An Innovative Approach to Medication Management Presenter: Mary Anne Foley, RN, MSN Chief Operating Officer, Jewish Association on Aging AgeWell Pittsburgh Collaboration

AgeWell Pittsburgh A coordinated effort of Jewish Community Center of Greater Pittsburgh Jewish Family & Children’s Service Jewish Association on Aging Provides a broad range of community-based services to seniors living in the Pittsburgh community Helps older adults continue to live independently in their own homes by identifying seniors at risk of losing their independence and helping them connect to services that will allow them to remain safely at home

HomeMeds℠ Program “Any symptom in an elderly patient should be considered a drug side effect until proved otherwise.” (Gurwitz et al. 1995)

HomeMeds℠ Endorsement HomeMeds℠ is an approved Disease Prevention and Health Promotion program Included in the National Registry for Evidence-based Programs and Practices (www.nrepp.samhsa.gov) HomeMeds℠ is also included with a strong evidence rating on the US Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange (http://www.innovations.ahrq.gov/content.aspx?id=2841) The HomeMeds℠ system has been implemented in over 45 sites and 18 states In the past four years, 11,000+ older adults have had their medications screened for potential risks; 40-50% of those screened had potential problems, the majority of which were resolved through pharmacist collaboration with physicians, patients, families and care managers Successfully implemented in area agencies on aging, senior centers, post-acute care transitions programs, home-delivered meals programs, fall prevention collaboratives, care management programs, housing and assisted living

HomeMeds℠ Workflow Comprehensive in-home medication assessment Electronic file created and data verified Pharmacist notified of potential problem alert Pharmacist sends med list & recommendation to MD; intervention is documented Tracking of status and MD response Changes to meds & conditions are documented and alerts are resolved Pharmacist advises patient and/or staff, if needed

HomeMeds℠ – Proven Solutions Four important problem areas affecting seniors: Unnecessary therapeutic duplication Falls and confusion related to possible inappropriate psychoactive medication use 3. Cardiovascular problems such as continued high/low blood pressure or low pulse 4. Inappropriate use of non-steroidal anti-inflammatory drugs (NSAIDs) in those with high risk of peptic ulcer/gastrointestinal bleeding

Medications – From Help to Harm The Problem Medication Errors are: Serious: 1.5 million Adverse Drug Events (ADE’s) annually; Over 700,000 people go to ED each year for ADE’s 7,000 deaths/year Costly: Drug-related morbidity/mortality > $170 billion (ER, hospital/readmissions, SNF use, 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 IOM , 2000. To Err is Human: Building a Safer Health System. Washington, D. C. National Academy Press. IOM, 2007. Preventing Medication Errors. Washington, D.C. National Academy Press

Phase I HomeMeds was originally rolled out in Riverview Towers, a more controlled environment with specific safety controls built in: Case management resources were already available to all residents in the building Riverview Towers is adjacent to the campus of one of the AgeWell Pittsburgh Partners – Jewish Association on Aging (JAA) AgeWell Pittsburgh had an affiliate relationship with Riverview Towers and was already providing some services in this building Many of the residents were already clients of AgeWell Pittsburgh

Phase II Phase II - Part I Assessments in additional facilities West Homestead HUD facility/Large percentage of Russian speaking clients Beacon Place apartments/privately owned & managed JAA’s Adult Day Program

6-Month Pilot Data HomeMeds Assessments Completed

Alerts Generated

Phase II Phase II - Part II Senior Center Pilot Targeting 200 older adults in senior center community environments Bring medications/lists in to receive assessments Even though the program is called HomeMeds℠, it doesn’t change the efficacy of it being an Evidence-Based Program whether in the home or in a community-based setting Other cities across the country are currently using this program in a community center model

HomeMeds℠ Pilot Senior Center In 2015, AgeWell at the JCC received a grant from PA Dept. of Aging to implement a pilot program in a Senior Center environment An MOU was established with Duquesne University’s Non-Profit Pharmacy to serve as the Pharmaceutical partner Use of Pharm Interns, as well as Program personnel for screens Couple screens with education seminars, health fairs and “meet the pharmacist” tables The Pilot consists of: An in-Center review of a comprehensive medication list with notes on how each drug is to be taken, plus other indicators of adverse effects; vital signs, falls, symptoms, etc. Use of evidence-based protocols and processes to screen for risks and deploy consultant pharmacist services appropriately Electronic medication risk assessment and alert process with report system Consultant pharmacist addresses problems with prescribers, seniors, families & staff

How The Program Worked in a Senior Center Environment Process Participants were recruited through our Senior Center programs, word of mouth, flyers, and website information Time/date set to meet with pharmacy students or staff If signed up in person, the client will receive an informational packet and an AgeWell brown bag The packet will include the appointment card with date, time; informational consent form; business cards for the Duquesne Pharmacy; and a reminder letter on what to bring to the appointment Meet to complete assessment at the senior center Follow-up Pharmacists/Pharmacy Students vs. staff Register for other programs within the center

6-Month Pilot Data HomeMeds Assessments Completed

Partnership Added Value Services

Experience an Assessment

HomeMeds℠ Assessment

HomeMeds℠ Assessment

HomeMeds℠ Assessment

HomeMeds℠ Assessment

HomeMeds℠ Assessment

HomeMeds℠ Assessment

HomeMeds℠ Assessment

Questions