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Diane Catellier, DrPH, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, 137 E. Franklin Street, Suite 203, CB #8030, Chapel Hill, NC 27514-4145, Scott R. Smith, MSPH, PhD, School of Pharmacy, University of North Carolina at Chapel Hill, 205-J Beard Hall, CB #7360, Chapel Hill, NC 27599-7360, Elizabeth A. Conlisk, PhD, School of Natural Science, Hampshire College, 893 West Street, Amherst, MA 01002, and Gina Upchurch, RPh, MPH, Senior PHARMAssist, 123 Market Street, Durham, NC 27701-3221, 919-682-4962, gina@seniorpharmassist.org.
Background: National, state and local elections for the last decade have frequently included discussions about the elderly and their prescription medication needs. The problems elderly Americans face with accessing prescription medications has led to the recent enactment of new federal legislation that will offer drug benefits to all Medicare beneficiaries. Previous efforts to improve access to prescription medications in the elderly have created a patchwork of drug assistance programs funded by community, state, and pharmaceutical industry-sponsored programs. Most of these programs have focused on providing drug products, with the implicit assumption that improved access to pharmaceuticals will translate into better health for seniors. However, there are few formal evaluations of the effects on health outcomes of prescription drug assistance programs in the elderly. Recent findings from Gurwitz and colleagues support previous studies that suggest older adults not only need access to prescription medications but also need assistance with the management of drug therapies to avoid prescribing and monitoring errors to optimize treatment outcomes. Senior PHARMAssist is a non-profit pharmaceutical care program that has been operating in Durham, North Carolina since 1994. Objective: This study evaluated whether the Senior PHARMAssist pharmaceutical care program of medication assistance payment, medication management, and tailored community referral for seniors with limited incomes resulted in improved and sustained outcomes. Methods: Baseline interviews and 3 follow-up interviews (months 6, 12, and 24) were conducted to assess changes in medication knowledge, medication adherence, polypharmacy, health and functional status, and health service utilization. The PRECEDE-PROCEED model provided the framework for development and evaluation of Senior PHARMAssist. Results: Among 506 program participants with follow-up data, knowledge of medication purpose and perceived health improved significantly. Rates of bed-bound episodes, emergency department (ED) visits (number in previous year, mean – 1.23 at baseline, 0.97 at 6 months, 0.81 at 12 months, and 0.88 at 24 months) and hospitalizations (0.81, 0.72, 0.48, and 0.39 respectively) were significantly reduced. Improvements tended to occur during the first 6 months of participation and were sustained through year 2. Baseline functional health status was maintained through 2 years of follow-up. Conclusions: This evaluation provides evidence to support the benefits of integrating prescription drug coverage with medication management when providing pharmaceutical care to older adults. The observed benefits of this approach should be confirmed with a randomized controlled trial.
Learning Objectives:
Keywords: Community-Based Health Promotion, Elderly
Related Web page: www.seniorpharmassist.org
Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: I am the Executive Director of Senior PHARMAssist.