Senior Care Pharmacist最新文献

Pharmacists have historically been compensated through fees tied to traditional prescription medication dispensing in a pharmacy. However, contemporary pharmacy practice involves a wide range of direct patient-care activities across different settings, including long-term and post-acute care (LTPAC). The shift from fee-for-service (FFS) to value-based care (VBC) models necessitates the development of quality measures (QMs) that encompass pharmacists' clinical contributions that bring value to patient care and streamline costs.Although many pharmacists in LTPAC settings provide services above and beyond the traditional, regulatory-based requirements, the lack of QMs that acknowledge these clinical-based activities excludes pharmacists from fully participating in value-based reimbursement models. This article provides an overview of quality measures and examines the limitations of current metrics in the LTPAC setting. It also describes the efforts and conclusions of two ASCP volunteer workgroups tasked with identifying LTPAC-specific quality measures and outlines three areas for action.

Continuous glucose monitors (CGMs) have undergone tremendous improvements over the last decade and have become a crucial tool in day-to-day diabetes management. Despite technological advancements and their proven benefits, barriers exist that may impede the use of CGMs in older adults. However, these barriers can be overcome with proper education and a support system. The purpose of this article is to highlight the common barriers associated with continuous glucose monitoring and to present approaches to overcoming these barriers for older adults.The authors conducted a PubMed search using the following terms: continuous glucose monitoring, type 2 diabetes, limitations, continuous glucose monitoring adherence, age: 65+, continuous glucose monitoring challenges age: 65+, use of CGM in elderly patients with type 2 diabetes, and barriers to use CGM in elderly patients with type 2 diabetes. They also obtained guideline information from the American Diabetes Association (ADA) and the American Association of Clinical Endocrinology (AACE) on the use of CGMs in older individuals.Older adults may face several issues that could keep them from starting or continuing to use CGMs. These include lack of insurance coverage and concerns about cost, poor health numeracy and literacy, doubts about their ability to use CGMs, and lack of exposure to technology. Approaches such as assistance programs and comprehensive, hands-on education and training can help improve their ability, confidence, and willingness to use a CGM.CGMs have revolutionized the management of diabetes in older adults by alerting them to trends and fluctuations in their real-time glucose levels, which can be used to adjust their medications and prevent glycemic variation. Identifying an individual's specific barriers and then employing approaches to overcome them is crucial to empowering patients to benefit from CGM technology, optimize their overall diabetes management, and prevent complications. A patient must feel empowered and invested in managing their diabetes using their personal insights and the information and education they receive to guide care decisions.

The Senior Care Pharmacist is launching a series of age-friendly cases that demonstrate the value of collaboration between pharmacists and other health care professionals to integrate evidence-based practices, avoid harm, and improve care in alignment with What Matters to older adults. Over the next several issues of the journal, articles focused on each of the 4Ms - What Matters, Medication, Mentation, and Mobility - will demonstrate the application of Age-Friendly care principles consistent with the Institute for Healthcare Improvement and the John A. Hartford Foundation's Age-Friendly ecosystem. These case discussions will offer the opportunity for recertification credit for Board Certified Geriatric Pharmacists (BCGP) upon achieving a passing score on the associated self-assessment questions.

This is the first in a series of Age-Friendly case studies developed as a function of the John A. Hartford Foundation grant to the American Society of Consultant Pharmacists and the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland School of Pharmacy to Leverage Pharmacists as Age-Friendly 4Ms Champions. This series presents a case for each of the 4Ms: What Matters, Medication, Mentation, and Mobility, and examines how these elements interrelate to optimize care for older patients.This report involves adopting the 4Ms Framework of an Age-Friendly Heath System (What Matters, Medication, Mentation, and Mobility) in combination with the Patient Priorities Care (PPC) approach for a female patient with multiple chronic conditions. PPC supports patients and care teams in aligning health care decisions with what matters most to the patient. While applicable to all patients, it is particularly valuable for older patients with multiple chronic conditions, such as the patient in this case.The authors sought to identify what matters most to the patient, specifically her desires to spend more time with her grandchildren, volunteer in her community, and maintain independence in mobility. They then worked with the care team to determine how best to support those goals.Fatigue was identified as the greatest barrier. The team evaluated potential interventions to reduce the patient's fatigue, considering their risks, benefits, relative likelihood of effect, and feasibility. After engaging in collaborative decision-making with the patient, the team selected an intervention and followed up to assess its impact on the patient's ability to achieve her goals.This case illustrates how the PPC approach can help operationalize patient-centered care by aligning clinical decisions with what matters most to older adults with multiple chronic conditions.

