Wyoming Care Coordination Network Kickoff Event!
Who’s in the Room • What’s your name, and do you like it?
Get to Know Each Other • Which superpower would you like to have? Mind reading Invisibility Teleportation Flying I already have a superpower
Get to Know Each Other • Which organization are you representing? • Describe your role at your organization in five words or less.
Get to Know Each Other • Why did you decide to join this event today? Knowledge building Networking opportunities My boss made me
Wyoming Care Coordination Network Mountain-Pacific Quality Health
Mountain-Pacific Chronic Care Management (CCM) Support • Provide care coordinators with targeted educational tools and resources to distribute to patients Focus on 20 minute monthly interventions • Engage patients and empower them for long-term, continued program participation
Mountain-Pacific CCM Support • Disease-specific information Vaccines Nutrition Safety • Medication-safety tools Medication disposal Medication bags Pill planners Adherence and health literacy • Plus MORE
Calendar of Events • October 11 th : Kickoff! Polypharmacy and medication adherence Community resource discussion: patient safety in harsh weather • November 15 th : Nutrition The right diet for your health Community resource discussion: How to find fruits and vegetables in the winter • December 13 th : Stress and Loneliness in Winter Combating seasonal affective disorder and social isolation Community resource discussion: Community events to connect and socialize • January 10 th : Revisiting the Care Plan Incorporating patient goals and priorities in wellness Community resource discussion: How to keep moving in the winter
Mountain-Pacific CCM Support • What you can expect: Monthly newsletter • Timely tools and resources Monthly education event Community resource review Case studies and troubleshooting Resources from Mountain-Pacific
Mountain-Pacific CCM Support • What we are asking in return: Participate in live events • Encourage group learning Complete brief surveys following learning events Complete evaluations sent with tools and resources Share your knowledge and experiences Help guide our discussions and content
Medication Minute Polypharmacy and Medication Adherence
Patient Engagement and Chronic Care Management (CCM) • Interventions shown to increase patient engagement have one or more of the following focuses: Skill development Problem solving Peer support Changing the social environment Tailoring support to the person’s activation level What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs. JH Hibbard, J Greene. Health Affairs 2013 32:2, 207-214. Accessed from: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2012.1061
Polypharmacy • “ The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily ( n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines.” • What are the concerns with polypharmacy? Falls Adverse drug reactions Increased length of hospital stay Readmission Mortality What is polypharmacy? A systematic review of definitions. N Masnoon, S Shakib, L Kalisch-Ellett, GE Caughey. BMC Geriatr. 2017; 17: 230. Published online 2017 Oct 10. doi: 10.1186/s12877-017-0621-2
Polypharmacy • Appropriate or rationale polypharmacy Complex disease state management with many different desired therapeutic outcomes being achieved • Post myocardial infarction (MI) • Multiple disease states • Inappropriate polypharmacy Therapeutic duplications Adding therapy to address modifiable medication side effects Medication benefits do not outweigh the risks What is polypharmacy? A systematic review of definitions. N Masnoon, S Shakib, L Kalisch-Ellett, GE Caughey. BMC Geriatr. 2017; 17: 230. Published online 2017 Oct 10. doi: 10.1186/s12877-017-0621-2
Addressing Polypharmacy • Number of medications is just a starting point • Assess Indication of each medication Efficacy of each medication Potential for harm/drug interactions • Look beyond single disease management guidelines Consider all comorbidities and medications to focus on the patient as a whole and improving overall health • Build a relationship with the patient’s pharmacist What is polypharmacy? A systematic review of definitions. N Masnoon, S Shakib, L Kalisch-Ellett, GE Caughey. BMC Geriatr. 2017; 17: 230. Published online 2017 Oct 10. doi: 10.1186/s12877-017-0621-2
Polypharmacy and Chronic Care Management
Screening for Medication Events Look For: • Medication allergy • Sedation • GI distress • Weight gain • Depression • Fluid retention • New or worsening shortness of breath • Any other changes with new medication
Medication Event Reporting Who: Personnel Involved What: Details Why/How of the Event When: Time Where: Event Location of Occurred the Event
Root Cause Analysis Assess • Determine what is happening Diagnose • Determine WHY it is happening • Create a solution to prevent it from happening again Remedy
Pharmacist on Your Health Care Team • “Who is your pharmacist?” -or- “What pharmacy do you use?” • What services do the pharmacists offer at your local pharmacies? Immunizations Medication therapy management Comprehensive medication therapy management
Medication Adherence It’s a vital sign
Medication Adherence • Roughly one in five new prescriptions are never filled • Approximately half of all filled prescriptions are taken incorrectly Partner with Patients to Improve Med Adherence. Pharmacist Letter March 2018. Therapeutics Research Center.
How to Know if Adherence is a Problem • Identify patients: At risk for morbidity or mortality Taking high-cost medications Transitioning care settings • Examine prescription refill information Review for primary non-adherence ▪ Schedule follow-up calls Conversation Starter: Med Adherence Quick Guide. Pharmacist’s Letter. 2018 Therapeutics Research Center. Morisky Scale. Accessed from http://www.measureuppressuredown.com/hcprof/find/toolkit/plank4tool1.pdf
How to Know if Adherence is a Problem • Ask blame-free, open-ended questions: “It must be hard to take all your meds regularly. How often do you miss doses?” “Do you ever forget to take your medicine?” “When you feel better, do you sometimes stop taking your medicine?” “Sometimes, if you feel worse when you take your medicine, do you stop taking it?” Conversation Starter: Med Adherence Quick Guide. Pharmacist’s Letter. 2018 Therapeutics Research Center. Morisky Scale. Accessed from http://www.measureuppressuredown.com/hcprof/find/toolkit/plank4tool1.pdf
Optimize Therapy • What is the process in your organization for handling pharmacy phone calls? • What resources do you have access to in your electronic health record (EHR) for drug information? • How do you reconcile a patient’s medication list? How often do you do this? Who “owns” this in your facility?
Help Patients Remember • Minimize the number of medications and simplify the dosing regimen • Use technology Smartphone applications Text messaging ▪ OnTimeRx (http://www.ontimerx.com/reminders/services.html) ▪ RememberItNow (http://rememberitnow.com/index.php) Manufacturer provided adherence tools ▪ Pradaxa refill reminders (https://www.pradaxa.com/refill-reminders) ▪ Xarelto CarePath (https://www.xarelto-us.com/xarelto-patient- assistance/xarelto-carepath)
Help Patients Remember • Medication synchronization • Encourage 90 day fills • Pill boxes Variety to fit all needs Can incorporate technology • Adherence packaging
Address Physical Barriers • Do they have transportation? Can the pharmacy deliver? • Is the medication in stock/is the pharmacy open? • Does the patient have physical limitations? Autodrop or Magic Touch for eye drops Spacers for metered dose inhalers (MDI) Alternative device if unable to use correctly
Address Financial Barriers • Can you access the patient’s formulary? • What is the process for prior authorization in your facility? http://www.covermymeds.com • Have free or low-cost alternatives been considered? Do Medicare beneficiaries qualify for manufacturer patient assistance programs? • Can tablet-splitting be used to save money?
Communicate • Prescription reminders are sent electronically • Utilize the SIMPLE strategy S implify regimen I mpart knowledge M odify patient beliefs and human behavior P rovide communication and trust L eave the bias E valuate Adherence
Communicate • Avoid medical jargon • Listen, empathize, reassure and motivate • Assess understanding Teach-back method • Use visual aids • Help patients create an accurate medication list Encourage them to carry it!
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