Academic journal article Frontiers of Health Services Management

Come Together, Right Now

Academic journal article Frontiers of Health Services Management

Come Together, Right Now

Article excerpt

A RECENT SUMMARY of the evidence on errors in communication and information transfer between hospitals and primary care physicians found that quality of care was affected in up to 25 percent of cases.1 The authors of the feature articles suggest that quality problems during transfers could be reduced with interventions such as computer-generated summaries and standardized formats, because these would facilitate more timely transfer of pertinent patient information to primary care physicians and make discharge summaries more consistently available during follow-up care. But this is only a small piece of the transitional care puzzle.

HOSPITAL DISCHARGE

The article by Chugh and colleagues focuses on comprehension of discharge information among individuals with limited health literacy and impaired cognitive function. The authors walk the reader through the important questions regarding these vulnerable populations, while providing evidence along the way. Medication-related problems are a common theme throughout the discussion.

A recently published study sheds further light on the relationship between cognitive function and the ability to manage medications. Dr. Anderson and colleagues conducted a pilot study of cognitive screens to predict a patient's accuracy in filling a pillbox, a surrogate for understanding how to take medications.2 As noted by Chugh et al., the Mini-Cog and the Folstein Mini Mental State Examination (MMSE) are among the preferred tools to screen for impaired cognitive function. Dr. Andersoris study incorporated two additional components specifically addressing medication management concerns with cognitive impairment:

1. the medication transfer screen (MTS), a skills screen developed specifically for the study, which assessed an individual's ability to accurately fill a pillbox, and

2. the Medi-Cog, a combination of the MTS and the Mini-Cog.

In a predominately elderly Veterans Affairs Medical Center population, they found that the MMSE was a poor predictor of the ability to fill a pillbox. On the other hand, the Mini-Cog and MTS correlated well and detected quite accurately who might not be able to manage their medications at home. This study represents just one example of the continuing efforts to address this issue.

Another underutilized service to help address health literacy, cognitive impairment, and medication management concerns is medication therapy management (MTM) services. As a component of the Medicare Modernization Act of 2003 and Medicare Part D, Medicare beneficiaries are eligible to receive a comprehensive medication review (that is, MTM services). The Centers for Medicare & Medicaid Services (CMS) defines eligible beneficiaries as those enrolled in an approved Part D plan who have multiple chronic diseases and are taking multiple Part D drugs that are likely to have costs exceeding $4,000 per year.3 Recent evidence estimates that about one in ten Medicare beneficiaries, about 3.3 million people, meet the drug expenditure threshold for MTM services.4

Unfortunately, MTM is controlled by the prescription drug plans, making access highly variable. The combined poor participation in the MTM programs and the lack of published MTM service outcomes is likely hampering more widespread use of the benefit.5 Healthcare executives and providers can push for more access to this service.

The article by Chugh and colleagues includes a discussion on interventions for low health literacy. An area where we as healthcare providers often fall short in communicating with our patients, particularly those with low health literacy, is in the area of risk. Poor understanding of the risks and benefits of treatment increases the likelihood patients will not participate fully in their care.* Appropriate, literacycentric risk communication can be something we all strive to incorporate into our practices.

READMISSIONS

The article by Bisognano and Boutwell focuses on the issue of hospital readmission. …

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