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Urinary tract infections (UTIs) are one of the most common infections found in adults age 65 and older, including PACE participants. Unlike in younger adults, UTIs are often overlooked or mistaken for other conditions in seniors because older adults are less likely to present with typical symptoms. Because of this, it’s essential for PACE pharmacy providers and other members of the PACE center’s multidisciplinary team to know the symptoms associated with these infections, as well as how best to treat them. Let’s take a look at how UTIs uniquely affect seniors and how these infections can be effectively prevented and treated. [Tweet “#UTIs often present different symptoms in older adults than in younger adults.”]
Many providers are aware of some of the most tell-tale signs of a UTI, such as changes in urine color, scent, and frequency, pain or burning during urination, and a low-grade fever.
However, the elderly very often present with atypical symptoms, including:
Sometimes, these are the only symptoms that present in seniors, making it vital to keep an eye out for these sudden cognitive and behavioral changes.
There are a variety of risk factors that make older adults—including PACE participants— more susceptible to UTIs than other populations. These risk factors include decreased immune function, weakened bladder and pelvic floor muscle, and comorbidities such as diabetes, Parkinson’s disease, and dementia.
Because UTIs stem from a number of different causes and they come in multiple forms, treating these infections must be handled on an individual basis. UTI diagnoses are usually broken down into two variations:
Within each category, there is further differentiation, characterized by complicated and uncomplicated diseases. The most common form of UTI is uncomplicated cystitis, which may be characterized by the following:
It’s important to note that only female participants with no urologic abnormalities and no known kidney/bladder dysfunction or comorbidities can develop this type of UTI.
Complicated cystitis is characterized by the same symptoms as those of uncomplicated cystitis. However, complicated cystitis also includes additional criteria, such as having:
Similar to uncomplicated cystitis, gender plays a role in complicated cystitis: Whereas only females can get the former, only males can develop complicated cystitis.
For both UTI types, the first wave of antibiotic therapy, known as empiric therapy, can be provided based on symptoms alone. Empiric therapy aims to start fighting the infection and reduce the risk of further complications, and usually consists of broad-spectrum antibiotics, such as ciprofloxacin (Cipro®) and doxycycline (Vibramycin®, Adoxa®), that can fight against many different strains of bacteria. In addition to starting antibiotic therapy, a urine culture/analysis is often collected, providing more in-depth results to help guide treatment.
Antibiotic treatment of either two types depends on a variety of factors, including the severity of disease, previous history of infections, resistance rates in the local population, and kidney function, among others.
Pyelonephritis is a form of UTI that reaches the kidneys, causing inflammation in the region. Similar to cystitis, this diagnosis can be classified as either complicated or uncomplicated.
Uncomplicated pyelonephritis displays similar symptoms found in cystitis, but also presents:
The good news, though, is that other than these symptoms, the participant is generally healthy and can receive antibiotic treatment on an outpatient basis.
Complicated pyelonephritis, on the other hand, is extremely serious. In this case, the participant is hemodynamically unstable and immunosuppressed, has a form of anatomic abnormality or urologic dysfunction, and/or has a multiple-drug-resistant (MDR) strain of bacterial infection. Any participant falling into this criteria should be referred to the hospital immediately for evaluation and treatment.
Effectively treating a UTI entails eliminating the bacterial infection, providing supportive therapy to relieve pain and symptoms, and employing strategies to reduce recurrence of these infections.
For symptomatic relief of dysuria, phenazopyridine (Azo®, Pyridium®) can be given to residents without renal impairment. Moreover, non-pharmacologic treatment options—such as proper hydration, timed voiding, and heat-pad therapy—can help relieve symptoms and discomfort.
Preventive options to reduce recurrence of UTIs involve employing pharmacologic options, such as taking lactobacillus probiotics (Florajen 3®), maintaining hydration, and treating underlying diseases, like BPH or low estrogen levels in indicated participants.
While antibiotic therapy is used to treat UTIs, antibiotics generally aren’t chosen for preventive therapy, unless specific criteria is met.
If, for example, a participant is diagnosed with three or more UTIs within a year and proper non-pharmacologic steps have been unsuccessful, the participant may be a candidate for continuous, low-dose antibiotic preventive therapy. It’s important to note, though, that, if this care path is chosen, the participant must be monitored for potential side effects, prevention of symptoms, and necessity of antibiotic therapy.
