Polypharmacy
Or, so little time, so many pills....
Ralph W. Kirk, Presenter
Healthcom www.Seniorhealthadvantage.com
LTCIF Conference
Las Vegas, 2006
Polypharmacy Starts With
Prescriptions
• U.S. Physicians Create 3 Billion Per
year and Increasing
• 3,000,000,000.00+
• With a B!
The Number of Prescriptions Is
Increasing Because:
• Increase in Population and Age
Structure
• Number of People Being Prescribed
Medications
• Increase in The Number of
Prescriptions Per person
The Number of Prescriptions Is
Increasing Because:
• Substituting Drug Therapies for
Alternative Therapies
• Advertising ($13.9 Billion in 1999)
70% is spent on 20 drugs
Donald Sutherland, Institute for SocioEconomic Studies 6/2001
The Number of Prescriptions Is
Increasing Because:
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Random Consumer Survey:
151M-177M Heard or Saw Meds Ads
29% Have Asked Their Physicians for
Specific Drugs After Seeing Them on TV
25% Would Try to Persuade If Refused.
25% Would Change Doctors If Refused
Donald Sutherland, Institute for SocioEconomic Studies 6/2001
“Princess Bride” Syndrome
• Miracle Pill
• Cure or Treat Anything
• Chocolate Coated
Prescription Drug Expenditures
in Billions of Dollars
250
200
150
100
50
0
1960 1970 1980 1990 1997 2001 2002 2003 2004 2005
1993-2000:
• Oral Antihistamines—Up 1079%
(Claritin, Zyrtec, Allegra)
• Antidepressants—Up 399%
(Prozac, Zoloft, Paxil)
• Cholesterol Reducers—Up 365%
(Lipitor, Zocor, Pravachol)
• Antihypertensive drugs—Up 168%
Zestril, Vasotec, Accupril
• Anti-ulcerant Drugs-----Up 146%
Prilosec, Prevacid, Panatdine Hel)
Donald Sutherland, Institute for SocioEconomic Studies 6/2001
Result:
• 10.9 Prescriptions per capita. (2001)
• 65% of all your policyholder’s physician
encounters result in yet another
prescription.
American Journal of HealthSystem Pharmacy 2003
2002 Medco Prescription Study
• 25% of seniors had prescriptions from
four or more physicians annually
• 10% of seniors had prescriptions from
six or more physicians
annually.
LTC Stats-Healthcom Study
• 16.7 Prescriptions Daily--Average LTC
Policyholder Applying for HH Benefits
• 3.23 Times Per Day
• 500 Pills Monthly
What is Polypharmacy?
(1 of 2)
• Unwanted Duplication of Drugs
• Dosages That Are Too High or Too Low
• Medications Incorrectly Prescribed or
Filled
What is Polypharmacy?
(2 of 2)
• Herbal Medications Interacting
• Too Many Pills To Take
• More Than 5 Prescriptions Daily
Polypharmacy/Nonadherence
Mix
(1 of 2)
• Failure To Take (Forgot, Money, Side Effects,
Understanding, Confusion, etc)
• Taking Too Much Medication (Naps, Pain)
• Wrong Time (What Day is it?)
Health Alliance Plan, 2006
Polypharmacy/Nonadherence
Mix
(2 of 2)
• Premature Discontinuance of Meds
• Trading/Sharing of Drugs
• Self-Medicating (If 1 is Good, 3 is Even
Better!)
Health Alliance Plan, 2006
How Widespread Is
Polypharmacy/Medication
Nonadherence?
15,000 Studies
• 33% of Seniors Adhere
• 33% of Seniors Sometimes Adhere
• 33% Never Adhere
OIG Medication Regimens: Causes of Noncompliance
Symptoms of Polypharmacy
(1 of 3)
• Tiredness, sleepiness, decreased
alertness (ADL)
• Constipation, diarrhea, incontinence
(ADL)
• Loss of Appetite (ADL)
• Confusion (ADL)
By Elizabeth A. Peterson, MFA, Aging Gracefully: Reducing Your Risk of Polypharmacy
Symptoms of Polypharmacy
(2 of 3)
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Visual or Auditory Hallucinations (ADL)
Anxiety or Excitability
Dizziness (ADL)
Decreased Sexual Behavior
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By Elizabeth A. Peterson, MFA, Aging Gracefully: Reducing Your Risk of Polypharmacy
Symptoms of Polypharmacy
(3 of 3)
• Falls (ADL)
• Depression or Lack of Interest in
Activities (ADL)
• Weakness (ADL)
• Tremors (ADL)
By Elizabeth A. Peterson, MFA, Aging Gracefully: Reducing Your Risk of Polypharmacy
But, Other That That,...
• “Patients forget to take their
medications, creatively alter their
medications, engage in unendorsed
polypharmacy, mix their medications
and take medications in combinations
that may have dire synergistic
interaction effects, such as dizziness
and confusion. “ Harold Gottlieb, PhD, 2000 Drug Benefit Trends
Dizziness,Confusion
And ADL’s
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Dressing
Eating
Transferring
Toileting
Bathing
Ambulation
Polypharmacy and Nursing
Home Admissions
• 25% Of All Nursing Home Admissions
Are Because “the Client Cannot SelfAdminister Their Medications”.
