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1.13 1 in 5 1 in 4 Why should these numbers be important to you? There are 1.13 billion people diagnosed with high blood pressure (hypertension) in the world. 1 out of 5 women and 1 in 4 men in the World are diagnosed with high blood pressure. These numbers are remarkable and only growing from year to year. This article will define high blood pressure, ways to detect it, when to seek help, and how to manage high blood pressure. WHAT IS HIGH BLOOD PRESSURE? The American Heart Association (AHA) defines a normal or ideal blood pressure level as less than 120/80 mmHg. Hypertension is a blood pressure greater than 130/80 mmHg. It is normal for blood pressure to rise and lower throughout the day, however, if blood pressure is consistently elevated, it can be a sign of hypertension. WARNING SIGNS OF HIGH BLOOD PRESSURE High blood pressure is known as the “silent killer” because most times there are no warning signs that blood pressure is increasing. It is important to have blood pressure monitored regularly. Elevated blood pressure is defined as systolic (top number) readings between 120-129 mmHg and a diastolic (bottom number) reading > 80mmHg. When and if symptoms occur, they can include headaches, nosebleeds, irregular heartbeats, and vision changes. Stage 1 hypertension is when blood pressure readings consistently read between 130/80 and 139/89 mmHg. Stage 2 high blood pressure occurs when readings are ≥140/90 mmHg. Talk to your physician if you notice your numbers to be in these ranges, so that your physician can help you lay out the next best steps to improve your health. KNOW WHEN TO SEEK HELP It can be difficult to pinpoint the best time to seek help because most people do not have symptoms. If you have symptoms listed above, it is time to seek help from your provider because you may be indicated for treatment. If high blood pressure goes untreated, it can lead to heart attacks, strokes, kidney failure, blindness, and other complications. HOW CAN HIGH BLOOD PRESSURE BE MANAGED? Several options are available to help improve blood pressure control. Making behavior changes to diet and exercise along with taking medications can help manage high blood pressure and prevent cardiovascular events such as heart attacks and stroke. There are modifiable and unmodifiable risk factors that cause high blood pressure. Modifiable risk factors are those that can be controlled by changing behaviors. Unmodifiable risk factors are characteristics out of a person's control. MODIFIABLE RISK FACTORS - Diet - Physical inactivity - Tobacco and alcohol use - Being overweight or obese UNMODIFIABLE RISK FACTORS - Family history - Age (>65 years old) - Co-existing medical conditions (diabetes or kidney disease) BEHAVIOR MODIFICATIONS - Follow the DASH (Dietary Approaches to Stop Hypertension) Diet: rich in fruits, vegetables, whole grains, lean proteins, and most importantly sodium (salt) restriction/reduction to <1500 mg per day. Find more information about how to limit salt intake here. - Exercise: work towards getting 150 minutes of moderate intensity exercise every week (75 minutes of more vigorous activity) spread over 3 to 4 days. - Quit smoking, vaping, and avoid second had smoker. - Reduce alcohol consumption. It is recommended for women to have less than 1 drink a day and men less than 2 drinks a day. In conclusion, high blood pressure is one of the most common health conditions effecting Americans today. It is important to have your blood pressure routinely checked by a health care provider. Making behavior changes and working with a health care provider can improve blood pressure and prevent complications from untreated and uncontrolled blood pressure. TRIA HEALTH CAN HELP Tria Health can help you understand your risks of high blood pressure and what you can do to take better care of your heart. Tria Health offers Chronic Condition Management through our Pharmacy Advocate Program. High blood pressure is one of the many chronic conditions that Tria Health targets. Clinical Pharmacists provide one-on-one telephonic counseling for members and act as their personal advocate to help them navigate through the health care system. Through reviewing a member’s medications and lifestyle habits, Tria Pharmacists can make recommendations that will help control their chronic conditions and help them feel better! QUESTIONS? Call the Tria Health Help Desk at 1.888.799.8742 SOURCES Hypertension (who.int) High Blood Pressure Symptoms and Causes | cdc.gov Understanding Blood Pressure Readings | American Heart Association REVIEWED BY Sarah Ochs Annie Tribble Maggie Lewis PharmD, CDCES, CSOWM PharmD, CDCES PharmD, CDCES

Chronic condition management (CCM) services are designed to provide support for individuals who suffer from chronic conditions such as diabetes or heart disease. According to the CDC, 90% of the nation’s $4.1 trillion in annual health care spending are for people with chronic conditions. And, at least 60% of Americans suffer from at least one chronic condition, 42% have two or more! CCM companies offer a range of services, including some form of health coaching, patient monitoring, medication reminders and more. With the rising number of Americans suffering from chronic illnesses, employers are beginning to realize the benefits of hiring a company that specializes in these services. Here are six reasons why employers should consider hiring a chronic care management company: 1. More Productive Employees Healthy employees = More productive employees Chronic condition management companies help manage an individual’s medications, diet, and other lifestyle habits. The CDC states that “companies that support workplace health have a greater percentage of employees at work every day”. By hiring a chronic condition management company, employers will increase productivity and improve the quality of life for their employees. 2. Reduced Health Care Costs Medications are the primary line of treatment used to manage chronic conditions. However, 50% of people do not take medications as prescribed [1]. When people are not adherent to their medications, they don’t get the intended health outcomes. When this happens, they end up in the doctor’s office, emergency room, hospital, which increases overall health care costs. When medications are optimized, total health care costs are reduced. 