Transcript Land of the Dancing Sky Area Agency on Aging

Beyond the Pill Box:
Creative Approaches
to
Medication
Management
Moderator – Beth Budziszewski
Grants Manager, Program Developer
Land of the Dancing Sky Area Agency on Aging
Presenters:
Sara McCumber, MS, RN, CNP, CNS
Assistant Professor, Graduate Nursing
College of St. Scholastica
Steve Guttormson
Director of Marketing and Advancement
PioneerCare – Fergus Falls, Minnesota
Matt Schroeder
Pharmacy Operations Manager, Patient Programs
Thrifty White Pharmacy
Matt Just, PharmD
Long Term Care Consultant Pharmacist
Thrifty White Pharmacy
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Too many medications
Can’t understand the directions
Too complicated
Can’t afford
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Mr. Andrews 72 year old male with heart failure,
memory problems, COPD, OA
Widowed, lives alone, 8th grade education
Med: Lisinopril 2x daily, Furosemide daily if weight
increased 2# in 24 hours, Carvedilol 3x daily,
Combivent inhaler 4x daily, Aricept 10 mg daily,
Oxycodone 5 mg 4x daily, Coumadin daily, ASA
daily
"the extent to which a person's behavior
[in] taking medication...corresponds with
agreed recommendations from a health
care provider" (World Health
Organization, 2003).
 How
many of your clients
take their medications as
directed?
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Epidemic problem
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Hospital admissions
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Nursing home admissions
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Costs and adverse health outcomes
Consider these statistics (American Heart
Association):
12% of Americans don't fill their
prescription at all
12% of Americans don't take medication at
all after they fill the prescription
Almost 29% of Americans stop taking their
medication before it runs out
22% of Americans take less of the
medication than is prescribed on the label
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Cost
Don’t understand directions
Side effects
Thought drug would not help much
Don’t think I needed it
Condition improved
Taking too many medications and complex
regimen
A
pill box is not always the
answer to medication
management problems.
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1) Social and economic
2) Health care system
3) Condition related factors
4) Therapy related
5) Patient related
-Patient’s often do not report non-adherence unless
directly asked.
-Patient’s want to try to avoid disappointing the
health care provider.
-Provider’s fail to directly ask about adherence and
add more medicine.
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Normalize non-adherence
Assume that patients are not taking their
medications correctly.
Avoid closed-ended questions (yes or no)
questions such as “Are you taking your
medicine?” or “Do you have any problems
taking your medicines?”
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Utilize all members of the team
Engage patients in collaborative
conversations about their medications
Utilize open ended questions
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Effective communication is vital—
-Ask the patient, “A lot of people have trouble
taking medicine the way their doctors ask
them to. What gets in the way of you taking
your medicines?
-If the patient does not volunteer answers, offer
suggestions.
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Explore ambivalence as needed
Build on strengths
Explore barriers and solutions
Provide education/medication instructions &
check understanding (teach back)
Summarize
Affirm positive behaviors (Sobel, 2004)
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Mr. Andrews 72 year old male with heart failure,
memory problems, COPD, OA
Widowed, lives alone, 8th grade education
Med: Lisinopril 2x daily, Furosemide daily if weight
increased 2# in 24 hours, Carvedilol 3x daily,
Combivent inhaler 4x daily, Aricept 10 mg daily,
Oxycodone 5 mg 4x daily, Coumadin daily, ASA
daily
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Low health literacy, did not understand
medication directions.
Cost of medications
Complexity of medication plan
Too many medications
Memory problems
Side effects
 So
would a pill box have
solved Mr. Andrew’s
medication management
problems?
 More
effective approach
would have been
collaborative, patient
conversation about actual
medication use.
Director of Marketing
& Advancement for
PioneerCare
Fergus Falls,
Minnesota
24-hour Skilled
Nursing
 Assisted Living
 Memory Care
 Apartment Living
for Older Adults
 PioneerLink®
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Empowering People to Live
Independently, at Home,
Through Innovative
Technology and
Personalized Services
Began Planning in 2010
 Launched January 2011
 CS/SD grants from the
Minnesota Department of
Human Services
 Matching Corporate
Investment
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Minnesota DHS
Tunstall Americas
County Social
Services
Local Hospitals &
Clinics
Pharmacists
Home Care Agencies
Ambulance Services
Most Clients:
100 Percent
Adherence
Steve Guttormson
218.998.7094 |
[email protected]
Karen Wulfekuhle
218.998.7094 |
[email protected]
Medication Synchronization:
Appointment Based Model
Oldest Drug Store Chain in The United States. Since 1884 128 Years Old.
100% Employee Owned.
