Optimizing Aging in Place: Leveraging Medication Management to Reduce Hospitalizations

As the desire to age in place grows, ensuring safety and health at home becomes paramount for older adults. A recent study published in  Home HealthCare Now, and brought to my attention by McKnight's Home Care highlights a powerful strategy for improving aging-in-place outcomes: prioritizing medication evaluation and reconciliation. Conducted by Providence VNA Home Health in partnership with Washington State University College of Pharmacy, the study demonstrates how targeted medication management can significantly reduce hospitalization risks for high-risk home health patients, particularly those with heart failure. Here’s a closer look at the study’s findings and practical steps you can take to enhance your aging-in-place plan.

Key Findings from the StudyThe study, conducted between 2018 and 2020, focused on high-risk home health patients and examined the impact of medication evaluation and reconciliation—an interdisciplinary process involving clinicians and pharmacists to ensure accurate documentation and optimization of prescribed medications. The results were compelling:

• Reduced Hospitalizations: Among high-risk heart failure patients, 30-day hospitalization rates dropped from 12% to 9% following medication evaluation and reconciliation.
• Lower Rehospitalizations: The initiative reduced rehospitalizations by approximately two patients per month, underscoring its potential to improve long-term outcomes.
• Prevalent Medication Issues: Approximately 60% of patients had unreconciled medications upon admission to home health, and prior studies noted that up to 71% of heart failure patients face medication reconciliation challenges during transitions from hospital to home.
• Underutilized Practices: Despite their effectiveness, medication evaluation and reconciliation remain underused in home healthcare, highlighting an opportunity for improvement.

The study emphasizes that involving pharmacists in an interdisciplinary approach can address the complexities of medication regimens, ultimately enhancing patient safety and reducing costly hospital stays. For those aging in place, these findings point to actionable strategies to stay healthier and more independent at home.
Understanding Medication Reconciliation: What It Is, Who Does It, and How It’s Done? 

Medication reconciliation is a critical process in healthcare aimed at ensuring the accuracy and safety of a patient’s medication regimen, particularly during transitions in care (e.g., from hospital to home, or between healthcare providers). Below, we explore what medication reconciliation entails, who performs it, and how it is conducted, drawing on insights from the Providence VNA Home Health study and general healthcare practices.
Medication reconciliation is the process of creating and maintaining an accurate list of all medications a patient is taking, including prescription drugs, over-the-counter medications, supplements, and vitamins. The goal is to:

• Ensure accuracy: Verify that the medications a patient is taking match what is prescribed and intended.
• Prevent errors: Identify and resolve discrepancies, such as duplicate medications, incorrect dosages, or potential drug interactions.
• Optimize outcomes: Ensure medications are effective and safe, reducing risks like hospitalizations due to medication-related issues.

The Providence VNA Home Health study highlighted its importance, showing that medication reconciliation reduced 30-day hospitalization rates.Who Performs Medication Reconciliation?Medication reconciliation is typically a collaborative effort involving multiple healthcare professionals, depending on the care setting:

• Pharmacists: As seen in the Providence VNA study, pharmacists play a key role due to their expertise in medication management. They evaluate drug regimens for interactions, appropriateness, and adherence.
• Nurses: Home health nurses or clinicians often initiate reconciliation by collecting medication information from patients and comparing it to medical records.
• Physicians: Doctors review and approve the reconciled medication list, making adjustments as needed.
• Patients and Caregivers: Patients or their caregivers provide critical input by sharing details about what medications are actually being taken, including non-prescription items.
• Other Providers: In some cases, care coordinators or medical assistants may assist in gathering or documenting medication information.