3. Increased Employee Satisfaction Chronic condition management companies do not only focus on the health of their members; they also take pride in maintaining relationships. Because of this, they make sure to communicate regularly with individuals about their progress and any problems they may encounter. Not only does this keep them informed, but it also keeps participants happy and satisfied with their treatment plan. 4. Increased Revenue Companies spend thousands of dollars each year on insurance premiums, administrative fees, and doctor visits. A chronic condition management company takes over those responsibilities, giving you more time to focus on running your business and less time worrying about finances. By focusing on the physical health of their employees, companies can help reduce medical bills and other costs associated with chronic illness. 5. Most Offer Guarantees In most cases, chronic condition management companies offer guarantees. Typically, a chronic condition management company can (and should) report both pharmacy and health care savings. In most cases, the pharmacy savings, which are an immediate impact to your bottom line, will pay for the cost of CCM services. Over time, CCM companies can report total health care savings in the form of reduced hospitalization, reduced emergency room and doctor visits. A harder to measure savings comes from having healthier employees that are present and engaged. 6. Great Service The relationship between the patient and the provider at the CCM company is analogous to the relationship between the doctor and the patient. The CCM provider is able to spend time to not only understand the patients’ medications, but also understand their habits and lifestyle and customize a care plan that works for the patient. In addition, the provider can coordinate care with the patient’s physician to encourage communication across the patients care team. Tria Health Can Help Tria Health utilizes pharmacists for one-on-one consultations for members with chronic conditions. Since medications are the primary treatment method for chronic diseases and pharmacists are medication specialists, they are the best resource to provide support. In addition, Tria Health utilizes intelligent remote monitoring to improve health literacy in between telehealth appointments. During a consultation, the Tria Health pharmacist will review all current medications, including vitamins and supplements with member. Tria Health will assist members in identifying any possible drug interactions or savings opportunities! Pharmacists will work with members and their doctor(s) to ensure that the intended outcomes from their medications are being received. Questions? Contact the Tria Health Desk at 1.888.799.8742 Resources Health and Economic Costs of Chronic Diseases | CDC Multiple Chronic Conditions in the United States (rand.org) Medication Adherence: WHO Cares? - PMC (nih.gov) Increase Productivity | Control Health Care Costs | Model | Workplace Health Promotion | CDC Increase Your Practice’s Revenue with Chronic Care Management | iSalus (isalushealthcare.com) Best Way to Increase Medical Revenue with Health Wealth Safe

Diabetes is a chronic disease that requires regular monitoring and management. There are two main types of diabetes – Type 1 and type 2. The Diabetes Plate Method is a meal plan designed specifically to control diabetes. It involves measuring blood sugar before each meal, then avoiding foods high in carbohydrates and fats. It’s important to monitor your blood sugar levels regularly to check for any complications or side effects from your treatment. The Diabetes Plate Method is an effective solution to help manage your blood sugar levels. Half of Your Plate - Non-Starchy Vegetables Non-starchy veggies are low in carbs and can help keep your blood glucose levels steady. They're also full of nutrients that make them beneficial to health. Eat plenty of these kinds of foods to stay healthy. Some non-starchy vegetables include brussels sprouts, cabbage, celery, mushrooms, green beans, and tomatoes. One Quarter of Your Plate - Lean Protein Foods Protein foods usually contain nutrients, vitamins, and minerals that help keep your body healthy. Lean meats are also lower in fat and saturated fats, making them a healthier alternative. Poultry, fish, seafood, eggs, soy products, nuts, beans, peas, lentils, and whole grains are good sources of lean protein. One Quarter of Your Plate - Carbohydrates A large amount of carbohydrates has an effect on blood sugar. Eating a lot of carbohydrates can cause blood glucose levels to rise. Foods high in carbs include breads, pasta, rice, potatoes, corn, and sweets. Reducing how much you eat can help lower the amount of sugar in your body. Some carbohydrate foods include brown rice, oatmeal, green peas, acorn squash, and dairy products like milk and yogurt. Drink Options Water is the best option because it doesn’t contain any calories or carbohydrates and has zero effect on your blood sugar levels. Other zero- or reduced calorie drinks include unsweetened tea (unsweetened black, green, herbal), unsweetened coffee, and sparkling water/club soda. Tria Health & Diabetes Management If you are currently diagnosed with diabetes, Tria Health can assist you in managing your medications and finding a treatment plan that works for you. Diabetes is a disease that can be managed and prevented if you know what to do. At Tria Health, our pharmacists are certified diabetes care and education specialists (CDCES). They educate patients on medication management, diet, and exercise so patients with diabetes can live happy and active lives and reduce the risk of serious health complications. Watch how Tria Health is helping patients monitor their diabetes: Questions? Call the Tria Help Desk: 1.888.799.8742 Sources https://www.diabetesfoodhub.org/articles/what-is-the-diabetes-plate-method.html

