Improving Medication Adherence by Utilizing Case Managers in

Improving Medication Adherence by Utilizing Case Managers in an Outpatient Setting Stacey Bartell, MD Nina Desai, MD Thien (Hoa) Trang, MD

Disclosures • None

Providence Family Medicine Program St John Providence Hospital Community Hospital Two sites-Southfield, South Lyon, MI 9 -9 -9, dual program

Introduction AAFP Health Literacy Universal Precautions Toolkit 1 20 tools total Brown Bag Method, Using Health Education Effectively Improve Medication Adherence and Accuracy Mi. PCT

Methods - All patients except OB/Peds - April-Oct 2015 - Survey given while waiting for provider - If answered YES to questions 3 -9 - referral

Your health is very important us and together we can work on ways on how we can improve it. One such way is with your medications. Please circle YES or NO for each question. 1) Do you take more than 3 medicines? YES NO 2) Do you sometimes forget to take your medicines? YES NO If you answer NO to the first two questions, you can stop here. 3) Thinking over the past 2 weeks, were there any days you did not take your medicine? YES NO 4) Have you ever cut back or stopped taking your medicine without telling your doctor because it made you feel worse when you took it? YES NO 5) Have you ever stop taking your medicines because of cost? YES NO 6) When you travel or leave home, do you sometimes forget to bring along your medicine? YES 7) When you feel like your symptoms are under control, do you sometimes stop taking your medicine? YES NO NO 8) Did you miss taking any of your medicines yesterday? YES NO 9) Taking medicine every day is a real inconvenience for some people. Do you ever feel hassled about sticking to your treatment plan? YES NO 10) Do you know what each of your medicines are for? __ never/rarely __ most medicines __some medicines __none 11) How often do you have difficulty remembering to take your all your medicines? __never/rarely __once in a while __sometimes __usually __all the time 12) Do you have a method to remember to take your medications? if yes, how so______________________________? 13) What prevents you from taking your medicines? (cost, not sure how to take them. . . ? ) _______________________________? OFFICE USE ONLY Case Management Referral (YES to 3 to questions # 3 -9) YES NO

Case Management Referral - Face to Face encounter Identify all Medications Current process AAFP tools - Brown Bag Method (purple bag) - Pill box - Pill chart - “My Daily Medications” online form

Case Management Referral - Instructions for each Medication - AAFP: Teach-back method - Observation of pill box set-up - Review Survey

Case Management Referral - Telephone follow up in 2 weeks - • Evaluate - My Daily Medications - Filling own pill box independently - Taking medications as prescribed consistently - Understands importance of and why taking the medicine - Identifies person responsible for assisting the patient with set-up

Case Management Referral - Evaluate need for another face to face - Post- survey given: satisfaction survey - Notification sent to provider - case closed

100% 90% Response to questions #1 and #2 80% 86, 4% 70, 7% 70% 60% 50% Yes 40% No 30% 29, 3% 20% 13, 6% 10% 0% Take more than 3 meds Sometimes forget to take meds 2722 patients were surveyed / 917 answered “yes” to either question #1 or question #2

lt Fe in en ce d y da 12% ni ve co s 1 ed m l t en em ov pr m -I ve ra /t 11% M iss pe d w 9% ot Iss ue ct s 15% rg st fe Ef 10% Co e id -S ks w 25% Fo d pe s 2 ed m 26% St op op St M iss 30% Percent who responded “yes” (questions 3 -9) 20% 14% 12% 9% 5% 0%

Results Item 10 - knowledge of meds

Results Item 11 - difficulty remembering

Results Item 12. Do you have a method to remember to take your medications?

Results Item 13. What prevents you from taking your medicines?

Case Management Notes - Forgetting only to take one medication - Appliances - PRN medications - Case Management already in place

Case Management Notes - Timing - cost/insurance/health status/stress - Difficulties with pill box/container - Return Visits - Family Engagement

Discussion - Comprehensive Medication List - Non-Compliance vs Forgetfulness - Engaging Providers - Bridging the Health Literacy Gap - Team based approach

Discussion - Electronic Applications - EMR - Real Time Case Management Intervention - Family Engagement - Practice Policy for Medication Refills

Questions? ?

Please evaluate this session at: stfm. org/sessionevaluation

References 1 Horsley, Liz. Project Manager “Health Literacy Universal Precautions Toolkit. ” Agency for Healthcare Quality and Research, www. ahrq. gov/legacy/qual/literacy/healthliteracytoolkit. pdf 2 Morisky, Donald, Sc. D, Sc. M, MSPH, Professor, Department of Community Health Sciences, UCLA School of Public Health, 650 Charles E Young Drive South, Los Angeles, CA 90095 3 Boschert, Sherry. “Asthma Medication Nonadherence Mainly Unintentional. ”Family Practice News Apr. 2014: 31. print 4 Weiss, Barry D. M. D. “How to Bridge the Health Literacy Gap. ” Family Practice Management website, www. aafp. org/fpm. Jan/Feb 2014 5 Scott, Amy BSPHARM, RPH. Mc. Clure, Jane BA, RN. ”Engaging Providers in Medication Adherence: A Health Plan Case Study. ” American Health & Drug Benefits 2010 Nov-Dec; 3(6): 372 -380 6 Margoulis, D, Wong, J, Goldman, ML. “Delegating Responsiblity from Clinicans to Nonprofessional Personnel: The Example of Hypertension Control. Journal of American Board of Family Medicine. 2012 Mar-Apr; 25(2): 209 -15 7 Wens, J. , Vermeire, E. , Royen, V. P. , Sabbe, B. , and Denekens, J. GP’s perspective of type 2 diabetes patients’ adherence to treatment: A qualitative analysis of barriers and solutions. 2005; 6: 20.

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