Medication Management: Pharmacist a Must for Homecare

Article excerpt

Federal regulations governing nursing homes &quire that a pharmacist routinely review the medications taken by all residents in order to identify and correct common medication problems that, especially among older people, can jeopardize health and sometimes lead to death. If that same patient receives care at home from a home healthcare agency, no such pharmacist review is required. The result can be tragic.

Medication-related,problems are so widespread, say public health experts, that if they were classified as a distinct disease, they would rank as the fifth leading cause of death in the United States. Older adults are especially vulnerable to adverse medication events because of biological changes associated with aging and disease, coupled with their heavy use of prescription and over-the-counter (OTC) medications.


On average, older Americans take four-and-a-half prescription medications, plus another two OTC drugs, according to Mark H. Beers, editor in chief of the Merck Manuals (Generations, Winter 2000-2001). Even though all of these medications may be medically appropriate, the chance of an adverse reaction increases with the number of drugs consumed. Advanced age also has been implicated as a risk factor for adverse medication effects, with the incidence of side effects rising after age So and jumping after age 70. It has been said that any symptom in an elderly patient should be considered a drug side effect until proven otherwise.

Only a few years ago, medicationrelated problems were widely called a "silent epidemic." Since then, research documenting the scope of the problem has focused on solutions, and today a comprehensive pharmacist's review of medications is routinely provided for hospital and nursing home inpatients. However, community-dwelling elders remain vulnerable, and recent studies show there is ample cause for concern.

The federal Agency for Healthcare Research and Quality reported earlier this year that about one-fifth of the 32 million older Americans who were living in the community (not in nursing institutions) in 1996 used one or more of 33 prescription medicines considered potentially inappropriate for them, and nearly a million older adults used at least one of i i medications that experts say should always be avoided in older individuals. Researchers at Vanderbilt University (Journal of the American Geriatrics Society, June 2001) corroborated previous results. They found that as many as 30% of a sample of more than 6,700 elderly home healthcare patients had at least one possible medication error, such as use of an unnecessary drug or a drug for which the risks outweigh the benefits for particular patients.


Federal regulations have tried to address medication-related problems in the home-health population. When the U.S. Health Care Financing Administration, now the Center for Medicare and Medicaid Services (CMS), implemented the prospective payment system (PPS) for home-health providers in 2000, it also instituted new federal regulatory requirements to govern the system reform. Among these regulatory changes were new requirements designed to prevent adverse drug events. Under the revised Conditions of Participation-the set of requirements facilities must meet to receive Medicare payments-federal regulations now require home-health agencies to regularly monitor medications as part of a standardized patient assessment and to transmit this data to the state entity that oversees home healthcare, which in turn transmits it to CMS. Patient assessment data is analyzed and reported back to agencies as clinical outcome measures.

In addition, CMS now publishes an adverse-event outcome report for each of the nation's home-health agencies, based on its analysis of patient data. Among other outcomes, these reports cite the incidence of emergency care for improper medication administration and medication side effects. …