Photo by Gabin Vallet on Unsplash It’s almost the end of January and by this time many people have already given up on their New Year’s resolution. Don’t worry though, because it is not too late to jump back in and find fun ways to stay active! We all know that exercising and staying healthy is important, however we can still have a hard time sticking to it. Why is that? While we know how and why exercise is good for us, we don’t have the right mindset or smart approach towards exercise. When you think of exercising, your immediate thought may be of running or weightlifting. You might be groaning at the thought of doing these activities. These activities are the traditional sense of working out. There are many enjoyable activities that you can start so that working out is not a burden and more something to look forward to. This blog will focus on ways to spice up your normal workout routine.1 Think Outside the Gym The gym can be intimidating, too expensive, or simply too inconvenient with your lifestyle. There are many alternatives to going to the gym. Some of these activities include kayaking, rollerblading, Zumba, and fencing. Make it a Game This one may surprise you but playing a video game that gets you standing up and moving around is a productive – and fun way to exercise. You can burn at least as many calories as you would be walking on a treadmill! There are many games that can be found on the Wii and Kinect for exercising, but a few are bowling, tennis, and soccer. Pair it with Something You Enjoy You can also incorporate exercise into your favorite activities and responsibilities you are already doing. This could look like doing a light workout during the commercial breaks of a show or dancing to music as you do household chores. Make it Social Exercising is more fun when you are doing it with friends! Grab a friend or two and join a club sport or attend a dance class together. They say that friends grow closer through unique shared experiences, and this is a great opportunity. If you have kids, you can get them involved and implement exercising into your daily routine. This could look like going on afternoon nature walks together or doing seasonal activities (Skiing, cycling, etc.). Try a Mindfulness Approach Pay attention to your body when you exercise. This not only helps with improving your physical condition, but it also helps with interrupting the thoughts of worry and anxiety. Some activities that are great for mindfulness are rock climbing, swimming, and skiing. A few helpful tools that provide free at home workouts are: ACE Fitness: Provides workouts with descriptions of proper use and level of difficulty. https://www.acefitness.org/education-and-resources/lifestyle/exercise-library/ Adidas Training App Nike Training App Luckily, you don’t have to wait until next year to get back into the habit of exercising. With the right mindset and a smart approach, you can create change in your life TODAY. Remember that it is possible to find enjoyment out of all life has to offer! Tria Health Can Help For select groups, Tria Health offers a weight management service called Choose to Lose. If this structured weight loss program is included through your benefits plan, you can receive help from a combination of registered dietitians, health coaches and pharmacists, along the best-in-class nutrition tracker app ‘LoseIt!’ and a Bluetooth scale. Tria Health is a no cost benefit available through select members’ health plans. Tria Health’s Pharmacy Advocate Program offers one-on-one, private consultations with a Tria Health Pharmacist. During your consultation, your pharmacist will review all your current medications, including vitamins and supplements. Tria Health will assist you in identifying any possible drug interactions or savings opportunities! Your pharmacist will work with you and your doctor(s) to ensure the intended outcomes from your medications are being received. Questions? Contact the Tria Health Help Desk at 1.888.799.8742 Resources How to Start Exercising and Stick to It – HelpGuide.org #Exercise #NewYearsResolution #Resolutions

American Pharmacists Month is here! Pharmacists are medication experts that have a wealth of knowledge to assist patients with safe medication use, potential drug interactions as well as preventative services and over the counter medications. 4 WAYS PHARMACISTS HELP YOU 1. Pharmacists discuss your medicine with you Pharmacists help minimize side effects and safeguard against any possible interactions with other medications that can lead to more expensive health care costs such as emergency room visits, hospitalization, etc. 2. Pharmacists work alongside your physician Pharmacists communicate with your physicians to ensure that you are on the proper medications and avoid any harmful effects. They can provide the proper management for chronic diseases such as diabetes, asthma, hypertension, etc. 3. Pharmacists provide guidance on preventative services Pharmacists can provide guidance on all vaccine-preventable diseases and which immunizations are best for you. Retail pharmacists also administer vaccinations for the flu, shingles, various travel vaccines, and more. 4. Pharmacists give advice on over-the-counter medications Pharmacists give advice on any over-the-counter medications (OTC) that may interact with your current prescription medications. It’s important to let your pharmacist know all the medications you are taking, prescribed and OTC, so that they can best assist you in your health journey. MEET A FEW OF OUR TRIA HEALTH PHARMACISTS Tyler Page, Pharm.D. Why did you want to be a pharmacist? I wanted to be pharmacist to improve the health and wellbeing of as many people as I could. Becoming an expert in medication therapy allows me to help a wide range of people stay in good health. What do you enjoy the most about your job? I enjoy the thrill of helping people meet their health goals and I particularly enjoy helping those who need it the most. Who is your hero and why? I have several, but I would have to say my dad is my biggest hero. He is a pharmacist as well and taught me a lot about the field and how to care for others. ___________________________________________________________________ Kristin Hodge, Pharm.D. Why did you