Utilization management is a common pain point in PACE (Program of All-Inclusive Care for the Elderly). In older adults with chronic conditions, a key cause of unintended healthcare utilization is medication-related problems, which are prevalent with polypharmacy.
According to the Lown Institute, close to 20 percent of older adults (65 and up) take 10 or more medications. This puts them at greater risk for adverse drug events that could lead to falls resulting in ER visits and hospitalizations. The CDC reports that there are about 3 million ER visits each year due to falls among older adults and 1 million fall-related hospitalizations.
Among medications that can increase risk of falls are anti-hypertensive medications, prescriptions used to treat overactive bladder, and opioids. These are common among older adults with chronic conditions.
Leveraging polypharmacy calls with clinical pharmacists is key to reducing medication-related risk in PACE. By participating in and optimizing these calls, PACE organizations can help improve health outcomes for participants, decreasing unintended facility utilization and reducing total cost of care.
What Happens During Polypharmacy Calls?
On polypharmacy calls, pharmacists and healthcare providers review medication regimens and discuss how to lower risk. Each call typically reviews medication profiles for 3 to 5 participants. Common topics include disease state management, adverse effects, dosing, and profile maintenance.
- Disease state management. On polypharmacy calls, pharmacists and providers evaluate how symptoms for health conditions are managed and consider potential changes, as needed.
- Adverse effects. If a participant is not taking a medication as prescribed due to adverse effects, the call might explore if adjusting the time of day the participant takes the medication or choosing an alternate med could help. This in turn can improve medication adherence.
- Dosing. Lab results help determine whether a medication’s dose needs to be adjusted. For example, labs can indicate if a dose is too high based on a participant’s renal function. Blood levels can also help monitor adherence and potential toxicity for medications with a narrow therapeutic window, like some antiepileptics.
- Profile maintenance. When a participant stops taking a medication or a therapy is completed, it’s important for this to be documented in their EHR and on their EireneRx profile. Otherwise, that medication will continue to be factored into the participant’s medication risk score and pharmacist recommendations. Polypharmacy calls provide an opportunity to ensure pharmacists and providers have the most up-to-date information. This maintenance also makes profiles easier for providers to navigate moving forward.
After polypharmacy calls, pharmacists prepare summaries for providers. If medication changes need to be made, they might be handled by the pharmacist or provider, depending on the next steps agreed upon during the call.
Polypharmacy Review Considerations
Depending on the size of the PACE program, calls might be monthly or twice monthly and are generally scheduled for 30 minutes to an hour depending on their frequency. Some programs choose to include multiple providers on a call, while others break down calls per provider.
Prior to calls, providers should review any pharmacy notes they receive outlining what will be discussed on the call and questions to address. When providers review these notes in advance, it generally makes for a more successful call.
Another way to optimize polypharmacy calls is for providers to have their EHR open and available during the call. This way, if needed, they can provide lab results or other updated information pharmacists might not have access to.
Participating in and optimizing polypharmacy calls is key to reducing risk of adverse drug events. In a study of nearly 2,000 PACE participants, the odds of an adverse drug event increased by 8.6% per medication risk score unit. And each unit was valued at $1,037 in medical costs, including 3 ER visits and 2 hospitalizations per 100 participants per year. In reducing medication-related risk and unintended facility utilization, PACE programs support the best interest of participants—and they can help lower total cost of care.
