23 April 2014

Medication Adherence Programming: Assessing and Resolving Participant Adherence Challenges

The Partner

Mercy LIFE (Living Independently For Elders) is a member MLIFE logoof Mercy Health System, the largest Catholic healthcare system serving the Delaware Valley and a member of CHE/Trinity. Mercy LIFE has been providing comprehensive services to seniors for more than 10 years. Their mission is to provide accessible, quality service to the entire community, especially the poor and underserved, and address the diverse factors that impact the health needs of the whole person.

Currently, they are serving a diverse population of approximately 525 participants at four day centers in Philadelphia and Delaware County: Broad Street, Grays Ferry, North Hancock, and Valley View, a recent addition of Deaf and Deaf/blind participants in a residential care setting.

The Challenge

Mercy LIFE discovered their adherence challenges in 2012. They knew that participants were not taking their medications as prescribed when excess medications began showing up at the center for disposal. Additionally, in-home assessments by staff were finding excess supplies of medications.

Aides were sent into the homes to prompt participants to take their medications (“med cues”), but there was limited feedback about efficacy of this process. Then, Mercy used the CareKinesis Adherence Assessment Tool to examine participant behaviors through self-report. But these results magnified the challenge: the participants with excess supplies were the same ones who reported taking their medications exactly as directed and having no medication problems. The staff at Mercy LIFE aspired to improve participant adherence and were looking for a new solution.

The Solution

Mercy LIFE and CareKinesis created an Adherence Committee, with the goal of creating a process for identifying and improving non-adherence quickly and appropriately. The Committee created iterations of adherence assessment tools, to be used by various staff in the PACE Organization.

Home Care Nurses began regularly assessing adherence, using methods of self-reporting and of observation to fully understand medicationtaking behaviors. The IDT then sends the assessments to CareKinesis Clinical Pharmacists for analysis and recommendations on how to improve participant adherence. For Aides, the Committee created a training program to ensure competence with the medication use process. For participants, the Committee supported CareKinesis-led educational sessions, which focus on the medication packaging that is preferred by most participants of Mercy LIFE.

The Results

After partnering with CareKinesis for almost a year on Adherence Programming, the Mercy LIFE team reports improvement: Mercy LIFE now benefits from actionable information about non-adherence.

Targeted assessments (self-report, observed and data-driven) identified many participants who reported adherence but were observed to be not taking their medications as prescribed. These participants have received additional Home Care visits and education, and are targeted for close follow-up with the IDT. Comprehensive reviews are also conducted regularly and upon completion of Adherence Assessments.

Recommendations included:

  • Reduction in the number of medications.
  • Avoidance of potential averse outcomes or side effects.
  • Adjustments for potential drug interactions.
  • Dose Aggregation (three or fewer doses/day).
  • Changing from vial packaging to adherence packaging.
  • Medication administration time change.

Conclusion

Johanna Yurkow - MercyLIFEMercy LIFE, with the partnership of CareKinesis, is increasing participant adherence. The Adherence C
ommittee is gaining a more complete understanding of what practices and processes are most effective. Johanna Yurkow, DNP, MBA, NHA, VP of Operations shared that “In addition to improving pharmacy efficiency, including the reallocation of three nurses from pharmacy-related tasks, CareKinesis helps us reduce medication-related risk, improving safety and outcomes with programs like this one.”

“We are currently noticing increased levels of patient understanding,” says Suzanne Januszeski, Director of Operations at Mercy LIFE. “Over time, we anticipate greater improvements in participant outcomes, such as decreased ED visits and hospitalizations, as a result of improved adherence.”