Background Falls, specifically in the older population, can lead to adverse health consequences including fractures, head injuries, and increased length of hospital stay. In addition, falls greatly increase total medical costs. Although risk factors have been identified and studied, inpatient falls still occur at a high rate. Objectives The primary objective of this study was to identify the medications associated with inpatient falls when compared to a matched control group of patients who did not fall at a Veterans Affairs Medical Center (VAMC). Methods This single-center, case-control, retrospective study reviewed patients admitted to a VAMC from August 2018 to August 2023. Patients were included if they were 65 years of age or older and admitted for at least 48 hours. Patients admitted to the intensive care unit or hospice unit were excluded. Fall patients were matched 1:1 to the control group for age, gender, length of stay, and service type at time of fall. The primary outcome was identifying medications associated with falls. Results Antipsychotics (P = 0.009), non-sedating antidepressants (P = 0.011), and finasteride (P = 0.034) were found to have a higher association with falls compared to the control group. Comorbidities with higher association with falls were history of falls (P = 0.001) and urinary incontinence (P = 0.013). Conclusion Administration of antipsychotics and nonsedating antidepressants increased risk of inpatient falls in this study. Further research is needed with larger and more diverse patient populations to validate these results.

Background An estimated 14% of U.S. adults are affected by CKD, of whom about 34% are aged 65 years or older. Certain prescribed or over-the-counter medications can exacerbate or help slow CKD progression. Objective To evaluate prescriptions or recommendations for potentially beneficial and harmful medications in patients with CKD. Design Retrospective, cross-sectional analysis of medical records from U.S. office-based physician visits. Setting National Ambulatory Medical Care Survey, visits made by patients with CKD, 2014-2019. Interventions Comparison of rates and predictors for potentially beneficial versus potentially harmful medications including both prescribed and recommended over-the-counter agents. Methods CKD and related comorbidities were identified using indicators collected from the record regardless of the reason for the sampled visit. Medication classification was based on current guidelines and studies. Analyses included descriptive statistics of patient characteristics and predictors of beneficial versus harmful medication prescriptions/ recommendations. Results A total of 2,805 adult patients with a diagnosis of CKD were sampled. A plurality were aged 75 years or older (47.4%); majorities were White non-Hispanic (64.0%) with comorbid hypertension (78.8%). Beneficial medications only were prescribed/ recommended to 12.2% of patients, harmful medications only to 20.6%, a mix of beneficial/ harmful medications to 26.7%, and neither to 40.5%. Strong positive predictors of potentially harmful medication prescriptions/recommendations included polypharmacy and diagnoses of cerebrovascular disease or congestive heart failure. Discussion Prescribing patterns for patients with CKD highlight the importance of medication optimization to balance therapeutic benefits and harms. Conclusion Pharmacists can educate providers to improve prescribing practices in patients with CKD.

Background In post-acute and long-term care (PALTC) facilities, challenges exist to optimizing medication management. During the COVID-19 pandemic, nursing homes (NHs) sought ways to streamline medication administration and deprescribe medications. Objective This quality improvement (QI) initiative aimed to implement medication-related projects in three NHs. Methods Each NH was assigned a nurse practitioner (NP) QI mentor who led the facilities through the QI efforts using validated tools during the COVID-19 pandemic. Each facility selected their medication-related topic of interest. The QI efforts were implemented by the NH staff including the director of nursing, providers, and consultant pharmacists. Results Two facilities focused on general medication deprescribing, and the third facility focused specifically on antipsychotic deprescribing. Successful deprescribing interventions occurred in all three facilities; however, they did not achieve all QI goals. Conclusion Successful deprescribing can occur using mentored implementation of QI tools. However, it is imperative to have key stakeholders within NHs who are supportive and engaged in the deprescribing process, such as facility staff (leadership and front-line staff), facility providers, consultant pharmacists, and residents/families.