want to be a pharmacist? I've always enjoyed problem solving and being very involved in helping people in any way. Being a pharmacist allows me to be easily accessible in the community as a helping hand or useful resource. What do you enjoy the most about your job? I look forward to speaking directly with patients all day, every day. It is extremely fulfilling to assist people in achieving their health goals and feeling better overall. Who is your hero and why? My mom has always been my hero. She always seems to have a solution to any problem and drops everything to help in any way she can. Throughout my whole life she has been my biggest supporter and the person I lean on most. We want to say a big THANK YOU to all pharmacists and express to them how much we appreciate their dedication to keep us healthy and educated on our medications! Don’t forget to say thank you to your pharmacist this month. TRIA HEALTH IS HERE TO HELP Tria Health is a free and confidential benefit available through your health plan. If you have a chronic condition or take multiple medications, Tria Health’s pharmacists are ready to support you in managing your health. Not only will Tria Health’s pharmacists make sure your medications are working as intended and that you’re on the right medications, but they can support you by creating a care plan that is specific to your needs and share it with your doctor. WANT TO LEARN MORE ABOUT TRIA HEALTH PHARMACISTS? Contact the Tria Health Help Desk at 1.888.799.8742 SOURCES Get to Know Your Pharmacist | cdc.gov

Image Source: Canva Allergens such dust, mold or pollen can make indoor spaces uncomfortable. Whether you have allergies year-round or only experience them during a certain season, there are steps you can take to reduce allergens in your home! Allergy Symptoms Common allergy symptoms include watery eyes, runny nose, sneezing, rash or hives. More serious symptoms include swelling in the mouth or throat and trouble breathing.2 Bedroom Bedding: Use dust-mite proof covers on pillows, mattresses and box springs. At least once a week, wash pillowcases, blankets and sheets.1 Flooring: Limit the number of rugs in your home and wash any that are washable.1 If you have carpet, it is important to shampoo it frequently. Air filtration: Using an air filter can aid against allergens. Make sure that it is a certified asthma and allergy friendly filter. Try choosing an air filter that has a small particle or high efficiency particulate air filter (HEPA).1 Living Room Windows: Rely on air conditioning only during pollen season and close your windows. Clean any mold and condensation from window frames and sills.1 Curtains: Use washable curtains made of cotton or synthetic fabric.1 Fireplaces: Avoid use of wood-burning fireplaces or stoves because smoke and gases can worsen respiratory allergies.1 Kitchen Stove: Utilizing a vented exhaust fan to remove cooking fumes and moisture can help reduce allergens.1 Sink: To remove mold and food debris, thoroughly scrub sink and faucets.1 Cabinets and counter: Check under-sink cabinets for any plumbing leaks and clean counters with detergent and water.1 Bathroom Shower and tub: If there is any mold in or around the tub, scrub it with bleach. Clean or replace moldy shower curtains and bathmats.1 Toilet and sink: Repair any leaks and scrub mold from the plumbing fixtures.1 There are a few other ways you can minimize your exposure to allergens. When coming in from outside, remove your shoes and change clothing to rid of any allergens you may bring into the home. Additionally, shower before bed to remove any possible triggers such as tree, weeds, pollen, grass, or dander. Tria Health Can Answer Your Medication Questions If Tria Health is offered through your benefits plan, you have the option of receiving a one-on-one, private consultation with one of Tria Health’s pharmacists over the phone. During your consultation, your pharmacist will review all your current medications, including vitamins and supplements. If you’re interested in exploring medication treatments for allergies, Tria’s pharmacist will be able to provide you with recommendations. Questions? Call the Tria Health Help Desk: 1.888.799.8742 Sources: Allergy-proof your home – Mayo Clinic Allergies and Allergic Reactions | AAFA.org | AAFA | Allergies #Allergens #Allergy #TriaHealth

A healthy diet is important for a healthy life, as stated by the old saying “You are what you eat.” This is even more important in today’s world where diabetes and obesity are epidemics. In recent decades, low carbohydrate diets (LCD) and ketogenic diets (KD) have become widely known and popular ways to lose weight. These diet approaches are effective for losing weight, but there is growing evidence suggesting that caution is needed, especially when these diets are followed for extended periods of time, or by individuals of a young age or with certain diseases. The keto diet aims to adjust what fuel the body uses. Instead of using sugars from carbohydrates (grains, vegetables, fruits) the body uses ketone bodies that the liver produces from fat. The keto diet as a solution for weight loss and diabetes management is a newer concept. A keto diet limits the amount of carbohydrates an individual consumes to 20 to 50 grams a day to force the body into ketosis. To put this into perspective 1 medium - size banana has about 27 grams of carbohydrates. It takes the body a few days of consistent low carbohydrate and high fat intake to reach ketosis. When the body can maintain ketosis, it begins to burn fat that is stored to produce ketones to use for energy, this is referred to as nutritional ketosis. Nutritional ketosis can be beneficial for lowering blood glucose levels and aiding in weight loss which can have a positive impact on diabetes management. RISKS AND SIDE EFFECTS When following a keto diet there are risks to be concerned with. Ketoacidosis is the most serious risk to be aware of and work to prevent by getting a recommended amount of carbohydrate, so the body does not produce too many ketone bodies. Symptoms of ketoacidosis can include excessive thirst, confusion, urinating often, weakness, or fatigue. If an individual