Bringing medicine, patients, and community-based services together 1.
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Transcript of Bringing medicine, patients, and community-based services together 1.
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Bringing medicine, patients, and community-based services together
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Partners in Care FoundationSandy Atkins, VP, Institute for Change
HSAG University of Best PracticesNovember 21, 2014
High Tech in Support of High Touch Care at Home
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Partners in Care FoundationWho We Are
• Partners in Care serves as a catalyst for shaping a new vision of healthcare by partnering with organizations, families and community leaders in the work of changing healthcare systems, changing communities and changing lives—focusing on home and community care
• We evolved from the VNA of Los Angeles to be a nimble force for change.
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The Problem
Medication Errors are:Serious: Over 700,000 people go to ED each year for
adverse drug eventsCostly: Drug-related morbidity/mortality $170
billion – in Y2K dollars!ER, hospital/readmissions, SNF etc.
Common: Up to 48% of community-dwelling elders have medication-related problems
Preventable: At least 25% of all harmful adverse drug events are preventable
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Home visits uncover many “secrets” that providers may not know
• OTCs – Over-the-counter medications
• Prescriptions from other other providers
• Adverse effects such as falls, dizziness, confusion
• Adherence issues
• Out of system meds: Drugs from other countries,
borrowed, Wal-Mart $4
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HomeMedsSM Improves Med Safety
• Home visit by social worker, CHW, etc.– Collect comprehensive medication information– Assess for possible adverse effects & discrepancies– Screen through software to find potential problems
• Pharmacists review & resolve problems, educate• Original Model: Find a home visit—add HomeMeds • Emerging Models
– Targeted home visits for high-risk patients– Add to care transitions, CDSMP, caregiver support, etc.– Part of comprehensive fall prevention initiative
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HomeMeds: What it Is & How it Works
“Any symptom in an elderly patient should be considered a drug side effect until proved otherwise.” (Gurwitz et al. 1995)
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Core Components
Collect comprehensive medication listNote how each drug is being takenRecord BP/pulse, falls, uncharacteristic confusion,
symptoms, and indicators of adverse effectsUse evidence-based protocols to screen for
risks Computerized risk assessment and alert
processConsultant pharmacist addresses problems
with prescribers, seniors, families & staff.
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Risk-Screening Protocols
HomeMeds is a TARGETED intervention addressing a limited group of medication related problems identified by national expert consensus panel ¹• Targets problems that can be identified and resolved in the home.• Chosen to produce positive response by prescribers• Minimize “alert overload”: based on signs/symptoms.
Limited to only these medication-related problems
1. Unnecessary therapeutic duplication2. Use of psychotropic drugs in patients with a reported recent fall
and/or confusion3. Use of non-steroidal anti-inflammatory drugs (NSAID) in
patients at risk of peptic ulcer/gastrointestinal bleeding4. Cardiovascular medication problems -High BP, low pulse,
orthostasis and low systolic BP
¹A model for improving medication use in home health care patients . Brown, N. J., Griffin, M. R., Ray, W. A., Meredith, S., Beers, M. H., Marren, J., Robles, M., Stergachis, A., Wood, A. J., & Avorn, J. (1998). Journal of the American Pharmaceutical Association, 38 (6), 696-702.
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The first and most important step…
• Treasure hunt – find “hidden” meds• Transcribe accurate information from the bottle/box• Adherence Inquiry – For each medication ask client:
– What they take it for– How and when they take it, – How much they take– What happens when they take it (Is it effective? Side effects?
• Assess for common side effects– Falls– Confusion– Dizziness, shakiness, feeling light headed– BP/pulse
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Roles of the Pharmacist
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• Screen alerts to confirm problems
• Communicate with prescribers
• Consult with care manager • Identify problems beyond
protocols• Assist with complex cases
– simplify med regimen• Educate staff
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Typical Problems
In Community-Dwelling Elders:• Patient w/ mild cognitive impairment taking all
medications – including sleeper & 3 doses of BP meds – in a.m.
• Patient with dizziness taking 2 beta blockers • Patient >80 taking 3 medications that increased risk
of GI Bleed• Patient who fell w/ 5 meds that increased risk of falls • Patient taking 4 narcotic pain killers• Avg. 11 meds – many with 28+!
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HomeMeds-Plus
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HomeMeds-Plus: What is it?Home Evaluation and Needs Assessment• 2 hour home visit
– HomeMeds comprehensive medication risk assessment– Home Safety and Fall Risk evaluation– Functional and Psychosocial assessment
• PHQ 2/9• Mini mental• ADL/IADL
– Advance Directive education and assistance
• Pharmacist follow-through on medication problems• Develop community service plan with member• Coordination of community resources• Collaboration with plan/medical group case managers
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HomeMeds-Plus: Who Benefits?Who is it for?• Adults with 2+ chronic conditions and other risks:
– Recent history of ED visits or unplanned hospitalizations &/or– 5-9 prescribed meds &/or– Some functional impairment &/or– Mild to moderate cognitive impairment &/or– Possible caregiver needs or social challenges &/or– Live Alone &/or– Self-management issues (significantly off goal for chronic
diseases)
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Value Proposition 1 - ROI
• Compared to patients who met referral criteria but did not receive the intervention– 12.8% lower rate of ED use– 22% lower readmission rate (9.1% readmitted vs. 11.6%
readmitted)– 50% ROI
• Compared to overall readmissions for the medical group at the same hospital– 40% lower readmission rate– $224,000 cost avoidance on $88,000 investment
• 90% Uptake on qualified referrals
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Value Proposition 2 - Quality
• Addresses HEDIS measures– Fall risk management– Medication reconciliation post-discharge
• Required by NCQA for Health Plans
– Potentially harmful drug-disease interactions
– Blood pressure control– Antidepressant medication management– Health Plan all-cause readmissions
"No risk factor for falls is as
potentially preventable or reversible as
medication use. (Leipzig, 1999)
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Star Ratings – Medicare Advantage
• Yearly review of all medications/supplements
– % 65+ who fell or had problems with balance or walking in past 12 mo. who received fall risk intervention
• Controlling blood pressure – Medication adherence for hypertension: Taking meds as directed
• Plan members 65+ on high-risk drugs, when there may be safer drug choices
• Reducing risk of falling
• Readmission to a hospital within 30 days of discharge
• Yearly pain screening or pain management planBonuses for 4 & 5 Star Plans – growing!!
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Costly Mistakes
Inpatient: Fx Hip & Thigh Bone$53,247 (7 days)
Shoulder, Wrist, Hand (JPS)$31,148 (2 days)
Total Cost = $70,434
Rehabilitation: (HealthSouth)$17,187 (10 days)
Fall Prevention = Savings
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HomeMeds: Software, Startup
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Web-based: Use with PC or Tablet
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HomeMeds Software: Dashboard
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HomeMeds Software: Risk Assessment
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HomeMeds Software: Medications
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Sample Medications List
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Conclusion
HomeMeds is a proven tool for improved medication safety, health and well-being for older adults.
It is an affordable, evidence-based program that is a perfect bridge for partnerships between community agencies and healthcare.
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Contact Information
• Sandy Atkins, VP: [email protected]• Phone: 818.837.3775• Partners in Care Website: www.picf.org