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Doucette L, Kiely BT, Gierisch JM, Marion E, Nadler L, Heflin MT, Upchurch G. Participatory research to improve medication reconciliation for older adults in the community. J Am Geriatr Soc 2023; 71:620-631. [PMID: 36420635 PMCID: PMC9957786 DOI: 10.1111/jgs.18132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Medication reconciliation, a technique that assists in aligning a care team's understanding of an individual's true medication regimen, is vital to optimize medication use and prevent medication errors. Historically, most medication reconciliation research has focused on institutional settings and transitional care, with comparatively little attention given to medication reconciliation in community settings. To optimize medication reconciliation for community-dwelling older adults, healthcare professionals and older adults must be engaged in co-designing processes that create sustainable approaches. METHODS Academic researchers, older adults, and community- and health system-based healthcare professionals engaged in a participatory process to better understand medication reconciliation barriers and co-design solutions. The initiative consisted of two participatory research approaches: (1) Sparks Innovation Studios, which synthesized professional expertise and opinions, and (2) a Community Consultation Studio with older adults. Input from both groups informed a list of possible solutions and these were ranked based on evaluative criteria of feasibility, person-centeredness, equity, and sustainability. RESULTS Sparks Innovation Studios identified a lack of ownership, fragmented healthcare systems, and time constraints as the leading barriers to medication reconciliation. The Community Consultation Studio revealed that older adults often feel dismissed in medical encounters and perceive poor communication with and among providers. The Community Consultation Studio and Sparks Innovation Studios resulted in four highly-ranked solutions to improve medication reconciliation: (1) support for older adults to improve health literacy and ownership; (2) ensuring medication indications are included on prescription labels; (3) trainings and incentives for front-line staff in clinic settings to become champions for medication reconciliation; and (4) electronic health record improvements that simplify active medication lists. CONCLUSION Engaging community representatives with academic partners in the research process enhanced understanding of community priorities and provided a practical roadmap for innovations that have the potential to improve the well-being of community-dwelling older adults.
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Affiliation(s)
- Lorna Doucette
- Department of Maternal, Child and Family Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jennifer M. Gierisch
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care Center, Durham, NC
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Eve Marion
- Duke University School of Medicine, Durham, NC
- Duke Clinical and Translational Science Institute, Durham, NC
| | | | - Mitchell T Heflin
- Duke Health Center for Interprofessional Education and Care (IPEC), Duke University Schools of Nursing and Medicine, Durham, NC
- Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, North Carolina
| | - Gina Upchurch
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Senior PharmAssist, Durham, NC
- Department of Public Health Leadership, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Kanne GE, McConnell ES, Disco ME, Black MC, Upchurch G, Matters LM, Halpern DJ, White HK, Heflin MT. The interagency care team: A new model to integrate social and medical care for older adults in primary care. Geriatr Nurs 2023; 50:72-79. [PMID: 36641859 DOI: 10.1016/j.gerinurse.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 01/14/2023]
Abstract
To integrate management of social drivers of health with complex clinical needs of older adults, we connected patients aged 60 and above from primary care practices with a nurse practitioner (NP) led Interagency Care Team (ICT) of geriatrics providers and community partners via electronic consult. The NP conducted a geriatric assessment via telephone, then the team met to determine recommendations. Thirteen primary care practices referred 123 patients (median age = 76) who had high rates of emergency department use and hospitalization (28.9% and 17.4% respectively). Issues commonly identified included medication management (84%), personal safety (72%), disease management (69%), food insecurity (63%), and cognitive decline (53%). Referring providers expressed heightened awareness of older adults' social needs and high satisfaction with the program. The ICT is a scalable model of care that connects older adults with complex care needs to geriatrics expertise and community services through partnerships with primary care providers.
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Affiliation(s)
- Geraldine E Kanne
- Duke Population Health Management Office 3100 Tower Blvd Suite 1100, Durham, NC 27707, United States; Duke University Health System 2301 Erwin Rd, Durham, NC, 27710, United States.
