Implementation of the HomeMeds Medication Management System in a Primary Care Setting

Purpose: HomeMeds, an electronic medication management system, has been shown to prevent and reduce adverse effects of medications in the elderly by reconciling medications and looking at cardiovascular, psychotropic, nonsteroidal anti-inflammatory drug (NSAID), or duplication problems. The program was originally designed and tested for use in a home setting, but less is known about use in a primary care setting, and few studies can link the intervention to patient health outcomes. Methods: A retrospective analysis was performed on data from January – June 2017 of patients (n=300) 65 years and older in our electronic medication record (EMR) and from a Center for Disease Control (CDC) validated “Healthy Days” questionnaire administered by Meals on Wheels Inc (MOWI) of Tarrant County at a primary care geriatric clinic. The questionnaires examined physical and mental health and history of falls and hospitalizations, while the EMR provided Activities of Daily Living/Independent Activities of Daily Living (ADL/IADL) scores and demographic data. In addition to frequencies, odds ratios (OR) with 95% confidence intervals (CI) were estimated in a logistic regression analysis. Chi square tests compared groups. Results: The mean age was 77.63 years with 77% being female, and the mean number of medications per person was 11. Of those with alerts (n=210), the mean number of alerts per person was 2, with the most common being duplicate therapies (n=148) and 26% reported a fall history while 41% reported dizziness. The odds of reporting dizziness and a previous fall is 3.7 times higher compared to those without a previous fall. The odds of having a previous fall is 2.4 times higher for those reporting a lower health status (X2=8.433, df=1, p=0.004). Females had a higher proportion and were more likely to generate an alert than males (X2=5.679, df=1, p=0.017). The odds of having an alert are increased, but not statistically significant, for clients with low ADL/IADL scores and nonwhite (p=0.144, p=0.078, p=0.281). Conclusions: If patients are able to change or remove a medication predisposing them to dizziness, perhaps fall risk can be reduced. With the rising elderly population and the elderly’s increased frailty, this could be potentially life-saving. The primary care physician shortage and increasing elderly population make it more crucial than ever to improve patient health and HomeMeds is a feasible and relatively simple way to do just that.