About 28 percent of elderly patients were found to be at risk for harmful medication interactions or drug duplications when they were admitted to home care, according to a new study by the Center for Home Care Policy & Research.

The study also found that during the course of a home care episode, nearly a quarter of patients age 65+ experienced one or more symptoms or signs of a problem or complication related to their drug regimen. Medication-related problems - including falls related to anti-anxiety drugs, and weakness or confusion related to certain cardiac drugs - were targeted so that home care staff could take preventive action.

"Older home care patients often have more than one chronic condition and multiple doctors who prescribe multiple medications, including new prescriptions following a hospitalization," said Penny H. Feldman, Ph.D., director of the Center for Home Care Policy & Research (the Center), Visiting Nurse Service of New York.

Patients with chronic illness take as many as six to eight medications, with 20 percent taking nine or more medications, when they first enter into home care. Each additional medication increases the risk of an adverse interaction between two or more drugs, including over-the-counter preparations.

"Home care nurses and nurse managers are uniquely positioned to reconcile patients' entire medication regimen - both prescription and over-the-counter drugs - when they transition into home care, and to watch for signs of medication-related problems over time," said Dr. Feldman. "However, frontline nurses often lack the necessary tools, information and clinical guidance to consistently perform these critical assessments."

The Center launched the Geriatric CHAMP (Curricula for Homecare Advances in Management and Practice) Program to test whether state-of-the-art training and support in medication management and quality improvement would empower staff and lead to better practice.

"The good news," reported Dr. Feldman, "is that our data show that CHAMP's evidence-based, medication management training makes a marked difference in the capacity of home care agencies to minimize older patients' medication risks."

The Center's medication risk findings are based on data from 3300 patient records examined as part of evaluating the medication course of the CHAMP Program. The data come from the patients of 165 frontline nurse managers in 50 home care agencies across the nation (see list below) who graduated from the Geriatric Medication Management course. CHAMP, spearheaded by the Center since 2005 and funded by the Atlantic Philanthropies and The John A. Hartford Foundation going forward, is the first national, evidence-based geriatric quality improvement initiative in home care.

"The Institute of Medicine listed medication management as a top priority for improving the nation's health care quality nearly a decade ago. Our evidence shows that home care agencies face many challenges as they seek to incorporate consistent, comprehensive medication management into daily practice," said Dr. Feldman. "Nevertheless, significant improvements are achievable."

The CHAMP evaluation compiled systematic medication management data from CHAMP participants before and after they completed the 10-month CHAMP medication course. Patient records showed significant improvement on key medication management measures.

• Comprehensive medication assessments increased from half of older patients to 76 percent.
• Identification of possible signs of a medication-related complication, such as serious bruising in a patient taking a blood thinning medication, increased from less than half the time to 60 percent.
• Alerting patients' doctors to potentially harmful drug interactions or duplication of drugs increased from 45 to 70 percent.
• Overall, these improvements ranged from 30 to 56 percent compared to care prior to CHAMP participation.

CHAMP's Geriatric Medication Management course addresses key issues of medication management, including: medication reconciliation; medication errors and adverse drug events; medications inappropriate for use by older adults; drug/drug interactions; helping patients adhere to their medication regimen; and communicating with physicians about medication-related problems.

The CHAMP program also includes a course devoted to improving geriatric pain management. This year the CHAMP program expanded and is establishing a national Community of Practice for geriatric homecare excellence. The Community will be based on the nation's first evidence-based recommendations specific to geriatric homecare.

Home Care Agencies that Participated in the CHAMP Geriatric Medication Management Course

California

Butte Home Health and Hospice Chico
Central Coast VNA & Hospice Monterey
Sierra Nevada Home Care Grass Valley
Sutter VNA & Hospice Emeryville
Tahoe Forest Home Health Services Truckee
UC Davis Home Care Services Sacramento

Connecticut

Day Kimball Hospital Home Care & Hospice Putnam
Interim Healthcare Wallingford
Visiting Nurse and Health Services of CT Vernon
VNA Community Healthcare Guilford
VNA Health Care, Inc. Hartford
VNA of South Central Connecticut New Haven

Colorado
Visiting Nurse Corporation of Colorado Denver

Illinois
Blessing Home Care Quincy
US Home Health Care Chicago

Iowa
VNA of Pottawattamie County Council Bluffs

Massachusetts
Baystate VNA & Hospice Springfield
Greater Medford VNA Medford
Home Health VNA Lawrence
VNA Care Network Worcester
VNA of Boston Charlestown
VNA of Southeastern Massachusetts Fall River

Michigan
Hackley Visiting Nurse Services & Hospice Muskegon
Superior Home Nursing & Hospice Hancock

Minnesota
Minnesota Visiting Nurse Agency Minneapolis
North Memorial Home Health & Hospice Robbinsdale

Nebraska
VNA of Omaha Omaha

New Hampshire
Rockingham VNA & Hospice Exeter
Souhegan Home & Hospice Care Milford

New Jersey
VNA of Central Jersey Red Bank

New York
Community Health Center Johnston
Visiting Nurse Service of New York New York
VNA of Central New York Syracuse

Ohio
Caring Visiting Nurse & Hospice (ProMedica) Toledo

Pennsylvania
Covenant Home Care Pottsville
VNA of Pottstown and Vicinity Wyomissing

Rhode Island
VNA of Care New England Warwick

Texas
VNA of Texas Dallas

Vermont
VNA & Hospice of Vermont and New Hampshire White River Junction

Wisconsin
Horizon Home Care & Hospice, Inc. Brown Deer
Home Health United Madison
Kenosha VNA, Inc. Kenosha
Ministry Home Care Marshfield
St. Vincent Home Health Care Green Bay
University Hospital Home Health Agency Middleton
Wheaton Franciscan Home Health & Hospice Milwaukee

The Center for Home Care Policy and Research conducts scientifically rigorous research to promote the delivery of high quality, cost-effective care in the home and community and support informed decision making by policy makers, payers, managers, practitioners, and consumers of home and community based services. The Center is part of the Visiting Nurse Service of New York and conducts research that is broadly applicable to real-world home care settings. The Visiting Nurse Service of New York, serving 132,000 patients and making a quarter of a million professional visits annually, is the largest nonprofit home care agency in the United States.

Center for Home Care Policy and Research

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