Chronic care management of multimorbidity patients almost always brings polypharmacy along for the ride. This makes effective medication reconciliation and monitoring essential for quality care.

You know well the risks of polypharmacy to your patients. According to the Department of Health and Human Services, polypharmacy leads to “an increased risk of adverse drug events (ADEs), drug-interactions, medication non-adherence, reduced functional capacity and multiple geriatric syndromes.” Yet patients often forget to list some of the medications they’re taking or neglect to take the medicines they’ve been prescribed.

“A multitude of factors—such as patients’ lack of knowledge of their medications, physician and nurse workflows, and lack of integration of patient health records across the continuum of care—all contribute to a lack of a complete medication reconciliation, which in turn creates the potential for error,” writes Jane H. Barnsteiner, Ph.D. and R.N. in Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

Incomplete Medication Records, Poor Adherence, and Pharmacogenomic Variation

It’s no surprise then that discrepancies are common on medication records. According to a review in NPS Medicinewise, “Studies in ambulatory care settings report 26–87% of medication records as incomplete or having discrepancies between medicines taken by the patient and those documented in the patient record.”

Medication adherence is similarly poor. According to the CDC, “Approximately one in five new prescriptions are never filled, and among those filled, approximately 50% are taken incorrectly, particularly with regard to timing, dosage, frequency, and duration.”

Reporting on a study by the World Health Organization, U.S. Pharmacist found that “Nonadherence can account for up to 50% of treatment failures, around 125,000 deaths, and up to 25% of hospitalizations each year in the United States.”

Add to this that pharmacogenomic variations may lead some patients to metabolize certain drugs differently, and you’re left with a very complicated puzzle to solve for each of your patients.

All of this adds up to poorer patient outcomes and higher healthcare costs.

Medication Reconciliation Through Drug Metabolites

Best practices for medication reconciliation have come a long way in the past decade or so. Optimized workflows, better training, and electronic records all support better medication reconciliation. The face-to-face relationship with your patients remains paramount in this process, however accuracy does still ultimately depend on the fallible self-reporting of your patients. No matter how good the systems, human error is inevitable.

Lab analysis of drug metabolites gives you an objective tool to verify that you have the complete list of a patient’s medications, that they are taking those medications, and that their bodies are metabolizing them as expected.

Did your patient neglect to mention that they take a daily low dose aspirin or are on diazepam? Urinalysis can identify the drug metabolites if present, filling in any gaps in the patient’s medication records.

Is your patient taking their atorvastatin or metoprolol as you directed? If the drug metabolites are absent in lab analysis, you know they’re not adhering to your prescription and you can intervene as needed.

Is your patient a fast metabolizer of the antidepressant or diabetes medicine you’ve described, lowering the level of active drug in their bloodstream? If drug metabolites are present but in lower concentrations than expected, you may consider ordering pharmacogenomic testing to inform your choice of a different medication or dose.

It all supports you in making well informed treatment decisions for your polypharmacy patients who receive your practice’s chronic care management. You’ll likely save them on their prescription costs while avoiding adverse drug events, and you may give them a higher quality of life.

Drug Metabolite Testing for Chronic Care Management is Available to Your Practice

LifeBrite Labs offers a proprietary, non-invasive, urine-based chronic care management (CCM) panel that tests for the metabolites of more than 125 medicines commonly prescribed for chronic conditions. Our CCM reports give you a complete list of all the medications your patient is taking, allowing you to identify any potential risks or intervene when patients aren’t adhering to your prescribed treatment.

We help you reconcile medications for polypharmacy patients, monitor adherence, and evaluate the efficacy of current prescriptions. When the CCM panel suggests a medicine is not having the desired effect, we may recommend a pharmacogenomics panel to help you evaluate alternative medications.

It all empowers you to give your chronic care management patients the best in personalized care.


Does your practice provide chronic care management to polypharmacy patients with multiple morbidities? Our Chronic Care Management panel gives you objective analysis of drug metabolites for better medication reconciliation, adherence, and efficacy. Contact us to learn more.

Atlanta-based LifeBrite, led by CEO Christian Fletcher, operates LifeBrite Laboratories, LifeBrite Community Hospital of Stokes, and Lifebrite Community Hospital of Early.