How to Get Better Care with Lower Costs? See the Person, Not the Patient

This article discusses the importance of interacting with individuals as “people” not “patients” in order to provide a more all-inclusive type of care. This is especially important for older adults, who experience chronic health problems, functional limitations, physical challenges, and a deeper reliance on social support. Programs such as disease state management fail to recognize a person as a whole, with many other factors affecting their health and outcomes than just one specific disease itself.

The process of a person-centered care program means putting people in charge of their own health. It involves taking time to identify their personal needs, preferences, and values, consulting familial support if needed. When this information is combined with a health and functioning assessment, the person is able to shape their own personal goals rather than those based simply on medically-defined clinical outcomes. This process allows for the development of a care plan and implementation strategy individual for each person. By allowing each person to identify their own personal goals, and providing the needed support for it to happen, they will be much more motivated and successful in striving for those goals. This process has been developed with and supported by the American Geriatrics Society (AGS).

Three critical indicators of quality person-centered care for older adults are high functional quality of life with minimal intervention, healthcare providers acting in an efficient, convenient manner, and ability to easily navigate the care system as needed. The degree or extent of each of these indicators will vary for each person based on individual functional abilities, family support, and more.

There are several models that embrace this paradigm. They have been able to demonstrate that there is an opportunity for better care for high-need older adults at lower costs. These cost savings may not seem favorable initially when considered on a short-term small scale. This is the case with remote mail-order pharmacies for prescription refills rather than direct pharmacy interaction. However, Washington University’s care management program under the CMS Medicare Coordinated Care Demonstration Pilot is working on proving the long-term benefit of face-to-face interaction over mail-order pharmacy experience for individuals in the older adult population. Considering the points made in this article and the person-centered care approach that is outlined, do you think the emphasis we are seeing currently in mail-order pharmacy for many Medicare patients will be short-lived

Westphal, E., Alkema, G., Seidel, R., Chernof, B. How to get better care with lower costs? See the person, not the patient. J Am Geriatr Soc. 2016; 64:19-21. Doi: 10.1111/jgs.13867 

Medication Disposal Challenges in LTC

Handling disposal of unused or expired medications is a major issue faced by long-term care facilities (LTCF). Roughly 1.5 million pounds of unused medications are accumulated each year by LTCF’s. This can be the result of many factors, including drug-therapy problems such as adverse effects, ineffectiveness, and adherence, as well as patient death. Negative consequences of inappropriate disposal practices includes accidental poisoning, overdose, and environmental contamination.

CMS requires LTCF’s to have policies and procedures in place for proper medication storage and disposal, but other regulatory agencies, such as the FDA, are also involved in this process, causing high potential for confusion due to inconsistencies and complicated directions. The FDA provides a list of medications is deems as safe to flush down a toilet or dispose down a drain. However, the White House Office of National Drug Control Policy (with FDA input) provides guidelines that say to NOT flush medications, but instead refer to a drug take-back program of disposal in cat litter or coffee grounds. OSHA (the Occupational Safety and Health Administration) provides specific instructions on disposal of materials such as sharps containers, which may often include used Fentanyl patches. The Secure and Responsible Drug Disposal Act went into effect in 2014, authorizing DEA regulations for drug take-back programs. LTCF’s may also be required to adhere to the EPA’s proposed regulations about solid and hazardous wastes.

The increased involvement of regulatory agencies in medication disposal means that LTCF’s should evaluate their current processes of medication disposal and modify them as needed. A team approach of handling medication disposal, including a consultant pharmacist, is recommended. Continuous education and training, best practice guidelines, and self-audit programs are all suggested ways to help promote consistency in procedures.

I think this articles raises an interesting point about managing medications in long-term care facilities. The patients in LTCF take an average of 8 routine medications and three as needed, according to the article. When you consider the large amount of medications, and strong possibility of experiencing adverse effects, as well as the higher chance of fatality among the elderly population, it is understandable how medication disposal is a primary concern for LTCF’s. I was surprised at the conflicting, complicated guidelines and regulations for the process, and can understand how this can pose a major obstacle for many facilities. I think it is important for us as pharmacists to be aware of medication disposal regulations and recommendations, and wonder if there is an effective way to simplify the information for more effective application in long-term care facilities.

Coggins, Mark D., PharmD. Medication Disposal Challenges in LTC. Today’s Geriatric Medicine. 2016;9,8-11.