| | - Eleanor S McConnell
- Duke School of Nursing 307 Trent Dr, Durham, NC 27710, United States; Geriatric Research, Education, and Clinical Center (GRECC) Department of Veterans Affairs Medical Center, Durham, NC 27705, United States
| | - Marilyn E Disco
- Senior PharmAssist, 406 Rigsbee Ave #201, Durham, NC, 27701, United States
| | - Melissa C Black
- Triangle J Council of Governments Area Agency on Aging 4307 Emperor Blvd, Durham, NC 27703, United States
| | - Gina Upchurch
- Senior PharmAssist, 406 Rigsbee Ave #201, Durham, NC, 27701, United States; Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, Department of Public Health Leadership, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, United States
| | - Loretta M Matters
- Duke University Health System 2301 Erwin Rd, Durham, NC, 27710, United States; Duke School of Nursing 307 Trent Dr, Durham, NC 27710, United States
| | - David J Halpern
- Duke Primary Care 411 West Chapel Hill St, Durham, NC 27701, United States
| | - Heidi K White
- Duke Population Health Management Office 3100 Tower Blvd Suite 1100, Durham, NC 27707, United States; Duke Aging Center 201 Trent Dr, Durham, NC 27710, United States
| | - Mitchell T Heflin
- Duke Aging Center 201 Trent Dr, Durham, NC 27710, United States; Duke Health Center for Inter-professional Education and Care, 311 Trent Dr, Durham, NC, 27710, United States
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Pickett B, Shin TR, Norton M. Utilizing clinical pharmacists and a medication assistance program to improve medication access for indigent and underserved patients in primary care. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 9:100211. [PMID: 36582998 PMCID: PMC9793302 DOI: 10.1016/j.rcsop.2022.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Background Medication Assistance Programs (MAP) provide needed medications to uninsured and underinsured patients. In 2019, 24% of adults had difficulty affording their medications. Literature has shown enrollment in MAP decreased emergency department (ED) visits, hospital admission, and total hospital cost. Objectives Primary objective described cost savings of MAP in patients identified by pharmacists. Secondary objectives included comparing rates one year before and after MAP utilization for hospitalization, ED visits, and combined hospitalization and ED visits. The purpose of the study was to evaluate the effect of pharmacists in improving medication access. Methods A retrospective observational cohort was conducted in primary care and family medicine resident clinics. Inclusion criteria included one or more visits with a pharmacist and MAP application between January 1, 2019 through December 31, 2019. The primary objective and demographics were analyzed using descriptive statistics. Secondary objectives were analyzed using paired t-test. Results In total, 18 patients saved $187,789, with an average of $10,432 per patient, for 35 medications. There were no statistically significant differences in average hospitalizations, ED visits, and combined hospitalizations and ED visits. Conclusions Pharmacists utilizing MAP resulted in cost savings and increased patient access to medications. The study did not find differences in hospital visits, ED visits, or combined hospital and ED visits.
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Affiliation(s)
- Brianna Pickett
- Brodstone Memorial Hospital/Cardinal Health Innovative Delivery Solutions, 520 E. 10th St. Superior, NE 68978, United States of America,University of Kansas-Wichita School of Pharmacy, 1010 N Kansas Bldg 92, Suite 2331, Wichita, KS 67214, United States of America,Ascension Via Christi Hospitals, 1100 N St. Francis, Suite 220, Wichita, KS 67214, United States of America,Corresponding author at: Brodstone Memorial Hospital/Cardinal Health Innovative Delivery Solutions, 520 E. 10th St. Superior, NE 68978, United States of America.
| | - Tiffany R. Shin
- University of Kansas-Wichita School of Pharmacy, 1010 N Kansas Bldg 92, Suite 2331, Wichita, KS 67214, United States of America
| | - Melissa Norton
- Ascension Via Christi Hospitals, 1100 N St. Francis, Suite 220, Wichita, KS 67214, United States of America
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Cooper JB, Scotti A, Carr ML. Implementing medicare education for medication access: A review of the literature using the RE-AIM framework. Res Social Adm Pharm 2022; 19:16-27. [DOI: 10.1016/j.sapharm.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/24/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022]
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Mah J, Rockwood K, Stevens S, Keefe J, Andrew MK. Do Interventions Reducing Social Vulnerability Improve Health in Community Dwelling Older Adults? A Systematic Review. Clin Interv Aging 2022; 17:447-465. [PMID: 35431543 PMCID: PMC9012306 DOI: 10.2147/cia.s349836] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Social vulnerability occurs when individuals have been relatively disadvantaged by the social determinants of health. Complex interventions that reduce social vulnerability have the potential to improve health in older adults but robust evidence is lacking. Objective To identify, appraise and synthesize evidence on the effectiveness of complex interventions targeting reduction in social vulnerability for improving health related outcomes (mortality, function, cognition, subjective health and healthcare use) in older adults living in the community. Methods A mixed methods systematic review was conducted. Five databases and targeted grey literature were searched for primary studies of all study types according to predetermined criteria. Data were extracted from each distinct intervention and quality was assessed using the Mixed Methods Appraisal Tool. Effectiveness data were synthesized using vote counting by direction of effect, combining p values and Albatross plots. Results Across 38 included studies, there were 34 distinct interventions categorized as strengthening social supports and communities, helping older adults and their caregivers navigate health and social services, enhancing neighbourhood and built environments, promoting education and providing economic stability. There was evidence to support positive influences on function, cognition, subjective health, and reduced hospital utilization. The evidence was mixed for non-hospital healthcare utilization and insufficient to determine effect on mortality. Conclusion Despite high heterogeneity and varying quality of studies, attention to reducing an older adult's social vulnerability assists in improving older adults' health.
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Affiliation(s)
- Jasmine Mah
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Susan Stevens
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Janice Keefe
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Melissa K Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
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