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 Adherence
When 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 Reviews
A 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
In these cases, clinical judgment should be utilized to determine whether the off-label use is appropriately supported based upon the participant’s medical history and if the benefits of therapy outweigh the risks of adverse effects.
Another important practice for preventing polypharmacy is optimizing medication regimens when more than one agent is being used to treat a condition. A common example of this is the use of multiple agents to manage hypertension in participants. It’s not uncommon to see as many as four or five antihypertensive medications ordered for the same participant.
One of the fundamental guidelines in treating a disease state that may require more than one medication is to start with one medication and maximize the dose until either the maximum recommended dose is reached or the maximum dose without adverse effects is reached. Once the maximum dose has been reached, an additional agent can be used and titrated if better control is needed.
PACE participants on multiple medications at suboptimal doses should have their regimen evaluated and, if clinically acceptable, have a medication discontinued while adjusting the doses of the other medications.
Medication Regimen Reviews: Best Practices That Limit Polypharmacy in PACE Participants
MRRs 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.
Acute status change reviews can be requested by completing and faxing the Medication Regimen Review Request Form to the pharmacy. Results of the review will be provided to the patient’s facility within three business days of the request.
- 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.
Any irregularities and/or clinically significant risks from medications will be documented in the participant’s medical record and recommendations related to the irregularity will be made to his or her physician.
In addition, a separate report detailing all irregularities identified during the consultant pharmacist’s reviews for the month will be provided to the participant’s prescribing physician each month.
- 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.
While polypharmacy in seniors itself isn’t a problem, the inherent risks are. That’s why it’s essential to review medication regimens to ensure participants are properly managing and taking their prescriptions.
Want to learn more about the impact Grane Rx PACE pharmacy services can have on your PACE center? Start the conversation by calling (412) 449-0504 or emailing firstname.lastname@example.org.
Jennifer Devinney is the Chief Clinical Officer for Grane Rx. In this role, she works with clinical pharmacists and nurses in conjunction with facility staff to develop and oversee clinical initiatives. Additionally, she is the clinical EHR integration specialist.
Categories: Clinical Care Advantage