Many PACE participants have multiple disease states that require numerous medications. This leads to complex medication regimens consisting of multiple medications—what we in the industry refer to as polypharmacy. Without oversight, polypharmacy in seniors can be a significant problem, as taking multiple medications at one time increases the risk for adverse reactions. That’s why Medication Regimen Reviews (MRRs), provided by consultant pharmacists, are essential when administering medications to those in the PACE population. These reviews help prevent drug interactions and promote medication adherence among PACE participants.
Polypharmacy in PACE Participants Impacts Medication AdherenceWhen PACE participants take multiple medications, it’s not uncommon for medication adherence to decline. It can be difficult for anyone to keep up with numerous medications and instructions. Additionally, packaging that’s difficult to read, understand, or open for seniors can also lead to a lack of medication adherence. Regardless of why seniors fail to adhere to their medication regimens, the fact remains that with an increased number of medications comes an increased number of side effects, the potential for duplicate therapies, and the possibility of drug-drug interactions. Grane Rx partners with PACE centers to provide clinical consults, in which a specialty pharmacist reviews participant medications on a routine basis. These pharmacy consults serve two important purposes: promoting positive outcomes for PACE participants while helping PACE centers contain costs and make efficient decisions. Let’s take a look at the role of pharmacy consults—specifically, regular MRRs—in limiting polypharmacy in participants.
Polypharmacy in PACE Participants and the Role of Medication Regimen ReviewsA thorough MRR is necessary not only when participants are accepted but also throughout the duration of their medication therapy. In a nutshell, these reviews are one of the most important steps that PACE centers can take to help eliminate unnecessary medications, and ultimately, the incidence of adverse reactions. It’s important to determine why a participant is using a particular medication and to match each medication to an appropriate diagnosis. Often, medications are associated with one of three types of diagnoses:
- a general diagnosis
- no diagnosis
- a diagnosis that is not an FDA-approved indication
Medication Regimen Reviews: Best Practices That Limit Polypharmacy in PACE ParticipantsMRRs are a major point of concern in recent years surrounding medication management in seniors. As part of CMS’ new Final Rule, for example, a major focus will now be on preventing or minimizing adverse consequences in skilled nursing residents related to medication therapy. While the new regulations don’t apply to PACE pharmacies, they can still apply the following best practices to help reduce the incidence of polypharmacy and adverse medication-related reactions in participants:
- Having a licensed pharmacist review each participant’s medication regimen at least once a month—The consultant pharmacist’s review will include a review of the participant’s complete medical record/chart.
- Reviewing participant’s regimens more frequently, depending upon his or her condition and the risks or adverse consequences related to current medication(s)—A consultant pharmacist will review the medication regimen of a participant upon request by any member of an interdisciplinary care team, based upon a change in care status and/or the presence of an adverse consequence.
- Identifying and reporting irregularities to the participant’s prescribing physician—The consultant pharmacist will identify irregularities through a variety of resources and review specific information using any medical information available for the participant.
- Providing proof of action taken in response to the irregularities identified—Physicians may either accept and act upon the suggestions, or reject the suggestions and provide an explanation for disagreeing. All recommendations must be reviewed and responded to.