Frequently Asked Questions (FAQ)

What is the rationale behind the MMIS?

Summary of Issue

Medication-related problems exact a heavy toll on American public health. Indeed, medication errors are a leading cause of death in America. Older adults, especially home health patients, are especially vulnerable to medication errors because of the number of medications they take and the biological changes associated with aging and disease.

The Problem (Literature references follow)

The problems are widespread. If adverse reactions to medications were classified as a distinct disease, it would be the fifth leading cause of death in the U.S.¹ Among people over the age of 65, it may rank as the third or fourth leading cause of death. ¹
The problems are costly, amounting to between $85 billion and $177 billion annually in direct medical costs. ^3,4,5
The problems are physically harmful, often fatal. According to one report, a meta-analysis of 39 prospective studies, in a single year approximately 2,216,000 hospitalized patients experienced a serious adverse drug reaction and 106,000 died as a consequence of their medication. ¹
Perhaps worst of all, the problems for the most part are preventable. "There is a substantial body of literature," write Perry and Webster, "that indicates that most medication-related problems are predictable and, thus, in many cases, preventable." ⁶

Older Adults

As the nation's greatest consumers of prescriptions and over-the-counter medications by far, older adults are especially vulnerable to medication-related problems. ⁷

While they constitute about 13% of the U.S. population, older Americans consume an estimated 34% of all prescriptions. ⁵
On average, they take four and a half prescription medications at any one time, plus another two over-the-counter medications.⁷While all these medications may be medically appropriate, the chance of an adverse reaction increases with the number of drugs consumed. Advanced age has also been implicated as a risk factor for adverse medication effects, with the incidence of side effects rising after age 50 and jumping after age 70. Indeed, it has been said that any symptom in an elderly patient should be considered a drug side effect until proven otherwise.
In 1991, more than 2 million Medicare beneficiaries received home health care services.⁸ This population is at high risk for potential medication errors for several reasons. Because of underlying illness, home health patients are frequent medication users. Their advanced age and greater frailty might also increase susceptibility to adverse medication effects. Complicating matters is that most patients receive home health following a hospital stay, during which their medication regime may have changed, resulting in compliance difficulties. At the same time, the home health setting presents an opportunity to improve medication use. The reason: These patients receive regular visits from registered nurses, who can assess medication appropriateness, coordinate changes in drug regimes, and facilitate physician intervention as needed in a timely manner.

How much does it cost to implement the Medication Management Improvement System?

The MMIS is designed to be integrated into the usual practice of care management programs without need to add staff.

The system is designed to use a computerized risk assessment screening. This online system can be used for around $100 per month. The system is designed to interface with other existing systems. We also have a detailed algorithm that can enable the protocols to be programmed into existing systems. Past implementations have successfully used a manual screening by a consulting pharmacist.
Optimal implementation uses a consulting pharmacist or other medication expert such as a geriatric nurse practitioner or a physician. We estimate that the consulting pharmacist would cost between $50 and $75 per hour. Reviewing a client’s medications and potentially interacting signs and symptoms and making a written report with recommendations for improvement takes an average of about 15 minutes. Our experience is that about 50% of clients will need consultation upon initial assessment (i.e. when they first enter the care management program). Some states’ Medicaid waivers enable care managers to use waiver funds to pay for pharmacist consultation. Medicare Part D provides for Medication Therapy Management services to be provided to individuals who take 5 or more medications, have 2 or more chronic conditions, and whose medications cost $4,000 or more per year. Pharmacists can bill Medicare for providing this service. Some community pharmacists are willing and able to review the medication report produced by the software. Schools of pharmacy can work with agencies to provide interns who can cost-effectively review medications and related conditions. Retired pharmacists and physicians are a potential source of volunteer medication-related consultation.
We highly recommend acquiring tablet computers (or laptops) with wireless cards and entering the medications during the initial home visit so that the nurse or other care manager will have immediate feedback and can counsel the client as soon as the problem is noted. This is not essential, of course, but adds speed and a personal touch to the program.
Of course, there is some staff training and supervision required and the time dedicated thereto can be considered to be a cost. We provide free comprehensive toolkits on this website. There are no licensing fees and all materials may be freely duplicated. Sites that are not our official partners can arrange for our staff to provide training, either on-site or via web-based conferencing.