experiences these symptoms, they should contact their doctor right away. SHORT-TERM EFFECTS (up to 2 years) The keto diet causes rapid and sensible weight loss along with favorable biomarker changes, such as a reduction in A1c in patients with diabetes. However, it also causes a substantial rise in LDL, “bad” cholesterol levels, and many physicians are therefore hesitant to endorse it. This diet is recommended to be followed for a minimum of 2 weeks and up to 12 months. The keto diet does not have many short-term side effects. The most common short-term side effects include nausea, vomiting, headache, fatigue, dizziness, insomnia, difficulty in exercise tolerance, and constipation, referred to as keto flu. LONG-TERM EFFECTS It is still unclear if the keto diet is the best way to manage your diabetes long-term, due to limited literature. Long-term side effects that can have a major impact: Hepatic steatosis: increased buildup of fat in the liver Hypoproteinemia: very low levels of protein in the blood Kidney stones: small, hard deposits of minerals and salts that form in kidneys Vitamin and mineral deficiencies It is always recommended to talk to your physician before switching over to the keto diet. For some, this diet could be beneficial and accomplish the weight loss goals they are looking for. For others, this could make their diabetes worse. Either way, this is a big lifestyle decision, and your physician should be involved in helping you get started. Tria Health Can Help If you are diagnosed with diabetes or concerned about developing diabetes and considering the keto diet, Tria Health can assist you in managing your medications and discussing treatment plan options. Diabetes is a disease that can be managed and prevented if you know what to do. At Tria Health, our pharmacists are certified diabetes care and education specialists (CDCES). Tria Health ensures patients are taking the right medications, at the right dosage for the most affordable cost. Pharmacists also provide additional support through our remote monitoring device, iGlucose. This allows patients who need to monitor their blood glucose to do so easily while sharing their data directly with their care team. For patients that need additional nutrition counseling, Tria Health offers consultations with a health coach to help individuals with diabetes get on track. Patients also have access to the Tria Health portal where they can utilize various diet and lifestyle resources. For select groups, Tria Health offers a weight management program called Choose to Lose. This structured weight loss program provides you with a dedicated health coach, industry leading calorie tracking app, and a pharmacist. This program is not only helping patients work on changing their lifestyle and building long-lasting habits but is also improving health literacy so they can continue to make healthy decisions in the future. Questions? Contact the Tria Health Help Desk at 1.888.799.8742 Resources Ketogenic Diet - StatPearls - NCBI Bookshelf (nih.gov) The Ketogenic Diet for Diabetes: Is It Good for Diabetics? (webmd.com) Low-Carb and Ketogenic Diets in Type 1 and Type 2 Diabetes - PubMed (nih.gov) The ketogenic diet: Pros and cons - Atherosclerosis (atherosclerosis-journal.com) Reviewed by Annie Tribble, PharmD, CDCES Maggie Lewis, PharmD, CDCES

Managing a chronic illness can be very difficult to manage and it can often feel like you must carry the burden alone. However, loved ones can provide much needed assistance. This could include medication reminders or assistance in monitoring blood pressure readings. Family Support Networks Having a supportive family can make life easier in many ways. But there are two things we will focus on today that revolve around communication. First, it is important that you can talk openly about your chronic illness with your family. Many do not know the difficulties and accommodations that need to be made with specific chronic illness. While it’s important for your family and friends to understand how you are feeling and what you’re experiencing, it should not always be the center of conversation. Your illness does not have to define you. Second, everyone is different in how they might want to be supported with chronic illness. You may simply want someone to listen or you may want to help them in a practical way. In order to help family members understand what kind of help you need, take the time sit down with them to communicate clearly what they can do for your situation. They should only meet the needs that you're seeking. Do Not Isolate Don't feel isolated during this time. It is easy to believe that no one understands what you are going through. You may not want to be a bother to your family members and would rather handle your condition alone. Studies show that being around people who understand what you are going through helps you reach your health goals faster. The Benefits The California Healthcare Foundation (CHF) has studies that prove these health benefits of loved ones helping you manage your chronic illness: Better glycemic control Better blood pressure control Fewer cardiac events Better joint function and less inflammation Better self-management behavior Increased self-efficacy Decreased depressive symptoms Your loved ones are not a hinderance to helping you have successful outcomes. You are not a bother to them when you need accommodations. They can play a huge part in your health journey if you allow them to. In conclusion, managing chronic illness often means juggling many different responsibilities. And while it may seem impossible to manage all those tasks and juggle everything, you can – with the help of your loved ones! Tria Health Can Help Tria Health is a no cost benefit available through select members’ health plans. Tria Health’s Pharmacy Advocate Program offers one-on-one, private consultations with a Tria Health Pharmacist. During your consultation, your pharmacist will review all your current medications, including vitamins and supplements. Tria Health will assist you in identifying any possible drug interactions, possible medications you could discontinue, and savings opportunities! Tria Health patients can grant their caregivers or family members access to their portal accounts and/or text alerts. It can be useful to have a family member connected with your blood sugar/pressure readings to help you manage your health together. Your pharmacist will work with you and your doctor(s) to ensure the intended outcomes from your medications are being received. Questions? Contact the Tria Health Desk at 1.888.799.8742 Resources https://www.igliving.com/magazine/articles/IGL_2012-06_AR_The-Impact-of-Chronic-Illness-on-the-Family.pdf https://www.chcf.org/wp-content/uploads/2017/12/PDF-FamilyInvolvement_Final.pdf

