Community-Based Medication Management

The Partners in Care Foundation Medication Management Improvement System (MMIS) is an evidence-based intervention specifically designed to enable social worker and nurse care managers to identify and resolve certain medication problems common among frail elders living in the community.

MMIS was successfully piloted in three Southern California Multipurpose Senior Services Program (MSSP) sites, which serve functionally impaired clients that are deemed to need a nursing home level of care.

These dually Medicare and Medicaid-eligible clients, whose average age is 80, are provided with services to enable them to continue living safely at home. The results have been impressive – 49% of the 615 clients screened in with at least one potential problem and pharmacist review found that 29% of clients had problems that warranted consulting the physician about a change in medication or dose. Three months later, 60% of the medications identified as problematic had been changed.

For more information please visit our website: www.homemeds.org

Medication Management Improvement System (MMIS) 2 page briefMedication Management Improvement System: Medication-related problems and errors endanger lives and well being of community dwelling older adults.

What do we know about medication errors?

• Serious: There are at least 1.5 million preventable adverse drug events (ADEs) that occur each year in the US, resulting in 7,000 deaths.
• Frequent: Up to 48% of community-dwelling elders have medication-related problems
• Costly: Drug-related morbidity and mortality costs exceed $170 billion
• Preventable: About 25% of ADEs in ambulatory settings are preventable

Evolution of Partners in Care Foundation’s Medication Management Program

• 1993-2003: Program developed and piloted for elders receiving home health care
  • An intervention to improve medication use was developed and tested in a randomized controlled trial; then disseminated and adapted (Wayne Ray, et al, Vanderbilt University)
• 2003-2007: AoA Evidence-Based Prevention Initiative – Adapted for Care Management
  • Community-Based Medication Management Intervention
  • Model successfully tested in 3 Medicaid Waiver sites in Los Angeles County
• Next Phase (2006–2010): Taking medication management statewide and then nationwide in care management programs for elders
  • John A Hartford Foundation and NIH grants to Partners in Care Foundation and RTZ Associates, Inc. to further adapt the computerized screening and pharmacist assistance for staff and clients of care management programs.

What is the medication management intervention?

• By working with a pharmacist to review their clients’ medications in light of vital signs and adverse events such as falls, home care nurses and care managers have discovered a high rate of potentially dangerous medication problems among older adults living in the community. After working with physicians, patients and family members, most of the problems were resolved by a change medication or dose. Now we have created a computerized screening tool to analyze medication lists and symptoms to discover potential medication problems. Our panel of experts identified four problems amenable to intervention by homecare staff:

  1. Unnecessary duplication of drugs from a single class, often a generic and brand name version of the same drug or two similar medications prescribed by different doctors;
  2. Uncontrolled cardiac symptoms related to medication use: continued high blood pressure, low blood pressure, a sudden drop in blood pressure upon standing, or low pulse.
  3. Experience of falls, dizziness, or uncharacteristic confusion related to use of psychotropic medications.
  4. Use of non-steroidal anti-inflammatory drugs in those prone to gastric bleeding and ulcers.
• 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 medication problems. Care managers work with clients, a pharmacist, and the physician to resolve problems.

What do we know so far?

• 615 clients screened at 3 Medicaid waiver sites
  • Average age 81; 80% female
• Hospitalization, SNF, or ER in Last Year? ~ 38% yes
• Falls in Last 3 Months ~ 22%; Dizziness ~ 27%; Confusion ~ 31%
• Average # of medications: 8.76
  • 12+ medications – 22.3%
• 49% of clients had at least one potential medication problem (N=299)
• After collecting further information from the client and consulting with a pharmacist, 26.3% of clients were confirmed with a medication problem. 61% of confirmed problems were resolved when the care manager worked with the client, pharmacist, and physician.

Confirmed Medication Problems and Change Rates at 3-Month Follow-Up
Medication Problem	MSSP Sample Screened (N=615)		Medication Change (N=162)
	N	% Prevalence	N	% Change
All confirmed problems	162	26.3%	99	61.1%
-Therapeutic Duplication	79	12.8%	49	62.0%
-Psychotropic w/Falls or Confusion	59	9.6%	32	54.2%
-Cardiovascular Problems	24	3.9%	11	45.8%
-NSAIDs	44	7.2%	22	50.0%