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© 2010 Center for Technology and Aging1
Emerging Technologies for Medication Management: Promoting the Independenceof Older Adults
David Lindeman, PhD
John Feather, PhD, CAE
Lynn Redington, DrPH, MBA
Valerie Steinmetz
16 March 2010, Chicago
Aging in America, NCOA/ASA Conference
© 2010 Center for Technology and Aging2
Introduction to Today’s Speakers
David Lindeman, Lynn Redington, Val Steinmetz
• Center for Technology and Aging Staff
John Feather
CEO, American Society of Consultant Pharmacists
Chair ASA board
© 2010 Center for Technology and Aging3
Introduction to Today’s Discussion
• Medication management for older adults
Importance of medication use in older adults
Opportunities for improvement
• Technologies to optimize medication use
• Diffusion of medication technologies
• Examples of medication technology diffusion programs
• Response and discussion
© 2010 Center for Technology and Aging4
Importance of Medication Use in Older Adults
Medication use is ubiquitous in older adults
• 90% use 1 or more prescription medications per week
• 41% of older adults take 5 or more medications per week
Suboptimal medication use . . .
• Can increase the burden of illness
• Result in higher costs to families and society
• Poor medication adherence doubles risk of hospitalization and
generates $290 billion/year of avoidable health costs
© 2010 Center for Technology and Aging5
Opportunities for Medication-Use Improvement
3 areas of improvement that could be technology-enabled:
1. Medication Reconciliation
Accurate list of medications to avoid adverse drug reactions
2. Medication Adherence
Taking medications as directed
3. Medication Monitoring
Watching for warning signs, adjusting dose as needed
© 2010 Center for Technology and Aging6
Technologies to Optimize Medication Use
Assess
Prescribe
Dispense Administer
Monitor
Example Technologies•Teleconsultations•Online Patient Education•Cognitive Assessment Tools•Pharmacy Kiosks
Goals•Patient history includes a complete and accurate medication list
•Patient needs are accurately conveyed and understood
Example Technologies•Medication List Software•Personal Health Records (PHR)
Goals• Medication
orders are documented and shared with patients
Goals• Medication is
made available• Medication picked
up by patient• Patient and
caregivers understand medication instructions
Goals• Individual dose
dispensed• Individual dose
taken by patient (on time, in the right does, and for the right length of time)
Goals• Routine dosing and
tracking of medication• Reports and trending
information from medication log generated
• Clinician adjusts medication as needed
• Prescriptions refilled
Example Technologies•Medication Adherence Devices (integrated and standalone, simple and advanced function)
Example Technologies•Personal Biometric Testing Devices•Wireless Communication Devices•Personal Health Records (PHR)
Example Technologies•Medication List Software•Personal Health Records (PHR)
Medication Adherence
Medication Reconciliation
Medication Monitoring
© 2010 Center for Technology and Aging7
Technologies to Improve Medication Reconciliation Problems
Name OrganizationDescription
My Medication Log
Cardiovascular and Public Health Detailing Programs
A medication log for use in the Cholesterol Action Kit ihttp://www.ihi.org/IHI/Topics/PatientSafety/MedicationSystems/Tools/MyMedicationLog.htm
Universal Medication Form
McLeod Health in Florence, SC
A form where patients can enter medications used, allergies, and immunization records
Health and Safety Passport
California Pacific Medical Center, San Francisco
Patients list their medications, health history, and other relevant information
Med List
A statewide, collaborative initiative in Massachusetts
Medication list to keep track of patient medications and supplements. Also offers tips for using medications wisely.
My Medicine List ASHP
A tool where patients can develop and manage their own medication list. The tool can be found on the ASHP Foundation website
Pill Card AHRQ
Information on how to develop an easy-to-use "pill card" for patients, parents, or anyone who has a hard time keeping track of their medicines at http://www.ahrq.gov/qual/pillcard/pillcard.htm
My Medicine Record FDA
Patients list prescription medicines, over-the-counter medicines and dietary supplements.http://www.fda.gov/cder/consumerinfo/my_medicine_record.htm
One-time entry Medication
List – electronic or paper
Continuous Electronic
Medication List
Continuous Electronic
Medication List
Integrated with Personal
Health Records• User adds medication
information for one-time print out• Medication information
stored online.
• Info can be updated
manually or
automatically if linked
to pharmacy.
• Print out required to
share information with
providers
• Medication information
stored online.
• Info can be updated
manually or automatically if
linked to pharmacy.
• Medication list accessible to
providers through PHR
© 2010 Center for Technology and Aging8
Medication Adherence Technology Functions
FILL REMIND DISPENSE INGEST METABOLIZE REPORT ADJUST
Patient fills
prescription
and
receives it.
Patient is
reminded to
take
medication.
Patient
removes
medication.
Patient
ingests the
medication.
The
medication
is
metabolized
by patient.
A report of
the patient’s
adherence
is given to a
clinician or
caregiver.
The doctor
adjusts the
patient’s
medication
accordingly.
* Technologies in blue are already available. Technologies in green are in development.