Finally, once a PACE participant completes antibiotic therapy for a UTI infection, a follow-up urine culture is generally not recommended. A follow-up is only necessary if the participant complains of recurrence of symptoms, at which point an alternative antibiotic therapy and urine culture can be provided.
By taking preventive measures and properly following treatment guidelines, we can work to reduce the recurrence and symptoms of UTIs in PACE participants, and, ultimately, decrease the number of antibiotics prescribed and improve health outcomes in our participants.
Seniors, including PACE participants, have unique and specialized needs. Our Grane Rx team of geriatric-specialized pharmacists understands those challenges and works with PACE centers to overcome them. Partner with us today by calling (412) 449-0504 or emailing email@example.com.
In PACE pharmacy, medications are typically dispensed to participants in monthly increments that are either picked up at the PACE center or delivered to the home. But what happens when a participant’s medication regimen needs to change in the middle of a cycle? Because PACE participants usually take multiple medications for a variety of medical conditions, it isn’t uncommon for physicians to switch out a medication or change its dosing. It also isn’t a problem. We’ve created a seamless process designed to handle medication regimen changes when they occur—without compromising participant safety or health. Read on to learn more. Let’s first take a look at the “why” behind our packaging. Medication nonadherence is a significant problem among the senior population and is especially critical for PACE participants. With this in mind, Grane Rx uses innovative packaging called SimplePacks when dispensing PACE pharmacy medications. This packaging is just one part of the overall Grane Rx PACE Pharmacy Solution, which is designed specifically with seniors in mind—featuring clear, understandable information about medications to encourage adherence. Each month, participant’s medications are packaged together inside two color-coded boxes: one for everyday medications and one for medications that are taken as necessary. Within those boxes, medications are packaged in SimplePacks, which are easily opened perforated packs of medications taken at the same time of day, whether morning, noon, evening or at night. This unique PACE pharmacy solution offers a much better medication management system than the bingo cards typically used by long term care pharmacy and other PACE pharmacy providers. The very thing that makes our packaging unique and innovative—our SimplePacks perforated pill packs—can seem like it would be tricky when medication changes are needed. But actually, that isn’t the case. [Tweet “A simple #PACEpharmacy process can make medication changes seamless”]
By Jennifer Devinney, RPh, PharmD Polypharmacy is an often silent, but very serious, problem in PACE pharmacy today. It is defined as the administration of more medication than is clinically indicated, which represents unnecessary medication use. Thorough PACE medication management is key to limiting polypharmacy. Polypharmacy is especially prevalent in elder care where it has been estimated that approximately a quarter of patients are prescribed nine or more medications, with some studies showing much higher percentages of patients exceeding five, nine or ten medications.
When compared with long term care pharmacy, PACE pharmacy presents its own unique set of challenges. Because participants are in the home environment rather than in a long term care setting with clinicians on hand, questions, concerns and needs may arise at any hour of the day. That’s why around-the-clock PACE pharmacy staffing is vital. Having PACE pharmacy providers available 24 hours a day, seven days a week means that there’s always a geriatric pharmacy expert on hand who can help PACE center staff meet participant needs. This allows for a smoother process for PACE medication management. So what are the distinct advantages of having around-the-clock PACE pharmacy staffing for your PACE center? There are three main benefits.
When you’re switching to a new pharmacy services provider, you want the transition to be seamless, so that staff and residents alike experience little or no negative impact. In choosing a new pharmacy services provider, it’s important to consider multiple factors, including the depth and thoroughness of a provider’s transition plan.
Grane Rx understands the importance of getting started on the right foot. When we partner with a new Skilled Nursing Facility or PACE program, we rely on a tried-and-true formula with several key components to pave the way toward a seamless transition.
The first step in the Grane Rx transition process is, quite simply, to thoroughly explain the process. In a kick-off meeting, our team meets with the center’s team to review the transition plan in detail and clarify any areas of concern or questions.
During this meeting, our teams also work together to establish a communication plan and schedule for the transition itself.
The second phase of the process includes a look at the current status of pharmacy services at the SNF or PACE program. During this stage, the Grane Rx team develops a gap analysis, comparing actual performance with desired performance.