In the study, an interdisciplinary approach involving clinicians and pharmacists was key to success, emphasizing the value of teamwork in complex cases, such as those involving high-risk patients with heart failure.How is Medication Reconciliation Done?Medication reconciliation follows a structured process to ensure thoroughness and accuracy. The steps typically include:

1. Collect a Comprehensive Medication History:
   • What Happens: A healthcare professional (e.g., nurse or pharmacist) gathers a complete list of the patient’s medications. This includes prescription drugs, over-the-counter medications, supplements, and vitamins, along with dosages, frequencies, and administration methods.
   • How It’s Done: The provider interviews the patient or caregiver, reviews medication bottles, and checks records from pharmacies, hospitals, or primary care providers. Tools like electronic health records (EHRs) or patient-reported lists are often used.
   • Challenges: Patients may forget to mention certain medications or supplements, as noted in the study where 60% of patients had unreconciled medications upon admission to home health.
2. Compare with Existing Records:
   • What Happens: The collected medication list is compared to existing records, such as hospital discharge summaries, primary care prescriptions, or home health orders.
   • How It’s Done: The healthcare team identifies discrepancies, such as medications listed in one record but not another, incorrect dosages, or medications no longer needed. Pharmacists may use software to flag potential interactions or errors.
   • Example from Study: The Providence VNA team found that patients with two or more unreconciled medications were at higher risk, underscoring the need for this step.
3. Resolve Discrepancies:
   • What Happens: Any inconsistencies are addressed through consultation with the patient’s healthcare team. This may involve clarifying prescriptions with the prescribing physician, discontinuing unnecessary medications, or adjusting dosages.
   • How It’s Done: Pharmacists or clinicians contact prescribers, discuss findings with the patient, and update the medication list. For example, a patient might be taking an outdated dose of a heart failure medication, which the team corrects.
   • Study Insight: The interdisciplinary approach in the study, involving pharmacists, helped resolve complex issues, contributing to reduced hospitalizations.
4. Create and Share an Updated Medication List:
   • What Happens: A finalized, accurate medication list is created, detailing each medication, dose, frequency, and purpose.
   • How It’s Done: The list is documented in the patient’s medical record, shared with the patient and caregivers, and communicated to all relevant providers (e.g., primary care physician, home health agency, or pharmacy). Patients may receive a printed or digital copy for reference.
   • Best Practice: The study emphasized thorough documentation to ensure continuity of care, especially during transitions like hospital-to-home.
5. Educate and Follow Up:
   • What Happens: Patients and caregivers are educated about the updated medication regimen, including how to take medications correctly and potential side effects to watch for.
   • How It’s Done: Nurses or pharmacists provide verbal or written instructions, answer questions, and may schedule follow-up visits to monitor adherence and address new issues. Tools like medication organizers or apps can support compliance.
   • Study Relevance: The study noted that reinforcing medication reconciliation practices improved outcomes, suggesting ongoing education is critical.

Practical Tips for Patients Aging in PlaceTo incorporate medication reconciliation into your aging-in-place plan:

• Keep an Updated Medication List: Maintain a current list of all medications and share it with every healthcare provider you see.
• Ask for Reconciliation During Transitions: Request that your home health agency or provider perform a medication reconciliation whenever you move between care settings.
• Engage a Pharmacist: Schedule a consultation with a pharmacist to review your medications, especially if you have multiple prescriptions or chronic conditions like heart failure.
• Use Technology: Apps like Medisafe or smart pill dispensers can help track medications and remind you of doses, reducing errors.
• Communicate Openly: Inform your healthcare team about all medications, including supplements, to ensure nothing is overlooked.

Why It Matters for Aging in PlaceThe Providence VNA study showed that medication reconciliation can significantly reduce hospitalization risks, particularly for high-risk patients. For those aging in place, this process minimizes medication errors, enhances safety, and supports independence by preventing health setbacks. By proactively managing medications with the help of healthcare professionals, you can create a safer, more sustainable home environment.

