As the director of Clinical Services at Mosaic Pharmacy Service, Patricia Powers, Pharm.D., is responsible for overseeing the development and delivery of clinical services for all Mosaic members. This month we asked Dr. Powers to share her insights around at-home care coordination benefiting both the patient and the health system and how Mosaic’s comprehensive pharmacy support can help enable better care at home.
“Patient Safety and Quality Healthcare recently put out an analysis on the challenges that have emerged since shifting towards providing at-home care. In your opinion, what have been the largest barriers of this shift when working with Mosaic members and caregivers and how have you successfully addressed them?”
In our experience, the two most common challenges that members face when trying to remain at home are (1) polypharmacy and (2) stockpiling medications. Research shows that taking five or more chronic medications increases the risk of adverse outcomes such as falls, frailty, disability, and mortality in the elderly1. In addition, the visual, physical, and cognitive decline associated with aging can result in non-adherence or patients not taking their medications as prescribed. Mosaic Pharmacy Service helps to address these barriers in the following ways:
Each Mosaic member has a medication review upon enrollment. Additionally, each member is monitored on an ongoing basis and will receive a follow-up medication review as-needed. The goal is to reduce unnecessary polypharmacy and to ensure the member has a safe, simple, and accurate drug regimen. We work with each member by providing education on disease states and medications, addressing actual and potential drug-related problems, and decreasing medication costs by recommending alternatives. We also work with the patient’s providers to ensure they are aware of any medication changes and recommendations.
We also synchronize medications and utilize adherence packaging that sorts by time and date of administration to help reduce confusion related to taking medications. Then, in order to minimize transportation barriers, we ship all medications directly to the member’s home.
“In this article, it references that a holistic view of a person’s health requires the full coordination of both the patient and the health system. How does Mosaic enable improved coordination of care, and how does this ultimately contribute to better health outcomes?”
At Mosaic Pharmacy Service, each patient has a routine check-in appointment. This helps to build the patient-pharmacist relationship and allows the pharmacist to assess therapy response, evaluate medication changes, and discuss recent hospitalizations or transitions of care. We screen for adverse effects such as falls and provide supplementary education. If we identify questions or concerns regarding the medication regimen, a pharmacist will coordinate with providers to ensure these issues are addressed. Lastly, all Mosaic patients are provided with 24/7 pharmacist access to assist with any immediate needs.
These touchpoints are particularly critical in the care of medically complex and vulnerable patients who want to remain at home. For example, we had a 76-year-old man hospitalized with a diagnosis of heart failure. He picked up four new medications from the hospital outpatient pharmacy upon discharge and added them to his current medication regimen. During our regular check-in phone call, we realized that he was taking a duplicate therapy (two medications in the same drug class) and three medications that would worsen his heart failure. We worked with his cardiologist and primary care provider to discontinue three medications and adjust the dose of another. Additionally, since the new diagnosis was overwhelming to the patient and his caregiver, we referred him to his health plan’s heart failure educational program to provide support and helpful resources about this new chronic disease.
By coordinating with all members of the patient’s care team, we were able to help provide the best care possible.
“Having access to the right information is critical when the patients are at home and unable to have face-to-face interactions with their care providers. How do Mosaic’s tech-enabled capabilities allow Mosaic pharmacists to discover potential barriers to medication adherence?”
Mosaic Pharmacy Service’s Therapeutic Decision Support (TDS) supports our clinical pharmacists in the early identification of some critical medication use-related issues; these could include challenges like non-adherence, high-risk medication combinations, polypharmacy or unnecessary drug therapies, and drug-drug interactions. TDS allows the clinical pharmacist to focus on patient care and better understand what barriers there may be to optimal medication use.
When this capability is combined with our other services, our clinical pharmacist are able secure actionable, affordable, and clinically relevant regimens for our members, and ultimately helps them to improve their medication use.
“The analysis concludes by pointing out that all parties involved would benefit from having high-quality at-home care, including the patient and the health system. How does Mosaic’s model help patients age in place and enable having them manage their complex medication regimens independently?”
It is more common for individuals to want to age in place today. This could be for several reasons: feeling more comfortable in their own home, the inability to afford the cost of a long-term care facility, or the desire to remain independent. Unfortunately, it is estimated that over the next ten years, there will be at least 4.6 million medication-use-related hospitalizations of Americans aged 65 and older1.
Mosaic Pharmacy is a value-based pharmacy committed to providing high-quality, at-home pharmacy services designed to support the individual who wants to age in place and reduce the risk of medication misuse. We provide essential benefits, including comprehensive medication management, reduction of drug-related problems, and ongoing communication with patients, caregivers, and prescribers. Our safe and effective medication adherence packaging helps increase the rate of taking the right medication at the right time of day to encourage better medication use. Lastly, a Mosaic pharmacist is available 24 hours a day, seven days a week to support patients and caregivers so they can remain independent at home.
References:
1) The Lown Institute. “Medication Overload: America’s Other Drug Problem.” 2019. https://lowninstitute.org/reports/medication-overload-americas-other-drug-problem/