Wyoming Care Coordination Network Kickoff Event! Whos in the Room - - PowerPoint PPT Presentation

Wyoming Care Coordination Network

Kickoff Event!

Who’s in the Room

• What’s your name, and do you like it?

Get to Know Each Other

• Which superpower would you like to have?

 Mind reading  Invisibility  Teleportation  Flying  I already have a superpower

Get to Know Each Other

• Which organization are you representing?
• Describe your role at your organization in

five words or less.

Get to Know Each Other

• Why did you decide to join this event today?

 Knowledge building  Networking opportunities  My boss made me

Wyoming Care Coordination Network

Mountain-Pacific Quality Health

Mountain-Pacific Chronic Care Management (CCM) Support

• Provide care coordinators with targeted educational

tools and resources to distribute to patients

 Focus on 20 minute monthly interventions

• Engage patients and empower them for long-term,

continued program participation

Mountain-Pacific CCM Support

• Disease-specific information

 Vaccines  Nutrition  Safety

• Medication-safety tools

 Medication disposal  Medication bags  Pill planners  Adherence and health literacy

• Plus MORE

Calendar of Events

• October 11th: Kickoff!

 Polypharmacy and medication adherence  Community resource discussion: patient safety in harsh weather

• November 15th: Nutrition

 The right diet for your health  Community resource discussion: How to find fruits and vegetables in the winter

• December 13th: Stress and Loneliness in Winter

 Combating seasonal affective disorder and social isolation  Community resource discussion: Community events to connect and socialize

• January 10th: Revisiting the Care Plan

 Incorporating patient goals and priorities in wellness  Community resource discussion: How to keep moving in the winter

Mountain-Pacific CCM Support

• What you can expect:

 Monthly newsletter

• Timely tools and resources

 Monthly education event  Community resource review  Case studies and troubleshooting  Resources from Mountain-Pacific

Mountain-Pacific CCM Support

• What we are asking in return:

 Participate in live events

• Encourage group learning

 Complete brief surveys following learning events  Complete evaluations sent with tools and resources  Share your knowledge and experiences  Help guide our discussions and content

Medication Minute

Polypharmacy and Medication Adherence

Patient Engagement and Chronic Care Management (CCM)

• Interventions shown to increase patient engagement

have one or more of the following focuses:

 Skill development  Problem solving  Peer support  Changing the social environment  Tailoring support to the person’s activation level

What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs. JH Hibbard, J Greene. Health Affairs 2013 32:2, 207-214. Accessed from: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2012.1061

Polypharmacy

• “The most commonly reported definition of polypharmacy

was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines.”

• What are the concerns with polypharmacy?

 Falls  Adverse drug reactions  Increased length of hospital stay  Readmission

 Mortality

What is polypharmacy? A systematic review of definitions. N Masnoon, S Shakib, L Kalisch-Ellett, GE Caughey. BMC

• Geriatr. 2017; 17: 230. Published online 2017 Oct 10. doi: 10.1186/s12877-017-0621-2

Polypharmacy

• Appropriate or rationale polypharmacy

 Complex disease state management with many different desired therapeutic outcomes being achieved

• Post myocardial infarction (MI)
• Multiple disease states
• Inappropriate polypharmacy

 Therapeutic duplications  Adding therapy to address modifiable medication side effects  Medication benefits do not outweigh the risks

What is polypharmacy? A systematic review of definitions. N Masnoon, S Shakib, L Kalisch-Ellett, GE Caughey. BMC

• Geriatr. 2017; 17: 230. Published online 2017 Oct 10. doi: 10.1186/s12877-017-0621-2

Addressing Polypharmacy

• Number of medications is just a starting point
• Assess

 Indication of each medication  Efficacy of each medication  Potential for harm/drug interactions

• Look beyond single disease management guidelines

 Consider all comorbidities and medications to focus on the patient as a whole and improving overall health

• Build a relationship with the patient’s pharmacist

What is polypharmacy? A systematic review of definitions. N Masnoon, S Shakib, L Kalisch-Ellett, GE Caughey. BMC

• Geriatr. 2017; 17: 230. Published online 2017 Oct 10. doi: 10.1186/s12877-017-0621-2

Polypharmacy and Chronic Care Management

Screening for Medication Events

Look For:

• Medication allergy
• Sedation
• GI distress
• Weight gain
• Depression
• Fluid retention
• New or worsening shortness of

breath

• Any other changes with new

medication

Medication Event Reporting

Who: Personnel Involved What: Details

• f the Event

Why/How When: Time Event Occurred Where: Location of the Event

Root Cause Analysis

Assess • Determine what is happening Diagnose • Determine WHY it is happening Remedy

• Create a solution to prevent it

from happening again

Pharmacist on Your Health Care Team

• “Who is your pharmacist?” -or- “What pharmacy do

you use?”

• What services do the pharmacists offer at your local

pharmacies?