While some medications may seem to work right away, they often do not provide lasting relief. That's why regular follow-up visits are so important. By tracking how your symptoms change over time, you can determine whether or not a particular drug is working correctly. Importance of a Care Plan A care plan is a written record of the actions someone takes to manage their health. A care plan can be used to assess your health and set goals for improving it. When you start taking responsibility for your health, you'll see better results. You may also learn about new ways to treat yourself or others that you might not have known about before. Don't be afraid to ask questions about what you should do and why if something doesn't make sense. The National Library of Medicine provides many benefits of having a care plan, here are just a couple: Anticipatory rather than reactive discussions about patient care: The healthcare system is actively working towards improving patient care through increased awareness of chronic conditions. Care plans are being implemented to help manage chronic diseases before they develop into acute issues requiring hospitalization. Setting an action plan early can help prevent a serious health problem from happening. In addition, these preventive measures create opportunities to improve employee productivity and increase customer satisfaction. Supporting patients to manage their health: A new approach to healthcare means empowering you to take charge of your care. Care plans are developed collaboratively between the patient and the healthcare team. Patients can identify their personal goals and priorities, then together with their healthcare provider, develop a personalized treatment plan that works for them. Importance of Follow-Up Appointments Follow-up appointments offer more value than most people realize. These meetings give patients and prescribers the chance to connect and discuss patient progress. Here are a few points that may be checked during a follow-up visit: Assess the efficacy of medicines Monitor side effects and adverse events for safety Determine if the medicine is helping with other symptoms (e.g., pain) Evaluate adherence; is the drug being taken as prescribed? Check for potential interactions between medications Understand whether a treatment plan has improved the quality of life Without following up with your doctor, you might miss out on vital information about your health. For instance, what if you find out that you have an easier way to help control your asthma? You could try that new inhaler that was recommended by your doctor. You will want to make sure you communicate any changes in your health status or symptoms to your doctor as well. The Patient’s Role in the Health Journey Patients should not be treated as passive recipients of care. You, the patient, must be involved in every aspect of your health journey. Being informed about what you can do to improve your overall health and wellness is important. You should understand how medications work, and why you may take certain actions. You should also know how to communicate effectively with your healthcare providers about any changes due to medication. It’s time to take control of your health! The Tria Health Difference Medications are the main course of treatment for chronic diseases and pharmacists are medication specialists. This makes them the best at helping you create a customized health care plan specifically for you. Tria Health is a no-cost benefit available through select members’ health plans. Tria Health’s Pharmacy Advocate Program offers one-on-one, private consultations with a Tria Health Pharmacist. During your routine consultations, your pharmacist will review all your current medications, including vitamins and supplements. Tria Health will assist you in identifying any possible drug interactions, possible medications you could discontinue, and savings opportunities! Your pharmacist will work with you and your doctor(s) to ensure the intended outcomes from your medications are being received. In conclusion, you should know whether your medication is working, if you have an effective treatment plan that helps you monitor how you're doing and by following up with your doctor who can assess your current symptoms, make the necessary changes, and help you get back on track. Questions? Contact the Tria Health Desk at 1.888.799.8742 Resources Follow Up with Patients: Tool #6 | Agency for Healthcare Research and Quality (ahrq.gov) Center for Accelerating Care Transformation (ACT Center) | ACT Center (act-center.org) Care plans and care planning in long term conditions: a conceptual model - PMC (nih.gov)

