New Grant Extends Benefits of Medication Management to High-Risk Elders Living at Home
Cost-effective Medication Management Interventions for Low-income Seniors in Home Care Minimizes Drug Errors, Saves Lives, Raises Standard of Practice
Dramatically high error rates, partly due to fragmented prescribing, result in huge insurance and human costs, but are largely preventable with intervention among vulnerable elderly
(San Fernando, CA, July 1, 2006) — Older adults, especially low-income seniors living at home, are seven times more vulnerable to drug errors than any other age group. According to several studies, medication problems among elders, whose error rate increases as they are treated by more doctors and prescribed more drugs without coordinated care, are the 5th leading cause of death and enormously costly, amounting to between $85 billion and $177 billion annually in direct medical costs. America spends nearly $200 billion annually treating the results of these errors. Yet, these medication problems are largely preventable.
In response to the high human and economic cost of these errors, The John A. Hartford Foundation has awarded $1.7 million to fund the national expansion of Partners in Care Foundation’s innovative Medication Management Model (www.homemeds.org) announced W. June Simmons, president and CEO of the San Fernando Valley, California-based non-profit. “This next-step grant underscores the importance of expanding Partners’ evidence-based model of care for the vulnerable at-home elderly population to an additional three states.”
Building on the success of previous Partners projects in medication management, the new grant will complement and extend work funded by the Administration on Aging. Currently the program utilizes interventions originally developed for older patients receiving home health services and adapts them for use with low-income elders living at home who would qualify for admission to a nursing home. The model introduces a computer-based tool that alerts care managers when a potential drug error is found. After consulting with a pharmacist, they communicate with the patient, family and physician to eliminate the problem. This computer-based alert system is being developed by RTZ Associates in San Francisco, California. Funding from The John A. Hartford Foundation will enable Medication Management project staff to introduce the model across four sites in California. After successful implementation across four intervention and four control sites, project staff will explore future possibilities to expand across partnering states.
Expanding Medication Management for High-Risk Elderly at-Home
“It’s a major issue of equity,” notes Dennee Frey, PharmD, the grant’s co-principal investigator. “Older adults living at home are acutely vulnerable to medication problems, largely because they lack the kind of medication management that can help prevent errors. Residents of skilled nursing facilities receive federally mandated monthly drug reviews by consultant pharmacists. However, equally vulnerable seniors remaining at home in their communities do not have the same benefit.”
Ms. Simmons, who serves as principal investigator, points out that, in a defining study led by Vanderbilt University and supported by The John A. Hartford Foundation between 1994 and 2001, the medication management model significantly reduced medication errors among home health care recipients aged 65+. “More recently, Partners in Care replicated this model among a population of frail elders living at home who are at even higher risk for medication errors, in a project funded by the Federal Administration on Aging.”
To date, the Partners project has tested the medication management intervention in three
Los Angeles-area nursing home alternative Medicaid waiver (MSSP) care management sites, with a sample of 615 elderly clients. Prior studies and Partners’ previous work had demonstrated the high prevalence of potentially serious and life-threatening medication errors among elders. In the most recent study, the incidence of medication errors was much higher than expected among Medicaid waiver clients. Almost 50% of the 615 clients screened presented with evidence of potentially harmful medication errors; almost 30% confirmed with problems. “This error rate is well over double the 17% incidence rate reported in the previous Vanderbilt home health study. Ms. Simmons points out, “The benefits of an intervention to identify and significantly reduce these errors are to prevent harm and enhance health and well-being.”
In addition, more than 100 home health agencies have adopted the Partners model. Dramatic preliminary findings have validated the need for continued efforts to improve medication management among the expanding elderly population.
Demonstration, Dissemination, Adoption are Major Grant Outcomes
In partnership with the National Council on Aging (NCOA), the new grant will demonstrate and support adoption of the evidence-based Medication Management Model in programs that oversee home care for low-income elders who otherwise would need nursing home care. Targeting eight geographically dispersed and diverse home care management programs in three states, the Project engages the Diffusion of Innovation Expert System to create a Medication Management Diffusion Tool that will screen and provide feedback to potential sites to increase their likelihood of success.
To further disseminate the model, the Partners Medication Management team will pilot-test and implement an innovative online workshop that provides Medicaid waiver programs across the country with the education, guidance, and support needed to implement this medication management intervention in their sites. The team will then broadly disseminate the intervention to home care agencies and other community-based care management programs using a proven strategy that includes web-based methods and the NCOA System.
Finally, the Project will measure and evaluate the impact of the intervention implementation, including a comparison and control group in California, provide technical assistance to additional programs nationally and disseminate the findings and observations to the professional community.
Establishing Higher Practice Standards for Home Care Medication Management
“These demonstration, diffusion and dissemination activities will assist waiver programs for elders in building capacity to efficiently identify and resolve their clients’ widespread and potentially dangerous medication errors,” observes Ms. Simmons. “In doing so, the project will help establish new, stronger, and much needed practice standards for medication management in waiver programs throughout the nation. The long-term goal of the Project is to integrate into waiver programs a national practice standard for medication management that will dramatically reduce medication errors and related health problems, thereby keeping very frail older adults in their homes and out of nursing homes.”
For additional details on medication management for the elderly, contact: W. June Simmons at (818) 837-3775, ext. 101.
About Partners in Care Foundation
Partners in Care Foundation changes the shape of healthcare and social services so they work better for everyone. Partners develops high-impact, innovative ways of bringing more efficient health and social services to people and communities. Partners’ direct services measure, refine, and replicate the innovative programs and services and bring needed care to diverse people and communities.
For more information, call (818) 837-3775 or visit: www.picf.org.