Studies from The New England Health Institute
estimate that non-adherence, along with
improper medication management, results in
$290 billion a year in avoidable medical
spending on our healthcare system.
•Poor medication adherence is recognized as
significant waste in our healthcare system.
•Poor adherence often leads to preventable
worsening of disease, posing serious and
unnecessary health risks, particularly for
patients with chronic diseases.
Source: New England Health Institute
http://www.nehi.net/news/press_releases/110/nehi_research_shows_patient_medication_nonadherence_costs_
health_care_system_290_billion_annually
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32 million Americans take 3+ medications daily.
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Almost 29% of Americans stop taking their
medicine before it runs out.
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30% of Americans don't pick up their filled
prescriptions.
•The average length of stay in hospitals due
to medication noncompliance is 4.2 days.
•50% of all Americans with chronic
diseases don't follow their physician's
medication and lifestyle guidance.
Source: American Heart Association
http://www.americanheart.org/presenter.jhtml?identifier=107
U.S. Surgeon General, 1982 -1989
All prescriptions ready on the same day.
Scheduled
calls placed to patient prior to appointment
day.
Appointment
day – pharmacist
meets with patient to review
entire medication profile.
Patient
experiences
convenience of a single trip.
Synchronized prescription refill model:
Designed to improve health outcomes and
improve business efficiency.
• Increase medication persistency
• Decrease gaps in therapy
• Provide higher level of patient care
• Increase patient and pharmacist
satisfaction
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Increases focus on consultations with patients to
improve health outcomes.
Syncing patient medications helps all parties
involved.
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Patient
Health Plans
Physicians
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Pharmaceutical
Companies
Pharmacies
27,000+ patients enrolled.
Patient Care Center
• Monthly touch points with
patients enrolled in Med
Sync
• Monitoring lapses in
therapy
• Discharge counseling
• Comprehensive Medication
Reviews/Medication
Therapy Management
Ateb Pharmacy Solutions
Automated Management and
Communication
• 10 day call verifying if there have been
any changes
– Interactive call; verifies correct patient
– Prompts patient to fill additional
prescriptions not in Med Sync
•3-4 day pickup notification for prescriptions enrolled in
Med Sync
Additional pick up reminders for patients who do
not pickup their order
•Enrollment
Inbound message explains program when
patients call in refill via IVR
•Patient Management Portal
HealthyPackRx
TM
Packaging Solutions
•Organizes all of a patients’ prescriptions into
pre-sorted packets
•Each packet is clearly marked with the date
and time they should be taken (i.e., Breakfast,
Morning, Lunch, Dinner or Bedtime), as well as
the name and physical description of the
contents.
Rx Timer Cap®
•Replaces a regular vial cap and
features a built-in LCD timer that automatically
counts the minutes and hours since a patient
last took their medication.
Medication Synchronization
Source: IMS Health Adherence Data; Various sources; AT Kearney analysis
Study Results
Virginia Commonwealth University/Thrifty White
Appointment-Based Model Study
 1 year of data
 3,300 Med Sync Patients
 45,000 Control Group Patients
 Patients represent 6 chronic medication classes:
ACEIs/ARBs
Thiazide diuretics
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Beta blockers
Calcium channel blockers
Metformin
Statins
Compared Proportion of Days Covered (PDC) and
Persistence Rates.
Source: Virginia Commonwealth University – ABM Study
Thrifty White/VCU Study with comparison to CMS Star Thresholds
90%
80%
70%
5 Star
60%
50%
4 Star
40%
30%
20%
10%
0%
Control
ABM
Control
ABM
Control
ABM
Statins
ACE/ARB
Metformin
Cholesterol
Blood Pressure
Diabetes
Study Results
• Patients enrolled in the program had 3.4 to 6.1 times
greater odds of adherence as controls during the
evaluation period.
• Control patients had a 52% to 73% greater likelihood
of
becoming non-persistent compared to ABM (Med Sync)
group.
• Resulted in 84 more days of medication for patients
in
Med Sync group (2.8 more refills/year)
Source: Virginia Commonwealth University – ABM Study
Medication Synchronization
Adherence among chronic disease patients can lead
to significant health care savings.
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Annual savings for adherent patients:
• Congestive Heart Failure
$7,823
• Diabetes
$3,756
• Hypertension
$3,908
• High Cholesterol
$1,258
The analysis indicated significant improvements in
adherence and persistence for Medication
Synchronization patients when compared to control
patients for all analyzed chronic medication classes.
Source: IMS Health Adherence Data
Decrease Overall Spend
Source: Optum “Medication Adherence: Rx for Success” White Paper
Patient Endorsements