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Emerging Technologies for Medication Management: Promoting the Independence of Older Adults

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Emerging Technologies for Medication Management: Promoting the Independence of Older Adults David Lindeman, PhD John Feather, PhD, CAE Lynn Redington, DrPH, MBA – PowerPoint PPT presentation

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Title: Emerging Technologies for Medication Management: Promoting the Independence of Older Adults


1
Emerging Technologies for Medication Management
Promoting the Independenceof Older Adults
  • David Lindeman, PhD
  • John Feather, PhD, CAE
  • Lynn Redington, DrPH, MBA
  • Valerie Steinmetz
  • 16 March 2010, Chicago
  • Aging in America, NCOA/ASA Conference

2
Introduction to Todays Speakers
  • David Lindeman, Lynn Redington, Val Steinmetz
  • Center for Technology and Aging Staff
  • John Feather
  • CEO, American Society of Consultant Pharmacists
  • Chair ASA board

3
Introduction to Todays Discussion
  • Medication management for older adults
  • Importance of medication use in older adults
  • Opportunities for improvement
  • Technologies to optimize medication use
  • Diffusion of medication technologies
  • Examples of medication technology diffusion
    programs
  • Response and discussion

4
Importance of Medication Use in Older Adults
  • Medication use is ubiquitous in older adults
  • 90 use 1 or more prescription medications per
    week
  • 41 of older adults take 5 or more medications
    per week
  • Suboptimal medication use . . .
  • Can increase the burden of illness
  • Result in higher costs to families and society
  • Poor medication adherence doubles risk of
    hospitalization and generates 290 billion/year
    of avoidable health costs

5
Opportunities for Medication-Use Improvement
  • 3 areas of improvement that could be
    technology-enabled
  • Medication Reconciliation
  • Accurate list of medications to avoid adverse
    drug reactions
  • Medication Adherence
  • Taking medications as directed
  • Medication Monitoring
  • Watching for warning signs, adjusting dose as
    needed

6
Technologies to Optimize Medication Use
Medication Monitoring
Medication Adherence
Medication Reconciliation
Monitor
Prescribe
Dispense
Administer
Assess
  • Goals
  • Routine dosing and tracking of medication
  • Reports and trending information from medication
    log generated
  • Clinician adjusts medication as needed
  • Prescriptions refilled
  • Goals
  • Patient history includes a complete and accurate
    medication list
  • Patient needs are accurately conveyed and
    understood
  • Goals
  • Medication orders are documented and shared with
    patients
  • Goals
  • Medication is made available
  • Medication picked up by patient
  • Patient and caregivers understand medication
    instructions
  • Goals
  • Individual dose dispensed
  • Individual dose taken by patient (on time, in the
    right does, and for the right length of time)
  • Example Technologies
  • Medication List Software
  • Personal Health Records (PHR)
  • Example Technologies
  • Medication List Software
  • Personal Health Records (PHR)
  • Example Technologies
  • Teleconsultations
  • Online Patient Education
  • Cognitive Assessment Tools
  • Pharmacy Kiosks
  • Example Technologies
  • Medication Adherence Devices (integrated and
    standalone, simple and advanced function)
  • Example Technologies
  • Personal Biometric Testing Devices
  • Wireless Communication Devices
  • Personal Health Records (PHR)

7
Technologies to Improve Medication Reconciliation
Problems
  • Continuous Electronic Medication List Integrated
    with Personal Health Records

One-time entry Medication List electronic or
paper
  • Continuous Electronic Medication List
  • User adds medication information for one-time
    print out
  • Medication information stored online.
  • Info can be updated manually or automatically if
    linked to pharmacy.
  • Print out required to share information with
    providers
  • Medication information stored online.
  • Info can be updated manually or automatically if
    linked to pharmacy.
  • Medication list accessible to providers through
    PHR

8
Medication Adherence Technology Functions
FILL
REMIND
DISPENSE
INGEST
METABOLIZE
REPORT
ADJUST
Patient fills prescription and receives it. Patient is reminded to take medication. Patient removes medication. Patient ingests the medication. The medication is metabolized by patient. A report of the patients adherence is given to a clinician or caregiver. The doctor adjusts the patients medication accordingly.
Technologies in blue are already available.
Technologies in green are in development.
9
Medication Adherence Technology Categories
  • Technologies can be divided by the complexity,
    type, and number of functions they perform

