More than half of adults aged 65 or older report taking four or more prescription medications. Some of those patients receive prescriptions from more than one doctor, and rarely do they — far and away, the most at-risk population for preventable adverse drug events (ADEs) — receive coordinated reviews of the medication risks that they may unknowingly be facing on a daily basis.
Part of the reason is that in many cases, providers are using antiquated methods like evaluating long lists of potential one-to-one drug interactions for medication compatibility. But that can change. We now have more modern and advanced systems that assess the active ingredients of a patient’s complete medication list, including over-the-counter drugs, herbals, etc., to identify simultaneous, accumulative, multi-drug interactions. The result is a more holistic view of the patient’s drug regimen that allows us to better understand and predict the risk of medication problems and ADEs, along with the action that can be taken to mitigate these risks from becoming reality, which are typically delivered by pharmacists.
Right now, we aren’t taking the safe use of medications seriously enough, and the results show.
Patients shouldn’t be harmed by their medications, nor should they and their healthcare providers pay the often-significant economic cost of ADEs. This is especially relevant to value-based programs like the Programs of All-Inclusive Care for the Elderly (PACE), which work to efficiently improve the care and well-being of their participants.
As the coronavirus pandemic made clear, we need to get more creative to better care for older Americans.
Increasingly, the value of bringing pharmacists and physicians together to deliver coordinated care is becoming evident. Using a structured medication risk mitigation (MRM) service can put this coordinated plan of action into focus. MRM includes a suite of clinical pharmacy services and technology solutions to optimize medication use in vulnerable older adults. MRM services include ADE risk stratification, clinical decision support software that aids pharmacists in the optimization of medication regimens, pharmacogenomic assessments, provision of expert drug information to PACE prescribers, and comprehensive medication adherence support.
Because many patients are prescribed medication from multiple doctors and may not report other over-the-counter or prescription drugs they’re taking, there’s an information gap that needs to be solved. Pharmacist-delivered medication safety reviews can be a major breakthrough if used appropriately — providing a holistic view of the risk patients are facing with their drug regimens.
Until recently, no controlled study evaluated the impact of MRM services on economic outcomes in PACE.
But a recent study published in March in Healthcare showed that identifying the risk of multi-drug interactions before they occur can drastically reduce healthcare costs — on average by $5,000 per participant annually — for PACE programs compared to those who did not receive these structured services.
The study compared total medical costs for those who received structured medication risk mitigation services with those who didn’t. It included more than 2,500 participants from 19 PACE organizations.
Around three quarters ($3,807) of the cost savings involved facility-related expenses (e.g., hospital admission, emergency department visits, skilled nursing). The remaining savings ($1,217) involved physician-related expenses. Importantly, these are direct costs only. There are also indirect costs that impact PACE organizations, such as transportation costs and expenses related to additional home aid associated with post-hospital care.
The savings highlighted in the Healthcare study are significant especially at a time when U.S. healthcare expenditures are expected to continue to rise through 2025 due in part to disease progression in an aging population. For those PACE centers, the value of MRM services is clear.
These results should drive how we think about caring for older Americans. We have the tools available to save lives and improve the financial footing for critical programs like PACE. We just need to utilize and apply them.
Ankur Patel, M.D., is chief medical officer of Tabula Rasa HealthCare.