Polypharmacy is defined as the regular use of five or more prescriptions taken daily by one patient. This is common in those that are 65 and up with multiple medical conditions. Most of these patients do not realize that at least one of their medications could be discontinued with the right care and health plan. A study from the Lown Institute shows that 42% of older adults take five or more prescription medications a day. Lown Institute identifies 3 big drivers of medication overload: Culture of Prescribing – Whenever a medical issue arises like diabetes, high blood pressure, etc. then it can be a patient’s immediate reaction to find a pill that can solve the issue. The problem with this is that our society has become so pill happy that even physicians are not reviewing a patient’s current prescriptions to decide if they can discontinue any. Information and Knowledge Gaps – Both physicians and patients lack the information to make informed decisions about medications. Pharmacists are the medication experts and the most qualified to be making decisions on the management of your prescriptions. Fragmentation of Care – There is a disconnect with communication between a patient’s multiple physicians. This disconnect leads to physicians prescribing medication to what they believe is a “new” condition, when in reality it is the side effect of another prescription they are taking. This is known as the prescribing cascade, when one drug is prescribed to help with the side effect of another drug. Care coordination is extremely important when you are taking multiple medications between multiple physicians. Read here why you should have an appointed care coordinator to walk alongside you in your health journey. How do you know if you are taking a drug that can be discontinued/changed? The National Library of Medicine lists a few indicators that you should watch out for that will let you know if you need to change or discontinue your medication. Indications that may warrant changing the drug regimen include: Worsening symptom or condition Medication-related adverse effect Poor medication adherence or compliance Excessive out-of-pocket expenditures Mandated therapeutic substitution Indications that may warrant discontinuing a medication include: Diminished benefit, such as cases of clinical improvement or stabilization Increased risk, such as medication-related adverse effects, drug interactions, and unsafe use such as high-risk drugs in older adults. Next Steps Step 1 - Talk to your physician if you notice an indication to discontinue a prescription. Step 2 - Explain exactly what indications and symptoms you are noticing so the physician can identify and prioritize the medication(s) that need to be targeted for discontinuation. Step 3 - Set up a discontinuation plan to communicate and coordinate with your physician. Step 4 - Be monitored by your physician for beneficial or harmful effects. Make sure to keep your doctor informed if you start to notice any major side effects after discontinuing or changing your medication. Dr. Gary Blanchard of Saint Vincent Hospital states that “It becomes easy to add medications…but it’s much harder to subtract it.” It will take time to adjust when discontinuing a medication. It is possible, but you will have to be committed to trusting and following through on your physician’s care plan for you. Tria Health Can Help Tria Health is a no cost benefit available through select members’ health plans. Tria Health’s Pharmacy Advocate Program offers one-on-one, private consultations with a Tria Health Pharmacist. During your consultation, your pharmacist will review all your current medications, including vitamins and supplements. Tria Health will assist you in identifying any possible drug interactions, possible medications you could discontinue, and savings opportunities! Your pharmacist will work with you and your doctor(s) to ensure the intended outcomes from your medications are being received. Questions? Contact the Tria Health Desk at 1.888.799.8742 Resources https://lowninstitute.org/projects/medication-overload-how-the-drive-to-prescribe-is-harming-older-americans/ https://knowablemagazine.org/article/health-disease/2021/tackling-growing-problem-of-overmedication https://www.wbjournal.com/article/seniors-are-being-overmedicated-as-momentum-grows-to-de-prescribe-patients https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119470/

Why does your medication dose matter? This week’s blog will help you learn about why you have been prescribed a specific dosing and why you should take your dosing serious. Burt’s Good Neighbor Pharmacy shines light on what your medication dosing means and the importance of taking it exactly as it has been prescribed. What All Is Calculated to Get a Correct Dosing? There are 3 things that your physician calculates to decide how to prescribe the correct dosage. Your dosing depends on your body weight, metabolism, and age. Body weight – The amount a person weighs influences the dosage given. If someone is larger, their dosage will be higher to ensure the medicine effects their whole body. Therefore, a person who is young or small will receive a smaller dosage. Metabolism – The speed of one’s metabolism and how fast their body processes and clears medications in the body influences the dosage given. Fast metabolism: Take longer or more frequent doses to have an effective level of the drug. Slow metabolism: Take shorter and less frequent doses for the drug to be effective. Age – Finally, your age can influence the dosage given. For older people, they usually have a slower metabolism, and their dosage may be lower. Although children have faster metabolisms, they are also smaller, and both those factors are taken into consideration when deciding on their dosage amount. Since there are many factors for physicians to take into consideration for a correct dosage, there can be issues that arise with incorrect evaluation. If this is the case and your prescription is not proving to be effective, let your physician know. 3 Big Reasons Why Your Dosing Matters Overdosing – Medication can work properly if it is taken in it’s correct dosing amount. However, if you go outside of the suggested dosing amount and take more than required, this could set you up for major health complications. This rule also applies for over the counter (OTC) medication such as Tylenol and Aspirin. If you or someone you know overdoses on prescription or OTC medication, then quickly seek medical advice. Speed of Action – If a prescription instruction reads “take twice a day”, this does not mean you can take two pills at the same time and forget about your medication the rest of the day. Some drugs are going to take various lengths of time to have an effect on you. Not taking the dosage correctly, can result in you not having any effect from the medicine you are taking. Underdosing – Underdosing is not as dangerous as overdosing can be, but it has its issues as well. Physicians prescribe you a certain dose of medication to successfully accomplish the task it was supposed to do. Taking