Download presentation
Presentation is loading. Please wait.
Published byRayna Holby Modified over 10 years ago
1
Detecting & Improving Medication Use Among Vulnerable Elders: A Community-Based Medication Management Intervention Gretchen Alkema VA Greater Los Angeles Healthcare System Kathleen Wilber USC Andrus Gerontology Center June Simmons, Sandy Atkins, Mira Trufasiu, & Dennee Frey Partners in Care Foundation Gerontological Society of America Meeting November 19, 2007
2
Acknowledgements Collaborators USC Andrus Gerontology Center Kathleen Wilber, PhD Partners in Care Foundation Dennee Frey, PharmD June Simmons, CEO/LCSW Mira Trufasiu, MSG Sandy Atkins, MPA Susan Enguidanos, PhD Huntington Hospital Senior Care Network Eileen Koons, LCSW Lois Zagha, MFT Funding Support Administration on Aging Evidence-Based Prevention Initiative (#90AM2778) John A. Hartford Foundation Doctoral Fellows Program in Geriatric Social Work AARP Scholars Program VA Postdoctoral Fellowship ( #TPP 65-007)
3
Problem of Medication Errors 65+ = 12% of population but consume ⅓ of all drugs 19 - 48% elders in community w/ med-related problems 7,000 deaths annually by adverse drug events Associated hospital costs = $2 billion ¼ of adverse drug events are preventable
4
Evidence-Based Practice (EBP) in a New Setting Implemented tested medication management protocols from: Medicare home healthcare RCT to… Medi-Cal waiver care management
6
Home Healthcare Context Site: Medicare-certified home healthcare Population: 65+ w/ skilled nursing need & MD orders Staff: Nurses w/ pharmacist support Length of Stay: Up to 6 weeks Contact: Up to daily visits
7
Care Management Context Site: Medi-Cal waiver care management Population: 65+ dual eligibles w/ functional impairment Staff: Nurses & social workers w/ pharmacist support Length of stay: 1 month to 3+ years Contact: Phoned monthly & quarterly home visit
8
Care Management Sample (N=615) Site #1: n=216 Site #3: n=126 Site #2: n=273
9
Targeted Medication Problems (Brown et al., 1998, Meredith et al., 2001) 1. Unnecessary therapeutic duplication 2. Psychotropic drug use w/ confusion or falls 3. Cardiovascular medication problems 4. Use of non-steroidal anti-inflammatory drugs (NSAIDs) with peptic ulcer risk
10
Research Design
13
Care Management Sample (N=615) 81 years old 80% female 53% widows 40% lived alone 36% new to care management Photo by Rollin Riggs, NY Times
14
Race/Ethnicity by Site (N=615)
15
Language Preference (N=615)
16
Health Status (N=615) Mean # of meds = 8.76 (SD=4.3); 12+ meds = 22% 38% ED, Hospital, or SNF in previous year 22% falls in previous 3 months 27% dizziness 31% confusion
22
Attrition 10 left before med problems confirmed ↑ fallers (p<.05) 100% w/ 1+ potential problem (p<.001) 19 left before intervention completed ↓ # of meds (p<.05) Main reasons: LTC, died, or moved
23
Prevalence Results (N=615) PotentialConfirmed Medication ProblemN%N% Any29948.6%18129.4% Ther. Duplication14924.2%8714.1% Psychotropic8814.3%6510.6% Cardiovascular8714.1%274.4% NSAIDs7912.8%538.6%
24
Associated Characteristics Any problems ~ ↑ age, new enrollment, & ↑ meds 2+ problems ~ ↑ meds Therapeutic duplication ~ ↑ meds Psychotropic ~ living w/ someone, new enrollment, ED/hospital/SNF, & ↑ meds Cardiovascular ~ new enrollment
25
Problems by # Meds
26
Screening to Intervention Medication Change at 3 Months (N=615)(N=162) Medication ProblemN%N% ∆ Any16226.3%9961.1% Ther. Duplication7912.8%4962.0% Psychotropic599.6%2367.6% Cardiovascular243.9%1145.8% NSAIDs447.2%2250.0% Intervention Results (N=162)
27
Staff Comments “As a SW, I became aware of potential dangers or complications of some medications; I now look at all medications my clients are taking” “No or slow response from the doctor…some clients have taken certain medications for so long that they were unwilling / fear to change” “Uncomfortable addressing this issue with MDs ~ feel it is beyond my scope of practice”
28
Conclusions Med problems highly prevalent in Medi-Cal waiver sample Intervention successful in care management Critical need for meds management across continuum of care Payment sources for meds management
29
Next Steps Disseminate Medication Management Improvement System ~ funded by Hartford Foundation Computerized screening for potential problems Integration into MSSPCare (by RTZ Associates) Stand alone online version & algorithm for other software Statewide replication in MSSPCare sites National replication -- 2+ states NCOA Readiness Tool Seeking potential sites for 2008
30
Photo by JL Forter
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.