HomeMeds – Care Management Implementation
The original Medication Management Model program to improve medication use was designed for Medicare-certified home health agencies providing in-home nursing and rehabilitation services to patients aged 65+. The model was then translated from the home health setting and tested in three Southern California Medicaid waiver sites as part of a national Evidence-Based Prevention effort led by the U.S. Administration on Aging (AoA).
The new model, now called HomeMeds (previously the Medication Management Improvement System or MMIS), funded by the Administration on Aging (AoA) as the “Community-Based Medication Management Intervention,” is a collaborative approach to identifying, assessing, and resolving medication problems in community-dwelling older adults receiving care management services. Specifically, the intervention was tested among functionally impaired, low-income seniors living at home under a 1915(c) Medicaid waiver program aimed at keeping people out of nursing homes. HomeMedsis currently being disseminated widely in California’s Medicaid waiver programs for elders, called the Multipurpose Senior Services Program (MSSP). The John A. Hartford Foundation funded further dissemination, which has led to implementatin in almost 30 sites in 8 states.
The effectiveness of medication management in care management programs became evident through the AoA-funded study. In this study of three Medicaid waiver sites, it was found that out of a total of 615 clients screened, 49 percent (N=299) had at least one potential medication problem. Twenty-nine percent of the 615 clients had a medication problem serious enough for the pharmacist to recommend a change in medication and re-evaluation by the physician. For this intervention group (N=118), 61 percent patients experienced a change in at least one problematic medication.
Targeted medication problems: HomeMeds focuses on identifying and resolving four of the most common medication errors 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 systolic 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/gastrointestinal bleeding.
Core elements: The HomeMeds evidence-based model contains the following core elements:
- Risk screening by protocols to identify potential errors and medication-related problems;
- Assessment of the client’s condition and adherence based on established guidelines
- Consultation with a pharmacist (or nurse practitioner) to develop a plan of action based on protocols; and
- Follow-up with physician and client to improve medication use
Software risk screening tool: HomeMeds for care management agencies was adapted from the home health model to work effectively in hybrid medical/social or simply social model programs. HomeMeds now incorporates a computerized risk assessment and alert system that helps care managers identify potential medication-related problems among their clients. This reduces the need for pharmacist consultation, limiting it to only those clients whose risk screening indicates a potential problem. Using the software also enables programs to provide clients with an editable comprehensive medication list that they can take to all of their appointments. Although currently available only in a standalone version, it has been designed to facilitate integration with other electronic health record systems.