Taking medication is not without risks, especially for the elderly. Drug interactions can have unexpected and unintended effects. Side effects can lead to complications. Directions can be misunderstood. The recommended dosage can require adjustments. The list goes on and on.
Traditionally, doctors and other medical professionals had close interaction with the elderly patients whom they treated in assisted living or rehabilitation facilities. They were readily available for fielding questions and could quickly address issues related to prescription medications.
Today, however, medical models are changing. Many elderly patients are turning to the “aging in place” concept of medical care. This model empowers those with chronic medical conditions to receive appropriate care in their homes rather than at an assisted living or rehabilitation facility.
The aging-in-place model offers a host of benefits, including better affordability and the ability for patients to stay more connected to their social circles. However, it also creates a distance between patients and their doctors that is much greater than they experience in care facilities. Because of this distance, patients have less available guidance from doctors when it comes to managing their medication.
Supporting aging-in-place with medication-at-home
To fill the gap created by the aging-in-place model, the world of healthcare is turning to an innovative method of medication management that is referred to as “medication-at-home.” This new model for patient care looks to pharmacists to provide an enhanced level of care for their patients. It looks to the clinical expertise that pharmacists bring to the care continuum as a key resource for patients who are looking to use medication safely and effectively while aging-in-place.
Appreciating the important role that pharmacists play in this new health landscape requires understanding how often pharmaceuticals are prescribed to the elderly. In 2010, studies showed that 87 percent of US adults 65 years-of-age or older used at least one prescription medication. By 2019, that number had grown to 89 percent. Elderly patients who do not use prescription drugs have come to be the rare exception.
It should also be noted that aging in place may soon be a necessity rather than an option. The aging population in the US is leading to what some are calling an assisted living crisis. Those in the 65 and older category comprise approximately 46 million Americans today. By 2050, that demographic is expected to nearly double. As the number in need of care continues to increase, finding space in assisted living facilities may prove to be an overwhelming challenge, leaving home care as the only available option.
Providing expert medication oversight
For those experiencing aging-in-place, the medication oversight that the medication-at-home model provides is essential. Polypharmacy, which is the term used to describe the use of multiple medications, is a reality for most elderly receiving medical care. Figures on polypharmacy show that among those 65 or older, an estimated 44 percent of men and 57 percent of women take five or more medications.
Pharmacists have the expertise that is necessary to provide medication reconciliation for those who are taking multiple prescription medications. This process involves pharmacists reviewing the entire listing of medications that a patient is taking to determine overlaps or possible adverse reactions that may result from combinations of drugs.
In an assisted living setting, doctors would have access to the full slate of medications that patients were using. With aging-in-place, patients may receive prescriptions from a variety of doctors, including their primary care physician and other specialists. Pharmacists may be the only ones who have the complete picture of the medications that aging-in-place patients are taking.
Pharmacists are also uniquely positioned to provide essential guidance to patients as they begin with new medications, such as those that might be prescribed after a hospital visit. Studies show that 20 percent of hospital readmissions are medication-related. Among those, 70 percent were considered preventable. When pharmacists step in to assess how new medications might interact with what a patient is already taking, as well as to provide clarity on the proper procedure for taking new medications, unnecessary hospitalizations can be avoided.
Medication reconciliation is an ongoing part of the medication-at-home process. It begins during the onboarding process and is assessed on an ongoing basis. Rather than simply filling and billing prescriptions without oversight, medication-at-home elevates the process to the level of clinical pharmacy care. As a result, aging-in-place patients receive the same attention to detail that they would receive from caregivers at an assisted living or rehabilitation facility.
Supporting healthy adherence
To experience the full benefits of their prescriptions, patients must adhere to the prescription guidelines. If they fail to take the right dose at the right time under the right conditions, the medical benefits of the medication can fail to be realized. Lack of adherence is thought to be one of the biggest risks for patients who are taking medications in an aging-in-place setting.
The medication-at-home model can provide significant adherence support to patients. One solution it provides is medications that are synchronized to one fill day and cycled into a continual fill date. This takes the confusion that can result from refills off of patients and the caregivers who support them. By packaging medications in date and time stamped pouches, patients have a much easier time of adhering to their medication schedules.
In addition, the medication-at-home process also facilitates the same type of multi-dose medication packaging that is made available at onsite care facilities. This method, which is proven to increase success rates with medication adherence, places all of the medications that must be taken at the same time in the same packaging, removing the need for patients to institute their own organization methods.
To further support the medication process, pharmacists can coordinate delivery services that ensure patients have what they need when they need it. Throughout the entire process, the medication-at-home team stays in contact with the patient to provide coaching, counseling, and whatever other reassurances are needed.
Reducing healthcare costs
Finally, medication-at-home facilitates a solution that makes effective healthcare much more affordable for elderly patients. By 2028, out-of-pocket costs for facility care are expected to total more than $266 billion. Aging-in-place dramatically reduces those costs. By leaning on the historically underutilized expertise that pharmacists bring to the healthcare puzzle, medication-at-home makes aging-in-place and the benefits it brings to patients a viable healthcare solution.
– Lindsay Dymowski is President of Centennial Pharmacy Services, a leading medication-at-home pharmacy, and co-founder and principal of The Centennial Group, a pharmacy management company supporting community pharmacies and health systems. Combining her over 15 years of pharmacy experience with her entrepreneurial spirit, Lindsay knows exactly what drives successful pharmacies, launches collaborative provider programs, and gets the attention of payers – and it’s not dispensing medications. It’s how well you can support an organization’s goals to better health outcomes with patient-centric pharmacy care.
