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Beyond the Pill Box: Creative Approaches to Medication Management

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 

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Beyond the Pill Box: Creative Approaches to Medication Management

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  1. Beyond the Pill Box: Creative Approaches to Medication Management

  2. Moderator – Beth Budziszewski Grants Manager, Program Developer Land of the Dancing Sky Area Agency on Aging Presenters: Sara McCumber, MS, RN, CNP, CNSAssistant 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

  3. Medication Management Too many medications Can’t understand the directions Too complicated Can’t afford

  4. Case Study • 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

  5. Medication Adherence "the extent to which a person's behavior [in] taking medication...corresponds with agreed recommendations from a health care provider" (World Health Organization, 2003).

  6. How many of your clients take their medications as directed?

  7. Scope of the Problem • Epidemic problem • Hospital admissions • Nursing home admissions • Costs and adverse health outcomes

  8. After the RX is written… • 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

  9. Reasons for non-adherence • 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

  10. A pill box is not always the answer to medication management problems.

  11. Factors Impacting Adherence • 1) Social and economic • 2) Health care system • 3) Condition related factors • 4) Therapy related • 5) Patient related

  12. Non-adherence is an invisible problem -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.

  13. Addressing non-adherence • 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?”

  14. Addressing non-adherence • Utilize all members of the team • Engage patients in collaborative conversations about their medications • Utilize open ended questions

  15. Addressing non-adherence • 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.

  16. Addressing non-adherence • 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)

  17. Case Study • 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

  18. Mr. Andrew’s Medication Problems • Low health literacy, did not understand medication directions. • Cost of medications • Complexity of medication plan • Too many medications • Memory problems • Side effects

  19. So would a pill box have solved Mr. Andrew’s medication management problems?

  20. More effective approach would have been collaborative, patient conversation about actual medication use.

  21. Steve Guttormson Director of Marketing & Advancement for PioneerCare Fergus Falls, Minnesota

  22. PioneerCare Is … • 24-hour Skilled Nursing • Assisted Living • Memory Care • Apartment Living for Older Adults • PioneerLink®

  23. PioneerLink Is … Empowering People to Live Independently, at Home, Through Innovative Technology and Personalized Services

  24. PioneerLink … • Began Planning in 2010 • Launched January 2011 • CS/SD grants from the Minnesota Department of Human Services • Matching Corporate Investment

  25. Collaborating With … • Minnesota DHS • Tunstall Americas • County Social Services • Local Hospitals & Clinics • Pharmacists • Home Care Agencies • Ambulance Services

  26. Success Stories …

  27. Success Stories… Most Clients: 100 Percent Adherence

  28. Steve Guttormson 218.998.7094 | steveg@pioneercare.org Karen Wulfekuhle 218.998.7094 | karenw@pioneercare.org

  29. Medication Synchronization: Appointment Based Model

  30. 150 Locations In 7 States Oldest Drug Store Chain in The United States. Since 1884 -128 Years Old. 100% Employee Owned.

  31. Catalyst Medication Synchronization 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.

  32. 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 Institutehttp://www.nehi.net/news/press_releases/110/nehi_research_shows_patient_medication_nonadherence_costs_health_care_system_290_billion_annually

  33. Medication Synchronization • 32 million Americans take 3+ medications daily. • Almost 29% of Americans stop taking their medicine before it runs out. • 30% of Americans don't pick up their filled prescriptions.

  34. 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

  35. Medication Synchronization U.S. Surgeon General, 1982 -1989

  36. Medication Synchronization 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.

  37. Medication Synchronization 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

  38. Medication Synchronization • Increases focus on consultations with patients to improve health outcomes. • Syncing patient medications helps all parties involved. • 27,000+ patients enrolled. • Patient • Health Plans • Physicians • Pharmaceutical Companies • Pharmacies

  39. Medication Synchronization

  40. Medication Synchronization Patient Care Center • Monthly touch points with patients enrolled in Med Sync • Monitoring lapses in therapy • Discharge counseling • Comprehensive Medication Reviews/Medication Therapy Management

  41. Medication Synchronization 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

  42. 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

  43. Medication Synchronization Packaging Solutions • HealthyPackRxTM • 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.

  44. Medication Synchronization Industry Adherence Data Source: IMS Health Adherence Data; Various sources; AT Kearney analysis

  45. Medication Synchronization 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: • Compared Proportion of Days Covered (PDC) and Persistence Rates. • ACEIs/ARBs Beta blockers Metformin Thiazide diuretics Calcium channel blockers Statins Source: Virginia Commonwealth University – ABM Study

  46. Medication Synchronization Thrifty White/VCU Study with comparison to CMS Star Thresholds 5 Star 4 Star Cholesterol Blood Pressure Diabetes

  47. Medication Synchronization 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

  48. Medication Synchronization Industry Adherence Data Adherence among chronic disease patients can lead to significant health care savings. • Annual savings for adherent patients: • Congestive Heart Failure $7,823 • Diabetes $3,756 • Hypertension $3,908 • High Cholesterol $1,258

  49. 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

  50. Medication Synchronization Decrease Overall Spend Source: Optum “Medication Adherence: Rx for Success” White Paper

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