Approximately 1 in 10 hospital admissions of seniors is related to medication non-adherence and while a multitude of factors contribute to hospitalizations and readmission, improved medication management can help to reduce them. While the issue of non-adherence spans age groups, managing medications can be particularly challenging for those 65 and over. Seniors take more prescription and over the counter medications than any other age group, as they have more chronic conditions. Over half of the individuals in this age group take at least three prescription medications. Approximately one-third take eight or more medications (prescriptions, non-prescriptions, and/or supplements).
For seniors with complex medication regimens and trouble remembering to take medications, self-management or simple pillboxes frequently do not suffice. In fact, in an independent pilot study, researchers found that the group using a pillbox averaged 30% missed doses per month versus less than 3% in the automated dispenser with voice-activated message group. In addition, while those who self-administered had no change in physician visits and a significant increase in number of hospitalizations over the course of the six month study, the automated dispenser group had a decrease in physician visits and in number of hospitalizations.
Being able to successfully improve compliance rates requires a detailed understanding of the causes of non-compliance, and a focused operational and clinical strategy to address each of those root causes. The Henry Ford Health System has employed a multidisciplinary model involving Home Health Care nurse case managers, telehealth nurses, ambulatory case managers, nurse practitioners, pharmacists, physicians and occupational therapists in a collaborative, system wide approach to solving the problem of medication non adherence. Creative solutions have also been implemented to address reimbursement which has allowed the hospital to offer this option to an increasing number of seniors at risk for and with a history of medication mismanagement. To date, Henry Ford has managed over 230 patients using telehealth medication dispensers, and has achieved a 96% compliance rate in this high-risk population.
New avenues to impact high risk populations utilizing telehealth medication dispensers are being explored every day. For example, patients with cognitive impairment have been identified as one of the highest risk populations at risk for readmission. Henry Ford Hospital estimates that there are 2500 patients discharged each year who suffer from cognitive impairment. Henry Ford Hospital plans to study this patient population to determine if medication dispensers can improve medication adherence and reduce readmission rates.
Mary Hagen, Associate Degree Nursing, e Home Care Supervisor; 313-874-3291; firstname.lastname@example.org