less than the suggested dose could make the drug ineffective. Liquid Medication If you are taking a liquid medication, then you should try your best to use an oral syringe to measure out the dosage. Using a kitchen spoon will not give you accurate measurements and could lead to under dosage or an overdose. Accidentally overdosing on your medication can lead to serious health issues. Immediately call the American Association of Poison Control Centers at 1-8000-222-1222 for advice and help. Antibiotics Antibiotics are used to help kill bacteria that could cause infections and diseases. Did you know that antibiotics are prescribed with a specific dose that is high enough to fully kill the infection in your body? This prescription must be taken for the full course outlined by your physician. You may start feeling better before the course is finished and decide to stop taking it early. This action is not recommended because not all the bacteria has been killed which can lead to the remaining bacteria multiplying and making you sick again. Always take your prescriptions as prescribed by your physician and ask questions if you are confused by your prescription. Tria Health Can Help Tria Health is a no cost benefit available through select members’ health plans. Tria Health’s Pharmacy Advocate Program offers one-on-one, private consultations with a Tria Health Pharmacist. During your consultation, your pharmacist will review all your current medications, including vitamins and supplements. Tria Health will assist you in identifying any possible drug interactions or savings opportunities! Your pharmacist will work with you and your doctor(s) to ensure the intended outcomes from your medications are being received. Questions? Contact the Tria Health Desk at 1.888.799.8742 Resources https://burtsrx.com/everything-need-know-medication-dose/

During your annual physical, ask your physician this question, “Is there someone on the team I can talk to if I have questions about these medications?” What you are really asking your physician is, “Who is going to be my care coordinator between all of my prescriptions and physicians?” Nearly one-third of older U.S. adults visit at least five different doctors every year. With multiple physicians prescribing multiple prescriptions, this can make it difficult to coordinate care between all. Therefore, it is important to have a care coordinator to speak with about your medications. Let’s dive into what care coordination is, why it is important, and how Tria Health is going the extra mile in care coordination. What is Care Coordination? The Agency for Healthcare Research and Quality defines care coordination as deliberately organizing patient care activities and sharing information among all the participants concerned with a patient’s care to achieve safer and more effective care. Our health system is becoming more complex and fragmented and so that makes it even more important to have someone that can be the head of tracking all your prescriptions. What is the Importance? Since most older adults are visiting at least five different doctors every year, this can become a confusing process not only for the patient, but also for physicians. Physicians are not perfect when it comes to communicating with a patient’s other physicians or making sure they are not double prescribing. When a care coordinator is appointed, the coordinator can come into the situation and be the glue between the multiple physicians. There are many results to proper care coordination, but here are a few: Reduced hospital admissions Improved quality of chronic disease management Improved patient satisfaction Better access to specialty care What Is Already Being Put into Place for Care Coordination? The New England Journal of Medicine Catalyst writes of three different ways that care coordination is starting to be implemented and used. Primary Care Coordination – This coordination involves registered nurses (RN) being the main point of contact and coordinating with the physician. The RN would be the one to develop the plan a care plan from there. Acute Care Coordination – This coordination is required for those that have health conditions that are more emergencies related. Coordinators in this role will schedule follow ups after an emergency visit and check in on the patient’s progression. Post-Acute/Long-Term Care Coordination – This coordination is for patients that are transferred to multiple facilities for rehabilitation, long-term care, or post-acute care. They require more coordinated care to manage all the medications that are being transferred. If you or someone you know is taking multiple medications or seeing multiple physicians, then it can be beneficial to find a medical expert that can help with coordinating your medications. Take control of your health today! The Tria Health Difference Most care coordination plans are completed by registered nurses. At Tria Health, our pharmacists are your care coordinators! Medications are the primary treatment method for chronic conditions and pharmacists are medication experts. This makes pharmacists the most reliable at helping you navigate your medications. Tria Health is a no cost benefit available through select members’ health plans. Tria Health’s Pharmacy Advocate Program offers one-on-one, private consultations with a Tria Health Pharmacist. During your consultation, your pharmacist will review all your current medications, including vitamins and supplements. Tria Health will assist you in identifying any possible drug interactions or savings opportunities! Your pharmacist will work with you and your doctor(s) to ensure the intended outcomes from your medications are being received. Questions? Contact the Tria Health Desk at 1.888.799.8742 Resources Almost 1 in 3 U.S. Seniors Now Sees at Least 5 Doctors Per Year - Consumer Health News | HealthDay Choosing a Doctor: Quick Tips - MyHealthfinder | health.gov Facilitators and Barriers to Care Coordination in Patient-centered Medical Homes (PCMHs) from Coordinators’ Perspectives - PMC (nih.gov) Care Coordination | Agency for Healthcare Research and Quality (ahrq.gov) What Is Care Coordination? (nejm.org)