How to Improve Your Aging-in-Place PlanBased on the study’s insights, here are practical steps to incorporate medication management into your aging-in-place plan, along with additional medication-related guidance to ensure success:

1. Request Medication Reconciliation with Every Care Transition
   • What to Do: Work with your healthcare provider or home health agency to ensure a thorough medication reconciliation whenever you transition between care settings (e.g., hospital to home). This involves reviewing all prescribed and over-the-counter medications, supplements, and vitamins to eliminate discrepancies, such as duplicate prescriptions or outdated medications.
   • Why It Matters: The study found that unreconciled medications were common among 60% of patients, contributing to hospitalization risks. A reconciled medication list ensures you’re taking the right drugs at the right doses.
2. Partner with a Pharmacist for Regular Medication Reviews
   • What to Do: Schedule periodic consultations with a pharmacist, either through your home health provider or a local pharmacy. Ask them to evaluate your medication regimen for potential interactions, side effects, or opportunities to simplify your prescriptions.
   • Why It Matters: The study highlights the value of pharmacist involvement in reducing hospitalization rates. Pharmacists can identify issues like polypharmacy (taking multiple medications), which is common among older adults and can increase risks of adverse effects.
3. Use Technology to Track Medications
   • What to Do: Invest in a medication management app or a smart pill dispenser to track doses, set reminders, and share your medication list with caregivers or healthcare providers. Examples include Medisafe or PillPack, which can organize and deliver medications.
   • Why It Matters: Technology can reduce errors, such as missed doses or incorrect timing, which are common contributors to medication-related complications. This is especially helpful for those managing complex regimens at home.
4. Simplify Your Medication Regimen
   • What to Do: Ask your doctor or pharmacist if your medications can be consolidated (e.g., switching to combination pills or once-daily formulations). Also, inquire about deprescribing unnecessary medications.
   • Why It Matters: Simplifying regimens reduces the risk of errors and improves adherence, which is critical for aging in place. The study notes the complexity of medication regimens in home health, making simplification a key strategy.
5. Educate Yourself and Caregivers on Medication Safety
   • What to Do: Learn about your medications, including their purpose, side effects, and proper administration. Share this information with family members or caregivers involved in your care. Resources like the National Institute on Aging or AARP offer guides on medication safety.
   • Why It Matters: Knowledge empowers you to spot issues early, such as side effects or interactions, and ensures caregivers can support you effectively.
6. Create a Centralized Medication List
   • What to Do: Maintain an up-to-date list of all medications, including dosages, schedules, and prescribing doctors. Keep a physical copy in your home and a digital version accessible to healthcare providers or emergency responders.
   • Why It Matters: A centralized list streamlines communication during medical appointments or emergencies, reducing the risk of unreconciled medications, as seen in the study’s findings.
7. Advocate for Interdisciplinary Care
   • What to Do: If you’re working with a home health agency, ask if they offer pharmacist-led medication evaluations or interdisciplinary care teams. If not, explore partnerships with local pharmacies or telehealth services that provide these options.
   • Why It Matters: The study underscores that interdisciplinary collaboration, particularly with pharmacists, enhances outcomes by addressing complex medication challenges.

Additional Medication-Related GuidanceBeyond the study’s focus, here are other evidence-based strategies to strengthen your medication management plan:

• Monitor for Side Effects: Regularly discuss any new symptoms with your doctor, as they may be medication-related. For example, dizziness or fatigue could signal issues that need adjustment.
• Stay Hydrated and Follow Dietary Guidelines: Some medications, particularly for heart failure, require specific dietary or fluid intake considerations. Consult your doctor or pharmacist to align your diet with your prescriptions.
• Plan for Emergencies: Store medications in a clearly labeled, accessible location and ensure emergency contacts know where to find them. Consider a medical alert system that includes medication information.
• Review Over-the-Counter Medications and Supplements: These can interact with prescriptions, so include them in your reconciliation discussions to avoid unintended consequences.

ConclusionThe Providence VNA Home Health study underscores the transformative potential of medication evaluation and reconciliation for aging-in-place success. By reducing hospitalization risks and improving medication safety, these practices empower older adults to live independently with confidence. To optimize your aging-in-place plan, prioritize medication reconciliation, engage pharmacists, leverage technology, and advocate for interdisciplinary care. By taking these steps, you can minimize health risks, enhance your quality of life, and make aging in place a safer, more sustainable reality.