Medication Management Improvement System-MMIS

A Partners in Care Aging Well Innovation

Computer and pharmacist screening can help prevent falls, dizziness, confusion, and other medication-related problems for elders living at home.

Medication-related problems and errors endanger the lives and well-being of a high percentage of community-dwelling elders, leaving them with poorly controlled cardiac symptoms, or at risk for falls, dizziness, confusion, or other side effects. Our data show that almost 50% of nursing-home eligible Medicaid waiver clients have potential medication problems, such as taking generic and brand name versions of the same drug. The Medication Management Improvement System (MMIS) is designed to enable community agencies to address this important safety and quality of life issue. Care managers use software and a pharmacist consultant to screen their clients’ medications for potentially harmful problems and bring these problems to the attention of their physicians.

This program has been implemented in two distinct environments:

1. By nurses in licensed home health agencies.

2. By nurses and care managers from other disciplines in Medicaid waiver programs.

What Do We Know About Medication-Related Problems and Errors?

Serious: They cause approximately 7,000 deaths per year in the US.¹
Costly: Annual cost of drug-related illness and death exceeds $170 billion.²
Common: Up to 48% of community-dwelling elders have medication-related problems.³
Preventable: At least 25% of all medication-related accidents and health problems are preventable.²

Why Ask Care Managers To Deal With Medication Problems?

Client Safety: Studies³ show that frail elders in Medicaid waiver programs use MORE medications and have MORE medication problems than the even more disabled population in nursing homes, where pharmacist consultation is required. Care managers already collect medication information – the MMIS enables them to better protect their clients by using that information to improve care.

Evolution of the Medication Management Improvement System

1993-2003: Medication Improvement Program developed for elders receiving licensed home health care and proven effective in a randomized, controlled trial.

2003-2007: Partners in Care (Partners) adapted MMIS for care management and computerized the screening – AoA Evidence-Based Healthy Aging Program

2006-2010: Taking medication management statewide and then nationwide in care management programs for elders. Partners and RTZ Associates, Inc. have received grants from the John A Hartford Foundation and NIH to further adapt and disseminate the MMIS and computerized screening tools.

What Is the Medication Management Improvement System?

The system addresses medication problems among frail older adults using criteria developed by an expert panel4 to address four problem types:
- Unnecessary therapeutic duplication (e.g. generic and brand name of same drug)
- Falls, dizziness, or confusion possibly caused by inappropriate psychotropic drugs (e.g. tranquilizers, antidepressants, sleep aids)
- Cardiovascular medication problems related to continued high blood pressure, dizziness, low blood pressure or low pulse.
- Inappropriate use of non-steroidal anti-inflammatory drug (NSAIDs) in those with risk factors for peptic ulcer or gastrointestinal bleeding.
Agency staff members work with a consulting pharmacist to (1) verify the accuracy and appropriateness of the client’s current medication list, (2) identify problems that warrant re-evaluation by the physician, and (3) follow through with the client and physician to resolve identified problems.
In response to increasing nursing shortages, the intervention has been streamlined to enable non-nurse care managers to implement the system.
Now a computerized risk assessment screening and alert process has been developed, using the medication list and clinical indicators (vital signs, falls, dizziness and confusion) to identify potential medication problems.

What Have We Learned About Medication Problems in Care Management for Elders?

In 2004-2006, 615 clients were screened at three California Medicaid waiver (MSSP) sites:
Average age 81; 80% female
Hospitalization, SNF, or ER in Last Year? ~38% yes
Falls in past 3 months ~22%; Dizziness ~27%; Confusion ~31%
Average number of medications taken by each client: 8.76
Percent of clients using 12 or more medications: 22.3%
49% of clients (N=299) had at least one potential medication problem. Record review and consultation with the client led the pharmacist to recommend either (a) continuing the medications; (b) revising the medication list; (c) collecting additional information; or (d) changing medications.
29% of clients had a medication problem serious enough for the pharmacist to recommend a change in medications, including re-evaluation by the physician.
For the intervention group (N=99) 61% of recommended changes were implemented.
Positive client outcomes have included discontinuation of potentially harmful medicines, decreased confusion and dizziness, better pain control, decreased risk of falls, and improved blood pressure control.

What Is the Next Step for Agencies Interested in Implementing the MMIS?

We are seeking partnerships with care management programs around the country to implement the latest version of the MMIS. If you are interested in finding out if your organization is ready to try implementing the Medication Management Improvement System, we have worked with NCOA to create a 15-minute questionnaire that will help you and our project staff determine if you might be a good candidate for a national demonstration site.

You will get a comprehensive report on your readiness for this change and we will receive a copy of the report. After reviewing your survey results we will contact you to discuss the project. Click here to find out if you are ready.

Please feel free to contact M. Iya Kahramanian at 818-837-3775, ext. 112 if you require more information.

References

IOM. 2000. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press.
IOM. 2007. Preventing medication Errors. Washington, DC: National Academy Press.
Rigler SK, Jachna CM, Perera S, Shireman TI, Eng ML. (2005). Patterns of potentially inappropriate medication use across three cohorts of older Medicaid recipients. The Annals of Pharmacotherapy, 39 (7), 1175-1181.
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). A model for improving medication use in home health care patients. Journal of the American Pharmaceutical Association, 38 (6), 696-702.