Pharmacist Medication Management Reduces LTC Admissions
Guttman, Cheryl K, Drug Topics
A study demonstrating the benefit of a medication management system in reducing nursing home admission rates in a frail elderly population provides strong evidence that pharmacists can play an important role in improving health outcomes and suggests a model for delivering value-added services, according to its lead author, Richard Schulz, PhD. The study was recently published in the American Journal of Geriatric Pharmacology.
The medication management system investigated in the prospective cohort study had 2 components.
Prescription medications for 1 group of patients were dispensed through their local pharmacy using a calendar card system (Medicine-On-Time, Hunt Valley, Md,), As medication management issues arose, the other group of patients received assistance from a health educator. Study participants were clients in a state Medicaid home- and community-based waiver program who chose to receive services in the community despite their eligibility for nursing-home care.
The outcome of nursing-home admissions was compared in an intervention group that included 273 clients who received the medication management service and a standard-care control group of 800 persons matched by age, race, sex, and start date in the Medicaid waiver program; the second group received medications in traditional prescription vials without the services of a medication coordinator.
Mean duration of participation in the study was about 9 months for the intervention group and 8 months for the controls. During that time, there were 6 (2,2%) nursing-home admissions among the participants receiving medication management services and 40 (5,0%) in the control group. Results of a logistic regression analysis adjusting for numerous variables that could affect nursing home admission showed the intervention independently predicted nursing-home admission, with the intervention group being 66% less likely than the controls to be admitted to a nursing home. During the 120 days after discontinuation of the medication management system, the nursing-home admission rate was 5,9% in both groups, providing further evidence that the intervention was effective.
Schulz, a professor at South Carolina College of Pharmacy, Columbia, told Drug Topics, "Medication management in this study involved the calendar card system as well as the service coordinator. …