Medication Management Model – Home Health

The Medication Management Model was designed specifically for home health agencies and was proven effective in a clinical trial. The model can be implemented with minimal need for additional personnel or procedures, so it can be readily and cost-efficiently incorporated into practice. It does require the services of a medication expert such as a consultant pharmacist, physician, or geriatric nurse practitioner.

Targeted medication problems: The model focuses on identifying and resolving the four most common medication problems that researchers have determined are amenable to collaborative staff and pharmacist intervention in homecare programs. They are:

Unnecessary therapeutic duplication;
Cardiovascular medication problems related to dizziness, continued high blood pressure, low blood pressure, substantial (20-point) drop in blood pressure upon standing (orthostasis), or low pulse;
Falls, dizziness, or confusion possibly caused by inappropriate psychotropic drugs;
Inappropriate use of non-steroidal anti-inflammatory drugs (NSAIDs) in those with risk factors for peptic ulcer.

Procedure: The intervention features a consultant pharmacist assisting the home health nurse to assess and resolve potential medication problems. The model follows a five-step procedure that includes the patient's primary care physician

The patient's medication list is screened for potential problems. The home health nurse and pharmacist consultant jointly review patient data and the potential problem using the model's guidelines.
If additional information is needed to assess the problem, the nurse collects it at the next scheduled visit.
With all data in hand, the pharmacist develops a plan to address relevant problems and consults with the nurse.
The nurse (and for complicated patients, the pharmacist) contacts the physician to present the problem, discuss the regimen, and obtain follow-up orders.
The nurse assists the patient with any medication changes and monitors need for follow-up.

Goals for problem resolution: For each of the targeted medication problems, the model's guidelines specify the goal of the intervention:

For therapeutic duplication, the goal is no unnecessary duplication.
For cardiovascular medication problems, the goal depends on the problem identified:
- High Blood Pressure: SBP/DBP<160/90 mm Hg (SBP=Systolic; DBP=Diastolic)
- Low SBP: SBP>100 and < 160mm Hg
- Orthostasis: No dizziness on standing and a smaller postural BP drop;
- Pulse >= 55bpm
For recent fall/confusion with use of psychotropic drugs (benzodiazepines, cyclic antidepressants, antipsychotic), the goal is to reduce the dose to minimum required or switch to an alternative with fewer side-effects; or discontinue if not required.
For NSAID use, the goal is to reduce dose or discontinue to minimum needed to control pain, with use of acetaminophen

Materials to implement the model can be found in the Tool Kit. It includes the guidelines, protocols and forms to document pharmacist interventions.