 Immunizations  Medication therapy management  Comprehensive medication therapy management

Medication Adherence

It’s a vital sign

Medication Adherence

• Roughly one in five new

prescriptions are never filled

• Approximately half of all filled

prescriptions are taken incorrectly

Partner with Patients to Improve Med Adherence. Pharmacist Letter March 2018. Therapeutics Research Center.

How to Know if Adherence is a Problem

• Identify patients:

 At risk for morbidity or mortality  Taking high-cost medications  Transitioning care settings

• Examine prescription refill information

 Review for primary non-adherence

▪ Schedule follow-up calls

Conversation Starter: Med Adherence Quick Guide. Pharmacist’s Letter. 2018 Therapeutics Research Center. Morisky Scale. Accessed from http://www.measureuppressuredown.com/hcprof/find/toolkit/plank4tool1.pdf

How to Know if Adherence is a Problem

• Ask blame-free, open-ended questions:

 “It must be hard to take all your meds regularly. How often do you miss doses?”  “Do you ever forget to take your medicine?”  “When you feel better, do you sometimes stop taking your medicine?”  “Sometimes, if you feel worse when you take your medicine, do you stop taking it?”

Conversation Starter: Med Adherence Quick Guide. Pharmacist’s Letter. 2018 Therapeutics Research Center. Morisky Scale. Accessed from http://www.measureuppressuredown.com/hcprof/find/toolkit/plank4tool1.pdf

Optimize Therapy

• What is the process in your organization for handling

pharmacy phone calls?

• What resources do you have access to in your

electronic health record (EHR) for drug information?

• How do you reconcile a patient’s medication list? How
• ften do you do this? Who “owns” this in your facility?

Help Patients Remember

• Minimize the number of medications and simplify the

dosing regimen

• Use technology

 Smartphone applications  Text messaging

▪ OnTimeRx (http://www.ontimerx.com/reminders/services.html) ▪ RememberItNow (http://rememberitnow.com/index.php)

 Manufacturer provided adherence tools

▪ Pradaxa refill reminders (https://www.pradaxa.com/refill-reminders) ▪ Xarelto CarePath (https://www.xarelto-us.com/xarelto-patient- assistance/xarelto-carepath)

Help Patients Remember

• Medication synchronization
• Encourage 90 day fills
• Pill boxes

 Variety to fit all needs  Can incorporate technology

• Adherence packaging

Address Physical Barriers

• Do they have transportation?

 Can the pharmacy deliver?

• Is the medication in stock/is the pharmacy open?
• Does the patient have physical limitations?

 Autodrop or Magic Touch for eye drops  Spacers for metered dose inhalers (MDI)  Alternative device if unable to use correctly

Address Financial Barriers

• Can you access the patient’s formulary?
• What is the process for prior authorization in your

facility?

 http://www.covermymeds.com

• Have free or low-cost alternatives been considered?

 Do Medicare beneficiaries qualify for manufacturer patient assistance programs?

• Can tablet-splitting be used to save money?

Communicate

• Prescription reminders are sent electronically
• Utilize the SIMPLE strategy

 Simplify regimen  Impart knowledge  Modify patient beliefs and human behavior  Provide communication and trust  Leave the bias  Evaluate Adherence

Communicate

• Avoid medical jargon
• Listen, empathize, reassure and motivate
• Assess understanding

 Teach-back method

• Use visual aids
• Help patients create an accurate medication list

 Encourage them to carry it!

Educate on Risks Versus Benefits

• Utilize shared decision making

 Explain the benefits of the medication and how it addresses the condition or prevents complications  Let patients know what to expect  Discuss side effects  Describe the risks and benefits of alternatives  Explore the patient’s preferences and values

Are you Culturally Competent?

Cultural Respect

https://www.nih.gov/institutes-nih/nih-

• ffice-director/office-communications-

public-liaison/clear- communication/cultural-respect

Resources

• Teach-back Method: http://www.teachbacktraining.org/
• STEPS forward Medication Adherence:

https://www.stepsforward.org/modules/medication-adherence

• Medication Therapy Management:

https://www.ahrq.gov/professionals/quality-patient- safety/pharmhealthlit/mtm.html

• Motivational Interviewing: https://motivationalinterviewing.org/
• r https://www.integration.samhsa.gov/clinical-

practice/motivational-interviewing

Resources

• Shared Decision Making:

http://shareddecisions.mayoclinic.org/

• Health Literacy:

https://nnlm.gov/initiatives/topics/health-literacy or https://www.cdc.gov/healthliteracy/learn/

Questions?

Stevi Sy, PharmD

ssy@mpqhf.org www.mpqhf.org

Developed by Mountain-Pacific Quality Health, the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Montana, Wyoming, Alaska, Hawaii and the U.S. Pacific Territories of Guam and American Samoa and the Commonwealth of the Northern Mariana Islands, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-MPQHF-WY-C3-18-21

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