Our agency/program is interested in adopting the model. What do I need to get started?

Agencies that have enthusiastic staff and understand the need to help elders avoid medication-related problems are well on the way to being able to implement the MMIS.

To get started, first read through the model overview, protocols and procedures in our Tool Kit.
Second, log in (coming November 2007) to complete the Diffusion of Innovations Readiness Tool developed by Partners in Care Foundation and National Council on the Aging (NCOA). This tool provides a framework for discussions within an aging service organization interested in offering evidence-based health promotion and self-management programming. The tool focuses specifically on how to assess “readiness” to proceed with implementation. After completing the online tool you will receive a report analyzing your agency’s indicators of capacity and willingness to move ahead with implement. Partners in Care will also follow up to offer assistance, if you wish. If more technical assistance is needed you can contact us.

What is a consultant pharmacist? How do I find one?

Consultant pharmacists specializing in elder care practice are essential participants in the health care system, recognized and valued for their unique contributions to people with chronic illness. In their role as medication therapy experts, consultant pharmacists take responsibility for their patients’ medication-related needs; ensure that their patients’ medications are the most appropriate, the most effective, the safest possible, and are used correctly; and identify, resolve, and prevent medication-related problems that may interfere with the goals of therapy. For more information refer to the American Society of Consulting Pharmacists: ASCP’s Senior Care Pharmacist website. To find a senior care pharmacist in your area, refer to www.seniorcarepharmacist.com.

Where can I find information on the medications that I am taking?

One of the most comprehensive sites available online that provides up-to-date drug information is www.drugs.com. Here you can find information on various prescription drugs, over-the-counter medications, and herbal remedies. There is also a wealth of additional information such as on medical conditions and diseases, and recent pharmaceutical news.

What are some of the drugs most prescribed to the elderly?

A list of the drugs most commonly prescribed to the elderly can be found here. On this list you will find the drug listed with its generic name as well as its brand name(s) and the therapeutic category of the drug.

What are the AoA evidence-based prevention programs?

The AoA evidence-based prevention programs focus on identified key health conditions and risk factors for older adults in the community. The programs are based on scientific evidence or proven intervention and are suitable for adoption by a variety of community aging service providers. In their development and implementation the prevention programs maintain fidelity to the original model. Once the program is implemented the focus is to recruit and retain high risk, diverse older adults. The effectiveness and reach of the program is evaluated and the aspects that work are disseminated. For more information please refer to the AoA website.

References

1. Lazarou J, Pomeranz BH, Corey PN. Incidence of Adverse Drug Reactions in Hospitalized Patients: A Meta-Analysis of Prospective Studies. Journal of the American Medical Association 1998; 279:1200-5.

2. Feinberg JL. Ensuring Appropriate, Effective, and Safe Medication Use for Older People. Generations 2001;5:5-7.

3. Johnson JA, Bootman JL. Drug-Related Morbidity and Mortality: A Cost-Of-Illness Model. Archives of Internal Medicine 1995; 155:1949-56.

4. Bootman JL, Harrison DL, Cox E. The Healthcare Cost of Drug-Related Morbidity and Mortality in Nursing Facilities. Archives of Internal Medicine 1997; 157:2089-96.

5. American Society of Consultant Pharmacists. Dear Abby Response. e-mail communication, April 3, 2001.

6. Perry DP, Webster RT. Medication-Related Problems in Aging: Implications for Professionals and Policy Makers. Generations 2001;5:28-35.

7. Beers MH. Age-Related Changes as a Risk Factor for Medication-Related Problems. Generations 2001;4:22-27.

8. Atkin PA, Veith PC, Veith EM, Ogle SJ. The Epidemiology of Serious Adverse Drug Reactions among the Elderly. Drugs & Aging 1999;14:141-152.