Nearly one-third of older home health care patients are taking medications that put their health at risk. Such patients usually are frail and have multiple care providers, making them particularly vulnerable to problems with medication use. They may benefit from a team approach to their care. For example, collaboration between an agency's visiting home health nurse and the patient's pharmacist can identify duplicate medications or dangerous combinations of medications. Once such problems are identified, the home health nurse can contact the patient's doctor for reassessment and possible medication change.
This approach can improve medication use among these vulnerable patients without increasing home health visits or duration of home health care, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS10384). However, the improvement is modest and varies substantially according to the particular medication problem, cautions Wayne A. Ray, Ph.D., of the Center for Education and Research on Therapeutics (CERT) at Vanderbilt University.
Dr. Ray and his colleagues used routine screening to identify 1,463 patients enrolled in one of two large U.S. home health agencies who had one of four common medication problems. These included: unnecessary therapeutic duplication (16 percent of study patients), cardiovascular medication problems (14 percent), use of psychotropic drugs in patients with possible adverse psychomotor or adrenergic effects (40 percent), and use of nonsteroidal antiinflammatory drugs (NSAIDs) in patients at high risk of peptic ulcer complications (35 percent).
The researchers randomized 317 patients—160 to the medication improvement program and 157 to the control group. Overall, there was improvement in medication use for 50 percent of program patients and 38 percent of control patients. At followup, more program than control patients had duplicate medications dropped (71 vs. 24 percent) and were taking more appropriate cardiovascular medications (55 vs. 18 percent). However, there were no significant improvements in patients with psychotropic medication problems (reducing the dose or switching to a preferred agent) or with NSAID medication problems.
See "Improving medication use in newly admitted home healthcare patients: A randomized controlled trial," by Sarah Meredith, M.B.B.S., M.Sc., Penny Feldman, Ph.D., Dennee Frey, Pharm.D., and others, in the September 2002 Journal of the American Geriatrics Society 50, pp. 1484-1491.