This analysis helps us formulate a framework for pharmacy services moving forward, one that makes the best use of capabilities and cultivates optimal performance.
[Tweet “A strong transition plan for #pharmacyservices can help you get started on the right foot”]
Pharmacy orders play an integral role in the everyday functionality of pharmacy services, and our goal is to make placing them simple for your team. In order to do this, our electronic health record adapts to integrate with the EHR already in place in your center. This allows data to transfer in real time from your center to our pharmacy.
During this phase, our IT team tests the functionality of EHR data integration to ensure the kinks are worked out before services go live and then configures the pharmacy information system.
Following this step, we begin to work with the center’s personnel to review processes and formulate implementation plans, which will include comprehensive, interdisciplinary training. As we begin the final stages of preparation, our team will also review final processes.
When pharmacy services go live, the Grane Rx pharmacy team will be onsite to ensure a smooth transition. This continues past the initial days—during the first 90 days after going live, key members of the Grane Rx team remain onsite to work with staff.
In addition to working with staff members to ensure things start on the right foot, our team also meets one-on-one with residents or PACE participants. These meetings give residents the opportunity to gain familiarity and comfort with the expertise of our team.
Interested in learning more about the pharmacy services Grane Rx can provide for your Skilled Nursing Facility or PACE program? Call (866) 244-MEDS (6337) or reach out to us here.]]>
In recent years, the older population and their caregivers have increasingly turned to long term care programs that allow them to age within their own communities, such as PACE centers. When evaluating options, potential participants consider a number of categories, including pharmacy services. So what are participants and their families seeking in a PACE pharmacy? Read on for a look at three criteria they’re evaluating:
Nursing Home Pharmacy Services Improve Med Adherence Medication adherence means taking the right dose of the right medication at the right time—always. Patients are at risk of problems if they:
PACE pharmacy solutions are SIMPLE when they:
Participants with complex medical needs have complex medication regimens. They need to know how much medication to take, how often to take it, why they take it, when to take it, and any special instructions for taking it. Any steps providers can take to streamline and simplify medication regimens go a long way toward improving adherence.
Grane Rx addresses this issue with its prepackaged SimplePacks. Pharmacy packaging is critical to the success of your participants and our SimplePacks make all medications accessible together (when medically possible), reducing the risk that clients will take too much or too little.
Information helps participants understand what they are taking and why they are taking medication. Clear information also makes med passing easier and safer. Clear labeling, like Grane Rx’s with names and dosage clearly printed on the outside of pre-packaged doses, is a critical vehicle for imparting knowledge.
Allowing people to make decisions about routines, including when to take medication, is part of a client-centered organization and can help improve medication adherence. Shifting from set med pass times is enhanced by Grane Rx’s use of the Universal Medication Schedule allows for greater flexibility.
At each step of the process, Grane Rx builds communication and trust. Certified Geriatric pharmacists provide summaries for each resident to help avoid drug interactions. This information is paired with prepackaged daily dosages. These SimplePacks go through 12 security checkpoints before they are ready for delivery to individuals. This process reduces medication errors and builds trust in the system.
[Tweet “Grane Rx PACE #pharmacy solutions keep adherence SIMPLE”]
Cultural and language barriers can also inhibit medication adherence. Patient education is critical. Providers must make sure participants understand their medications and that all barriers to taking it correctly are addressed. Our simplified packaging and labeling help reinforce patient education. Participants can get visual cues about medication appearance in addition to written information.
Are PACE pharmacy solutions actually working? It’s important to evaluate for medication adherence. This starts with asking directly if people have been taking their medication as they are supposed to be.
Questions may be direct and more specific—are you taking your medication every day? Do you take all of it? If non-adherence is indicated or suspected, it is critical to get at the root of the issue quickly. Is there confusion about the dosage, side effects? Financial concerns? Does the person understand why they are taking the medication and what will happen if they don’t? Is there mistrust that needs to be overcome?
The answers to these questions may require a review of some of the other SIMPLE steps, such as good communication, providing information, or building trust.
Medication adherence at-home is challenging but essential for the health of participants and the bottomline. Grane Rx understands how critical the right PACE pharmacy solutions are to meeting the challenge; that’s why we’re a leader in technological advances to improve outcomes.]]>
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