United Way of Dane County: Smart Meds Program

At a Glance

The Smart Meds program uses a Comprehensive Medication Reviews (CMR) to help low income, at risk older adults with chronic health conditions and complex medication regimens in managing their medications safely, in order to reduce adverse drug events and falls that lead to hospitalizations and emergency room visits.

This project supported the implementation and evaluation of Smart Meds in pharmacy clinic-based sites within a large local health system. Results, including a decrease in hospital readmission rates for Smart Meds participants, suggest that implementing CMRs into clinical workflow is an effective way to support older adults’ medication management needs.

The Challenge

In Dane County, four out of five Medicare patients over age 65 have a chronic health condition, many of which are managed with medication. According to a study by three major Dane County health systems of patients over age 65, from January to April 2010, who were prescribed at least one medication, these 7,978 older adults take an average of 6.4 prescription medications. Taking five to eight medications exposes a person to a 50 percent chance of experiencing a negative reaction to a medication, clinically known as an Adverse Drug Event (ADE). ADEs are one of the top five reasons older adults require hospitalizations and out-of-home care.

Project Goals

This grant supported a two-year pilot in which Smart Meds Comprehensive Medication Reviews (CMR) were held at three UW Health pharmacy clinic-based sites. The Smart Meds program, a collaborative project between United Way of Dane County, Pharmacy Society of Wisconsin and the UW Health Pharmacy Services Department, aimed to improve specific health outcomes for vulnerable older adults in Dane County with multiple chronic health conditions and complex medication regimens by providing them with CMR services at UW Health primary care clinics and improving physician-to-pharmacist communication on medication therapy management.

Funding from the Partnership Program supported the implementation and evaluation of the program at three UW Health clinic sites. The goal of the project was to evaluate whether implementing the CMR model in clinical settings would increase reach to the population and improve coordination among medical care providers.

By launching the Smart Meds program with clinic-based pharmacists, the project expected that physicians would be more likely to refer their patients for a CMR, pharmacists and physicians will confer after the CMR on recommendations, and the medical team will coordinate with the patient to assure adherence with the new medication plan.

Results

The Smart Meds CMR program was successful in supporting older adults and their medication management. This project integrated CMRs into clinical workflow at UW Health. The program was piloted at eight different UW Health Primary Care clinics, exceeding the original plan to pilot the program at 3 primary care clinics. This increase reflects the deepened relationship with UW Health partners and their acceptance and support of the program.

The project team also collected feedback from participants by using a post-CMR patient satisfaction
survey, which showed a high rate of participant satisfaction.
Since the program launched within the UW Health system in April 2017:

• It has served 110 older adult patients with Smart Meds CMRs.
• On average, Smart Meds participants took 14 medications, including 9 prescription (Rx) and 5 over-the-counter medications.
• The average age of participants was 73 years old.
• UW Health pharmacists made an average of 2 recommendations per patient to their medication regimen to help reduce adverse drug events.

The CMR program has allowed for primary care pharmacists to work collaboratively with the patient’s physician to establish a care plan which has improved communication between patient, physician and pharmacist. The program has an 83 percent acceptance rate of recommendations by the patients’ primary care providers.

Preliminary evaluation data shows a very positive impact on participant’s hospital readmission rate. National CMR data shows that 20 percent of all Medicare patients readmit to the hospital within 30 days of discharge. Preliminary Smart Meds patient readmission rate is 9.5 percent. The overall UW Health 30-day readmission rate for patients ages 65 and older is 11.5 percent.

The project is completing a final evaluation, including the impact of this program on specific patient health outcomes, including blood pressure, hospitalizations, ER visits and hospitalizations related to falls.

Lasting Impact

The Smart Meds program is integral to United Way of Dane County’s community-wide efforts to support individual older adults as well as multi-generational families. UW Health recognizes medication-related problems as major contributors to hospital readmissions and emergency room visits and sees this
project as a valuable resource for primary care pharmacists.