© 2010 center for technology and aging1 emerging technologies for medication management: promoting...

© 2010 Center for Technology and Aging1

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


Introduction to Today’s Speakers

David Lindeman, Lynn Redington, Val Steinmetz

• Center for Technology and Aging Staff

John Feather

CEO, American Society of Consultant Pharmacists

Chair ASA board


Introduction to Today’s 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


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


Opportunities for Medication-Use Improvement

3 areas of improvement that could be technology-enabled:

1. Medication Reconciliation

Accurate list of medications to avoid adverse drug reactions

2. Medication Adherence

Taking medications as directed

3. Medication Monitoring

Watching for warning signs, adjusting dose as needed


Technologies to Optimize Medication Use

Assess

Prescribe

Dispense Administer

Monitor

Example Technologies•Teleconsultations•Online Patient Education•Cognitive Assessment Tools•Pharmacy Kiosks

Goals•Patient history includes a complete and accurate medication list

•Patient needs are accurately conveyed and understood

Example Technologies•Medication List Software•Personal Health Records (PHR)

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)

Goals• Routine dosing and

tracking of medication• Reports and trending

information from medication log generated

• Clinician adjusts medication as needed

• Prescriptions refilled

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)

Example Technologies•Medication List Software•Personal Health Records (PHR)

Medication Adherence

Medication Reconciliation

Medication Monitoring


Technologies to Improve Medication Reconciliation Problems

Name OrganizationDescription

My Medication Log

Cardiovascular and Public Health Detailing Programs

A medication log for use in the Cholesterol Action Kit ihttp://www.ihi.org/IHI/Topics/PatientSafety/MedicationSystems/Tools/MyMedicationLog.htm

Universal Medication Form

McLeod Health in Florence, SC

A form where patients can enter medications used, allergies, and immunization records

Health and Safety Passport

California Pacific Medical Center, San Francisco

Patients list their medications, health history, and other relevant information

Med List

A statewide, collaborative initiative in Massachusetts

Medication list to keep track of patient medications and supplements. Also offers tips for using medications wisely.

My Medicine List ASHP

A tool where patients can develop and manage their own medication list. The tool can be found on the ASHP Foundation website

Pill Card AHRQ

Information on how to develop an easy-to-use "pill card" for patients, parents, or anyone who has a hard time keeping track of their medicines at http://www.ahrq.gov/qual/pillcard/pillcard.htm

My Medicine Record FDA

Patients list prescription medicines, over-the-counter medicines and dietary supplements.http://www.fda.gov/cder/consumerinfo/my_medicine_record.htm

One-time entry Medication

List – electronic or paper

Continuous Electronic

Medication List

Continuous Electronic

Medication List

Integrated with Personal

Health Records• 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


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 patient’s

adherence

is given to a

clinician or

caregiver.

The doctor

adjusts the

patient’s

medication

accordingly.

* Technologies in blue are already available. Technologies in green are in development.


Medication Adherence Technology Categories

Medication adherence

technologies

Standalone technologies

Integrated with health

management capabilities

Single Function

Multi-Function

Advanced

Function

• Technologies can be divided by the complexity, type, and number of functions they perform


Technologies to Improve Medication Adherence Problems

Category Description Sample Techs Pros ConsMarket Stage Economics

Single-Function

Performs one function currently available within the medication adherence technology spectrum

•iGuard•Timex messenger•Rex Pill bottle•Gentle Reminder

Simplest and easiest to use technologies

•Lacks greater functionality for more comprehensive health management

Many technologies out on the market and currently used

•Usually a one-time purchase•Prices can vary widely•Relatively inexpensive

Multi-Function

Performs two or more functions currently available within the medication adherence technology spectrum

•EMMA•Philips Medication Dispensing Service•MedSignals•uBox•Dispense-a-Pill

•Mostly easy to use•Integrates multiple functions for better health management

•May be complex or require greater caregiver involvement•Lacks functionality for more comprehensive management

Many technologies out on the market and currently used

•Usually a one-time purchase•Prices can vary widely (less than $100 to $1000+)

Advanced Function

Performs one or more of the currently available spectrum functions and can also perform one of the more advanced functions

•MagneTrace•Xhale’s SMARTTM

•Advanced technologies allow actual tracking/ adjustment/ingestion of medication•Integrates multiple functions

•Considerably more complicated than single/ multi function without clear benefit understanding•In some cases, may lack comprehensive management functionality

Most technologies still in development

•Currently unclear - most technologies still in development•May be relatively expensive

Integrated with Health Management Capabilities

Technologies that integrate medication administration with other health-related management functions (i.e. monitoring, sensors, independent living assistance)

•Med-eMonitor•HealthHero•Home HealthPoint•Zume Life Zuri•Intel HealthGuide

•Combined offering allows for broad patient management•Many devices likely to move towards integration of health tracking/ monitoring

•Relatively complicated, may require caregiver involvement•May require greater tech knowledge

•Some techs currently on market and used•Other techs in development

•Usually upfront cost plus a monthly fee (service-oriented model)•Upfront cost can be relatively high


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

Source: www.rxtalks.com

Health BuddyRex Talking Pill Bottle

MagneTrace


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.

Warfarin iPhone Application

Islet iPhone Application

Source:www.princeton.edu/main/news/archive/S25/10/88K09/index.xml?section=featured


Diffusion of Medication-Use Technologies

Many technologies wither on the vine . . .

• Social-cultural factors—readiness vs. resistance

• Economic factors—who pays, how?

• Political/legal factors—laws, policy that favor or impede

• Technology factors—ready for broad use or tech

enthusiasts only?


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


Medication Optimization Diffusion Grants Program

RFP released Fall 2009

January-December 2010 grant period

Five grantees selected:

1. Association of Consulting Pharmacists Foundation

2. Caring Choices

3. Connecticut Pharmacists Foundation

4. Veterans Administration (Central Calif.)

5. Visiting Nurse Service New York


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



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



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



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



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

Alzheimer’s Family Services Center


Center for Technology and Aging

www.techandaging.org

© 2010 center for technology and aging1 emerging technologies for medication management: promoting...

Documents

medication instructions

available medication

medicationuse improvement

older adults medication

patients goals medication

medication log cardiovascular

tracking of medication

week suboptimal medication