Caring Choices (CC), in partnership with Home Health Care Management, Inc. (HHCM), introduced a medication adherence program in senior living organizations and home health agencies to improve health outcomes and reduce excess health care utilization of older adults. Caring Choices and HHCM trained staff at four organizations, two home health agencies in Northern California (Alternative Home Care and Visiting Nurse Association of the Inland Counties) and two senior living organizations (Eskaton and Asian Community Center). The medication adherence program was developed by HCCM and was conducted over a one year period.
The medication management program utilized the Philips Medication Dispensing Service (PMD) machine to help individuals comply with their medication regimens while living in their homes and in residential care settings. The PMD is a home-based machine that is programmed to dispense proper medications at proper times, thereby reminding patients to take medications and ensuring proper levels of adherence. Medication dispensing devices and programs help mitigate non-adherence issues such as forgetfulness, confusion, and medication complexity. Medication dispensing devices do not address medication adherence challenges due to cost of medications, health beliefs, or side effects.
CC and HHCM trained staff at the four partnering organizations, providing the information and tools to successfully replicate the PMD program within home health agencies and senior living agencies in California. CC and HHCM provided mentoring and a turnkey program that could be modified to the agency’s situation. This included guidance on patient selection and a business model to support the PMD program as part of each organization’s service line.
The success of the PMD medication management program was determined through an evaluation of participant medication compliance rates, number of hospitalizations, and number of emergency department (ED) visits. Subjective data were collected from project partners regarding the use of the medication management program in their agencies. CC also evaluated the effects of the use of the PMD program on reducing caregiver burden and improving the quality of life of participants.
High Rates of Medication Compliance. Use of the PMD was associated with high rates of compliance: 98% of the participants received their medication on time. The effectiveness of medications depends on the efficacy and appropriateness of drugs and patient adherence to the drug regimen. Non-compliance results in decreased quality of life, increased health care costs related to acute and long term care admissions, and the need to enhance home care support.
Reduced Caregiver Burden. Results indicated that use of PMD machines was associated with a decrease in self-reported caregiver burden.
Reduction in Medical Utilization. Medication non-adherence is associated with increased ED and hospital visits. In this initiative, use of the PMD was associated with reductions in ED visits and hospitalizations compared to baseline.
Aging in Place. Needing assistance in taking medications is one of the most common reasons that prompt an older adult to move from home or independent living to a higher level of care with medication supervision, none of the participants in the PMD program required such a move.
Sustainability and Replicability:
Three project partners continued to use the PMD program with external funding support, while one program discontinued the PMD program after the initiative was over.
Slower Rates of Adoption of Medication Technology. The four participating organizations utilized 43 PMD machines, half of what was originally projected. This underscores the fact that technology adoption can be slowed by a number of factors, some directly related to the technology and some that are not. One organization’s capacity to implement the project was diverted due to an unanticipated competing priority, while another organization lacked an internal program champion, reducing organizational and staff buy-in throughout the project.
PMD Payment Models. PMD use during the project was provided free to participants. While likely increasing rates of participation, families indicated a willingness to pay for the PMD service with out-of-pocket funds after the project period because, without it, they would have to move relatives to a higher level of care with costs that far exceed those of using the PMD machine. According to CC, Medicare and Medi-Cal (California’s Medicaid program) do not cover on-going medication management programs.
PMD Use Promoted Workforce Efficiencies. While reimbursement was limited under traditional fee for service, one participating agency found that use of the PMD machine was cost-justifiable within their capitated payment model. This organization was able to reduce the number of home health nurse visits to clients with medication adherence challenges.
Regulatory Limitations. One agency made only limited use of the PMD program because of regulatory constraints on their ability to dispense medications. Professional and facility licensing regulations and standards need to be clarified prior to agencies incorporating medication dispenser installation and servicing (e.g., refilling the machine) into their service line.