again, as I stated, lots of different options that can get overwhelming.
00:36:16.447 --> 00:36:31.547
I always tell people, be your best advocate to your care, whether you're the patient or the caregiver, and don't hesitate to truly say what's going on, whether it's to your doctor, your pharmacist.
00:36:31.547 --> 00:36:39.628
On our population health team, we have fabulous community health workers and social workers, and we can really try to wrap around.
00:36:40.432 --> 00:36:53.000
you and your team at home to really make sure that you are set up best to be in the best place to take your medicines and feel the best.
00:36:53.000 --> 00:37:02.264
And I will say lastly, every Mia you know this too, but the best thing too is those non-medication interventions.
00:37:02.264 --> 00:37:04.266
Like are you drinking enough water?
00:37:04.266 --> 00:37:06.958
Are you going outside and getting some light?
00:37:07.000 --> 00:37:10.641
are you doing those types of things to keep your mood up?
00:37:10.641 --> 00:37:29.974
I think that having a really good diet and eating good nutritious foods, big believer in that, because I think that food is the best medicine that we have as well as exercise, even if it's just standing out on your front porch and moving your arms up and down, if that's all you can do.
00:37:31.601 --> 00:37:34.304
Your neighbors might be like, say hi.
00:37:34.445 --> 00:37:36.726
Why are you waving to me?
00:37:38.768 --> 00:37:40.679
Well, thank you so much, Molly.
00:37:40.679 --> 00:37:46.735
And I do want to add for people who might be wondering, how can I find a population health pharmacist?
00:37:46.735 --> 00:37:56.643
And I think usually those are associated with inpatient hospitalization, perhaps at the time that you're about to leave the hospital.
00:37:56.643 --> 00:37:59.266
It may be even helpful to request.
00:37:59.422 --> 00:38:05.985
to talk with a pharmacist or someone on the pharmacy team who can go through your medicines in detail.
00:38:05.985 --> 00:38:36.981
One thing that I actually do think will be really smart and really beneficial before people leave the hospital is to have their family members bring in all of the actual bottles that they take at home because it's more common than not that what is showing up on the hospital list is different from what is at home and it will be ideal if that can be reconciled before you leave the hospital rather than going home and say, I don't know why they listed this medicine twice.
00:38:36.981 --> 00:38:39.380
Am I supposed to take the one I was on before?
00:38:39.380 --> 00:38:41.141
Am I taking this new one?
00:38:41.141 --> 00:38:55.907
But a lot of times it's just because the hospital didn't have your particular brand or formulation on their hospital formulary and your doctor had to substitute for something, but then it causes more confusion later on.
00:38:55.907 --> 00:39:07.739
Definitely, and I will say that definitely ask if you're at discharge, but our population health team does, it doesn't have to be attached to a hospitalization anymore.
00:39:07.739 --> 00:39:17.206
We, you can ask any of your doctors to say, I'd like to talk to a pharmacist and they can send a referral to our team.
00:39:18.208 --> 00:39:21.731
at any time in our electronic health system.
00:39:21.731 --> 00:39:24.855
So it doesn't, and we can do a telephonic outreach.
00:39:24.855 --> 00:39:31.202
We can meet you in person, whether it's in your home or even if it's in collaboration with your clinic visit.
00:39:31.202 --> 00:39:36.833
We really try to meet the patient where they are in their healthcare journey to help them along.
00:39:36.833 --> 00:39:37.494
That's great.
00:39:37.494 --> 00:39:39.557
If you're in Winston-Salem, you're in luck.
00:39:39.557 --> 00:39:44.967
If you're not, then you might have to ask your doctor about what's available in your local community.
00:39:44.967 --> 00:39:48.311
But thank you so much for joining us today, Molly.
00:39:48.311 --> 00:39:50.195
And thank you all for listening.
00:39:50.195 --> 00:39:52.157
We'll talk to you next time.
