4/28/2017. Medication Management for Improved Compliance & Home Care Satisfaction PREPARED FOR NEHCC Presenter. Overview

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1 Medication Management for Improved Compliance & Home Care Satisfaction PREPARED FOR NEHCC 2017 Presenter Debra Demar, MS is the Community Liaison for White Cross Pharmacy, serving RI, MA and CT. She has a Master s Degree in Communication Disorders and began her career at Massachusetts General Hospital. She has served seniors in both Assisted Living, Home Care and as an Alzhiemer s Support Group Leader. Overview What is Medication Management? Medication Reconciliation Decreasing Hospital Readmissions Barriers to Safe & Effective Medication Management Medication Management Systems 1

2 The Joint Commission on Accreditation of Healthcare Organizations Medication management includes ensuring that All medications including self-administered medications are safely and accurately administered. Medication Adherence Taking medication. At the correct TIME In the Prescribed DOSAGE With the proper FREQUENCY According to the DIRECTIONS Medication Management To effectively manage medication, patients and caregivers must be given: Information about what medication they are taking A description of the administration method Expected actions and adverse effects The method for monitoring side effects 2

3 Stats on Medication Adherence Half of all patients do not take their medication as prescribed. [1] More than 1 in 5 new prescriptions go unfilled. [2] Adherence is lowest among patients with chronic illnesses.[3] At least 125,000 Americans die annually due to poor medication management. [4] 1. Osterberg L., Blaschke T. Adherence to Medication, N.E. J. Med., Aug 4, 2005; 353(5):487-97; 2. Fischer MA, Chaudry NK, et al Trouble Getting Started: Predictors of Primary Medication Nonadherence. Am J. of Med., Nov.; 124(11) 3. Sokol MC, McGuigan KA, et al Impact of Medication Adherence on Hospitalization Risk cand Healthcare Cost. Med Care, June 2005; 43(6): McCarth R The proce you pay for the Drug not Taken. Bus Health, 1998; 16:27-28, 30, The Facts Almost 50% of people prescribed a medication for chronic conditions do not take them correctly. Nearly 70% of Americans are on at least one prescription drug and over 50% of Americans are on at least two prescription drugs. Forty percent take 5-9 medications. 31% of prescriptions written are not filled A.J. Claxton et al. A Systematic Review of the Associations Between Dose Regimens and Medication Compliance. Clinical Therapeutics, August Zhong, W. et al. (2013). Age and sex patterns of drug prescribing in a defined American population. Mayo Clinic Proceedings, 88(7). eyreport2006.pdf Tamblyn, Robyn. The Incidence and Determinants of Primary Nonadherence With Prescribed Medication in Primary Care Ann Intern Med. 2014; 160(7). Impact of Dosing on Adherence A.J. Claxton et al. A systemic Review of the Associations Between Dose Regimens and Medication Compliance. Clinical Therapeutics, August

4 The Financial Stats Prescriptions drugs comprise 9.8% of healthcare expenditures This represents the third most costly component of the nation s health spending behind hospital care (32%) and physician and clinical services (20%) data Hospital Readmission Reduction Program- HRRP In October 2012, CMS began a program to reduce Medicare payments to hospitals with excess readmissions rates. Current focus of the HRRP is on readmissions occurring within 30 days of hospital discharge for selected conditions: ~ Heart attack ~Heart failure ~Pneumonia ~COPD ~Hip or knee replacement ~ CABG HRRP Medicare penalties assessed on hospitals for readmissions will increase to $528 million in 2017, $108 million more than in

5 Medication Reconciliation Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. It is done to avoid medication errors such as: ~ Omissions ~Duplications ~Dosing errors ~Drug interactions It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Continuity of Care Your patients health is most at risk after a stay in the hospital. Poor transitional care Premature hospital release Difficulty understanding or executing discharge instructions Inaccurate Documentation Medication-related problems after hospital discharge sometimes begin with an inaccurate or incomplete medication history upon hospital admission. The quality of the medication list is influenced by: Interviewer skills, Patient s knowledge Availability of prior documentation Time constraints. 5

6 What s the Problem? Medication poses a broad problem for Seniors who: Are over medicated Don t understand how to take their medication Refuse or forget to take their medication Take the wrong medication due to an error in the health care continuum of care Patient Related Barriers to Successful Medication Management Lack of health literacy Lack of social support Lack of transportation to appointments and/or pharmacy Confusion about prescription labels Depression Forgetfulness Lack of knowledge about medication and its use Denial or ambivalence regarding conditions Financial challenges Improving Communication Keep explanations simple and avoid medical jargon Confirm understanding of these essential items Provide ample opportunity for questions 6

7 Follow up Calling the patient by telephone a few days after discharge offers patients the opportunity to: clarify medication regimens report unforeseen problems in filling their prescriptions question new symptoms which may be medication-related. Health Literacy Case Study In a study of heart failure patients, an intervention provided: A. Support from a pharmacist B. Verbal instructions C.Written materials developed at a low literacy level D. Communication between the pharmacist and the patient s healthcare providers. 12. Evangelista et al (2010). Health literacy and the patient with heart failure implications for patient care and research: A consensus statement of the heart failure society of America. Journal of Cardiac Failure, 16(1): Health Literacy Case Study Results The intervention group had: Greater medication adherence B. Fewer ER visits & hospitalizations C. Lower overall costs D. Increased patient satisfaction than the control group 12. Evangelista et al (2010). Health literacy and the patient with heart failure implications for patient care and research: A consensus statement of the heart failure society of America. Journal of Cardiac Failure, 16(1):

8 Coordination of Care All health care professionals involved in the continuum of care need to be on the same page Doctors Home care services Home health agencies Hospitals Nursing homes Pharmacies Senior living communities Med Management Systems Traditional Vials Daily/Weekly Organizers Automatic Dispensing Systems Blister Cards Multi-dose Packaging Q&A For additional information contact White Cross Pharmacy 8

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