• 386,000 Present Residents
OIG Medication Regimens-Causes of Noncompliance
Polypharmacy and Cognitive
Impairment
• “Drug Induced Dementia May Be A
Cause of Cognitive Impairment In About
12% Of All Patients With Suspected
Dementia. “
OIG Medication Regimens-Causes of Noncompliance
Polypharmacy and Falls
• 33% of All Seniors and 50% of All
Seniors 85+ Fall Each Year
• Falls Often Trigger A Downward Spiral
That Ends In Death.
• Fear of Falling Can Start a ADL Spiral
• Polypharmacy is Often A Cause of Falls
What Does Polypharmacy/
Nonadherence Mean to LTCI?
• More Nursing Home Admissions
• Loss of Premium Payment
• More Cognitive Impairment To Create
Nursing Home and Home Health Claims
• More Falls To Create Nursing Home
and Home Health Claims
What Could Reduced Polypharmacy/and
Nonadherence Mean to LTCI?
• Fewer or Delayed Nursing Home
Admissions
• Fewer Physician Visits
• Fewer RN Visits
• Fewer Aide Visits
Studies Solutions
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Change Healthcare Attitudes/Seniors
Improve Support Systems
Computerize Pharmacy Tracking
Medication Screenings
Plastic Boxes
LTCI Solutions
• Practical
• Cost-Savings
• Non-Global
Solutions Currently In Use
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Muffin Tins
Egg Cartons
Shoeboxes
Screw and Bolt Boxes
Envelopes
Plastic Boxes
How Can LTCI Achieve
Savings?
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Utilize Pre-Claim Prevention
Utilize Patient and Family Education
Utilize Assistive Technology
Embrace Win-Win-Win Situations
Utilize Pre-Claim Prevention
• Expand LTC Mindset
• Educate Policyholders and Their
Families
• Multi-departmental Involvement
• Improve Predictive Modeling
• Monitor and Report Progress
Utilize Education
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Educate Your Case Managers
Provide Incentives
Regular Mailings To Policyholders
Advertise That You Care.
Educate the Public
Utilize Assistive Technologies
Policy From The Top
Change in Culture
Multi-Departmental
Monitored By Management
Examples of Assistive Technology
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Digital Assistant
Screen Display
Automatic Reminder
Keeps a Record
Internet Based In-Home
Automatic Meds Dispensers
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Lockable
28 Compartments
Beeps and Flashes
20 Pills
Live Interventions
Internet Reports
For Policyholders At Home
• Personal Emergency Response
The Technology Effect (Baylor)
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10-1 reduction in LTC costs
23% reduction in length of stay
6.5% decrease in ER visits
26% reduction in hospital admissions
More Assistive Technology
• Home automated medication manager
• Family/RN filling
• 98% Adherence
More Assistive Technology
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Talks/Flashes to Client to Remind
Holds 60 Cups of Meds
Can Dispense Up to 6 Times Per Day
Posts Adherence/Function/Load on
Internet Nightly
More Assistive Technology
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Live Intervention on Nonadherence
Family/Others Can Be Involved
Can Be Loaded By Family/Nurse
High Client Acceptance
For Policyholders At Home
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Adherence averages 98.5%
“Crashes” prevented
Clients stay at home
Claims reduced
Nursing home admissions
delayed/eliminated
For Policyholders At Home
Thoracic Base Impedence Fluid
Retention Monitors--Zoe
• CHF Patients
• Predictive of Fluid Build-up
• Monitors Medication Changes
For Policyholders At Home
In-Home Vital Sign Monitoring
• Blood Pressure
• Weight
• Glucose
• Pulse Ox
Case History 3358243
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Anna, 74 years Old
New York
10 Meds Daily
History/Pills on Floor
Asked For Help
LTCI
Case History 3358243
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Technology Installed
Aide Hours 6/2
$25,570.00 Prior
$8,190 After
$16,380 Savings
Happy Policyholder
Case History 6784536
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Shelia, 85 Years Old
Falls
Aide 9 Hours a Day
Complained
Nursing Home
Considered
Case History 6784536
• Technology Installed
• Aide 9/2 Hrs Per
Day
• $29,484 Prior
• $6,912 After
• $22,572 Savings
• $60,000 Nursing
Home Savings
Case History 6892434
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Dan, 71 Years Old
Suffered Stroke
Requires 8 hrs Aide
Wanted Privacy, Ind.
Case History 6892434
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Technology Installed
Requires 8 hrs Aide
$42,515.00 Prior
Aide Cut 8/4
$21,617.60 After
$20,897.40 Savings
Savings Can Be Significant
$125 month Tech
$100 RN visits
$2,700 annually
$5,000 monthly
nursing home
average
$60,000 annually
100=$270,000
100=$6,000,000
• Savings:
$5,730.000
Summary
• Polypharmacy is a serious, expensive
problem.
• As a society we are going to become
more drug dependent.
• Solutions are not easy, but rewarding.
• LTC has a challenge.
Summary
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Technology Is Advancing Rapidly
Client Acceptance Is High
Results Are Positive
Savings Are Real. Win-Win-Win
Society Is Changing
Thank You.
Ralph W. Kirk
Healthcom
800-525-6237 Ext 270
4/06 LTCIF