© 2010 Center for Technology and Aging9
Medication Adherence Technology Categories
Medication adherence
technologies
Standalone technologies
Integrated with health
management capabilities
Single Function
Multi-Function
Advanced
Function
• Technologies can be divided by the complexity, type, and number of functions they perform
© 2010 Center for Technology and Aging10
Technologies to Improve Medication Adherence Problems
Category Description Sample Techs Pros ConsMarket Stage Economics
Single-Function
Performs one function currently available within the medication adherence technology spectrum
•iGuard•Timex messenger•Rex Pill bottle•Gentle Reminder
Simplest and easiest to use technologies
•Lacks greater functionality for more comprehensive health management
Many technologies out on the market and currently used
•Usually a one-time purchase•Prices can vary widely•Relatively inexpensive
Multi-Function
Performs two or more functions currently available within the medication adherence technology spectrum
•EMMA•Philips Medication Dispensing Service•MedSignals•uBox•Dispense-a-Pill
•Mostly easy to use•Integrates multiple functions for better health management
•May be complex or require greater caregiver involvement•Lacks functionality for more comprehensive management
Many technologies out on the market and currently used
•Usually a one-time purchase•Prices can vary widely (less than $100 to $1000+)
Advanced Function
Performs one or more of the currently available spectrum functions and can also perform one of the more advanced functions
•MagneTrace•Xhale’s SMARTTM
•Advanced technologies allow actual tracking/ adjustment/ingestion of medication•Integrates multiple functions
•Considerably more complicated than single/ multi function without clear benefit understanding•In some cases, may lack comprehensive management functionality
Most technologies still in development
•Currently unclear - most technologies still in development•May be relatively expensive
Integrated with Health Management Capabilities
Technologies that integrate medication administration with other health-related management functions (i.e. monitoring, sensors, independent living assistance)
•Med-eMonitor•HealthHero•Home HealthPoint•Zume Life Zuri•Intel HealthGuide
•Combined offering allows for broad patient management•Many devices likely to move towards integration of health tracking/ monitoring
•Relatively complicated, may require caregiver involvement•May require greater tech knowledge
•Some techs currently on market and used•Other techs in development
•Usually upfront cost plus a monthly fee (service-oriented model)•Upfront cost can be relatively high
© 2010 Center for Technology and Aging11
Technologies to Improve Medication Adherence Problems
Single Function
• Performs one function
currently available
within the medication
adherence technology
spectrum
Advanced Function
• Performs one or more of
the currently available
spectrum functions and
can also perform one of
the more advanced
functions
Integrated Function
• Technologies that
integrate medication
administration with other
health-related
management functions
Source: www.rxtalks.com
Health BuddyRex Talking Pill Bottle
MagneTrace
© 2010 Center for Technology and Aging12
Technologies to Improve Medication Monitoring Problems• Medications that place patients at risk for adverse reactions are especially important to
monitor
• Point-of-care testing devices are available to monitor blood pressure, peak flow (for asthma),
blood glucose (for diabetes), warfarin dosing and a host of other health conditions
• Devices to monitor medication are becoming more prevalent with wireless capabilities and
enhanced tracking and trending features.
Warfarin iPhone Application
Islet iPhone Application
Source:www.princeton.edu/main/news/archive/S25/10/88K09/index.xml?section=featured
© 2010 Center for Technology and Aging13
Diffusion of Medication-Use Technologies
Many technologies wither on the vine . . .
• Social-cultural factors—readiness vs. resistance
• Economic factors—who pays, how?
• Political/legal factors—laws, policy that favor or impede
• Technology factors—ready for broad use or tech
enthusiasts only?
© 2010 Center for Technology and Aging14
Center for Technology and Aging Research and Grantmaking
Research: what medication problems are important and have
technology solutions?
Grantmaking: what programs can we fund to help. . .
• Older adults better use medications
• Improve health and independence
• Reduce the cost and burden of care
• Chronic disease self-management
• In the home or other community setting
© 2010 Center for Technology and Aging15
Medication Optimization Diffusion Grants Program
RFP released Fall 2009
January-December 2010 grant period
Five grantees selected:
1. Association of Consulting Pharmacists Foundation
2. Caring Choices
3. Connecticut Pharmacists Foundation
4. Veterans Administration (Central Calif.)
5. Visiting Nurse Service New York
© 2010 Center for Technology and Aging16
Diffusion Grants Program
Veterans Administration of Central CA
Home self-management and medication adherence
Veterans that are home-based with chronic heart failure
Remotely located internists and allied health professionals
5 central California rural and medically underserved counties
The Health Buddy® system plus weight scale, blood pressure monitor, assessment algorithms and clinician alerts
. . . VHA is a leader in telehealth coupled with care coordination
Health Buddy
© 2010 Center for Technology and Aging17
Diffusion Grants Program
Caring Choices - Chico, CA
Improve medication monitoring and adherence
Philips Medication Dispensing Service technology
Will be introduced to four home health and senior living organizations in four new rural and urban areas of CA
Partner, Home Health Care Management, has successfully deployed medication dispensers for the past 10 years
© 2010 Center for Technology and Aging18
Diffusion Grants Program
Connecticut Pharmacists Foundation - Long Beach, CA
Culturally and linguistically appropriate Medication Therapy Management (MTM) services
Community health workers and remotely located pharmacists will use videoconferencing, EHR, and spoken format technology to deliver MTM services to Cambodian-American older adults
© 2010 Center for Technology and Aging19
Diffusion Grants Program
Visiting Nurse Service of New York
A multi-faceted, IT based intervention designed to better support nurses, as well as cognitively impaired patients and their caregivers, in the challenging process of managing multiple medications in the context of multiple co-morbidities
4 Boroughs of New York City
Technology: medication complexity algorithm, electronic clinical alerts and decision support tool, and caregiver support materials for CI elders with complex medications regimens
© 2010 Center for Technology and Aging20
Diffusion Grants Program
American Society of Consultant Pharmacists Foundation
Pharmacists will use Monitor-Rx, a web-based patient medication assessment tool, to optimize the medication regimens of older adults
Implementing in 3 Southern California organizations;
OASIS Older Adult program
University of CA, Irvine Senior Health Center
Alzheimer’s Family Services Center
© 2010 Center for Technology and Aging21
Center for Technology and Aging
www.techandaging.org