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Older Adults in Home Healthcare at Elevated Risk for Receiving Unsafe Meds

Older adults receiving home healthcare may be taking a drug that is unsafe or ineffective for someone their age. In fact, nearly 40% of elders receiving medical care from a home health agency are taking at least one prescription medication that is considered potentially inappropriate for them, a new study in the Journal of General Internal Medicine has revealed.

The study's researchers, led by Yuhua Bao, PhD, an assistant professor of public health at Weill Cornell Medical College, found that home healthcare patients aged 65 and older are prescribed potentially inappropriate medications (PIMs) at rates three times higher than patients who visit a medical office. The researchers' data show that home healthcare patients are taking 11 medications on average, and that the concurrent use of multiple medications is a strong indicator of the presence of PIMs.

“Elderly patients receiving home healthcare are usually prescribed medications by a variety of physicians, and it's a great challenge for home healthcare nurses to deal with prescriptions from many sources,” says Bao. Still, she sees the home healthcare model offering potential for improving this situation. “Having a medical professional enter an elderly patient's home is an opportunity to do a proper medication review and reconciliation,” Bao explains.

The study used data from the National Home and Hospice Care Survey, conducted in 2007 by the Centers for Disease Control and Prevention, which is the most recent nationally representative epidemiological survey of home health patients. The 2002 Beers Criteria, a list generated by an expert panel that itemizes 77 medications or groups of medications considered inappropriate for older adults, was the basis for the PIMs chosen.

In a review of 3,124 home health patients aged 65 or older, the researchers found 38% were taking at least one PIM. Elder patients taking 15 or more medications were five to six times as likely to be prescribed PIMs as patients taking seven or fewer medications. Of those elders taking at least one PIM, 21% were taking 15 or more medications.

According to Bao, the study, if anything, underestimates the prevalence of PIMs taken by home health patients: The researchers were not able to look at potentially problematic drug-drug interactions or drug-disease interactions because data were not available.

There is no single reason PIMs are prevalent in home healthcare settings. “Anecdotal evidence shows that many physicians are not aware of what is on the PIM list,” says Bao. “In our fragmented healthcare system, we generally don't have an electronic reference for a patient that lists all medications from different physicians, and there isn't a readily available means for professionals to share essential information. Enhanced physician communication with home healthcare nurses may help to address the problem as well as better communication among physicians.”

Bao sees incentives for improvement in communication and care coordination in the implementation of the Patient Protection and Affordable Care Act passed by Congress in 2010. “The current payment system doesn't provide incentives to optimize coordination of care,” says Bao. “But when providers in different settings as a group are held responsible for outcomes and costs of care through, for example, an accountable care organization—a concept promoted in the Affordable Care Act—this could create an impetus to break the communication barriers that currently exist.”

— Source: NewYork-Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Hospital