A Partners in Care Aging Well Innovation
Computerized screening and pharmacist review can help prevent falls, dizziness, confusion, and other medication-related problems for elders living at home.
HomeMeds is an evidence-based, technology-enabled intervention that addresses medication safety among older aduts by connecting homecare and other community-based services to health care providers. Simply making better use of the information already being gathered in the home helps unmask potential medication problems so they can be resolved. HomeMeds addresses major gaps in care that leave home-dwelling older adults at risk for adverse medication effects, providing unique information not typically available to prescribers, such as adverse effects, patients' use of over-the-counter medications, duplications resulting from multiple prescribers or hospital stays, and adherence problems. Physicians are more likely to change prescribing behaviors when given this information together with recommendations from a consultant pharmacist. Using existing effort and a non-medical workforce, a technology core, and sources of funding outside of Medicare and Medicaid, HomeMeds is affordable and saves healthcare dollars by preventing serious adverse drug events that cause ED use, hospitalization and institutionalization.
Background: 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. HomeMeds 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 or care managers from other disciplines a variety of programs for older adults, especially in Medicaid waivers designed to help keep frail older adults at home.
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 – HomeMeds enables them to better protect their clients by using that information to improve care.
Evolution of HomeMeds (also known as the Medication Management Improvement System - MMIS)
1993-2003: HomeMeds developed for elders receiving licensed home health care and proven effective in a randomized, controlled trial.
2003-2007: Partners in Care (Partners) adapted HomeMeds 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, funded by the John A. Hartford Foundation.
What Is HomeMeds?
- 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, diphenhydramine)
- Cardiovascular medication problems related to 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 consultant 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.
- To enable spread to other agencies serving older adults at home, the HomeMeds intervention has been adapted to enable social workers and other non-medical personnel 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 HomeMeds?
HomeMeds is being implemented in a wide variety of agencies serving older adults, including post-hospital care transitions, Area Agencies on Aging, home-delivered meals programs, homecare programs, Medicaid care management, home health. If you are interested in finding out if your organization is ready to try implementing HomeMeds, Click here to learn more.
Please feel free to contact us by e-mail or by phone at 818-837-3775 if you would like more information.
HomeMeds has also been known as the Medication Management Improvement System (MMIS). In 2011 Partners in Care filed a service mark with the California Secretary of State for the name HomeMeds.
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.