10
Technologies to Improve Medication Adherence
Problems
11
Technologies to Improve Medication Adherence
Problems
  • Single Function
  • Performs one function currently available within
    the medication adherence technology spectrum
  • Advanced Function
  • Performs one or more of the currently available
    spectrum functions and can also perform one of
    the more advanced functions
  • Integrated Function
  • Technologies that integrate medication
    administration with other health-related
    management functions

Rex Talking Pill Bottle
Health Buddy
MagneTrace
Source www.rxtalks.com
12
Technologies to Improve Medication Monitoring
Problems
  • Medications that place patients at risk for
    adverse reactions are especially important to
    monitor
  • Point-of-care testing devices are available to
    monitor blood pressure, peak flow (for asthma),
    blood glucose (for diabetes), warfarin dosing and
    a host of other health conditions
  • Devices to monitor medication are becoming more
    prevalent with wireless capabilities and enhanced
    tracking and trending features.

Islet iPhone Application
Warfarin iPhone Application
Sourcewww.princeton.edu/main/news/archive/S25/10/
88K09/index.xml?sectionfeatured
13
Diffusion of Medication-Use Technologies
  • Many technologies wither on the vine . . .
  • Social-cultural factorsreadiness vs. resistance
  • Economic factorswho pays, how?
  • Political/legal factorslaws, policy that favor
    or impede
  • Technology factorsready for broad use or tech
    enthusiasts only?

14
Center for Technology and Aging Research and
Grantmaking
  • Research what medication problems are important
    and have technology solutions?
  • Grantmaking what programs can we fund to help. .
    .
  • Older adults better use medications
  • Improve health and independence
  • Reduce the cost and burden of care
  • Chronic disease self-management
  • In the home or other community setting

15
Medication Optimization Diffusion Grants Program
  • RFP released Fall 2009
  • January-December 2010 grant period
  • Five grantees selected
  • Association of Consulting Pharmacists Foundation
  • Caring Choices
  • Connecticut Pharmacists Foundation
  • Veterans Administration (Central Calif.)
  • Visiting Nurse Service New York

16
Diffusion Grants Program
  • Veterans Administration of Central CA
  • Home self-management and medication adherence
  • Veterans that are home-based with chronic heart
    failure
  • Remotely located internists and allied health
    professionals
  • 5 central California rural and medically
    underserved counties
  • The Health Buddy system plus weight scale, blood
    pressure monitor, assessment algorithms and
    clinician alerts
  • . . . VHA is a leader in telehealth coupled with
    care coordination

Health Buddy
17
Diffusion Grants Program
  • Caring Choices - Chico, CA
  • Improve medication monitoring and adherence
  • Philips Medication Dispensing Service technology
  • Will be introduced to four home health and senior
    living organizations in four new rural and urban
    areas of CA
  • Partner, Home Health Care Management, has
    successfully deployed medication dispensers for
    the past 10 years

18
Diffusion Grants Program
  • Connecticut Pharmacists Foundation - Long Beach,
    CA
  • Culturally and linguistically appropriate
    Medication Therapy Management (MTM) services
  • Community health workers and remotely located
    pharmacists will use videoconferencing, EHR, and
    spoken format technology to deliver MTM services
    to Cambodian-American older adults

19
Diffusion Grants Program
  • Visiting Nurse Service of New York
  • A multi-faceted, IT based intervention designed
    to better support nurses, as well as cognitively
    impaired patients and their caregivers, in the
    challenging process of managing multiple
    medications in the context of multiple
    co-morbidities
  • 4 Boroughs of New York City
  • Technology medication complexity algorithm,
    electronic clinical alerts and decision support
    tool, and caregiver support materials for CI
    elders with complex medications regimens

20
Diffusion Grants Program
  • American Society of Consultant Pharmacists
    Foundation
  • Pharmacists will use Monitor-Rx, a web-based
    patient medication assessment tool, to optimize
    the medication regimens of older adults
  • Implementing in 3 Southern California
    organizations
  • OASIS Older Adult program
  • University of CA, Irvine Senior Health Center
  • Alzheimers Family Services Center

21
Center for Technology and Aging
  • www.techandaging.org
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