JMIR Publications

ABSTRACT

Background:

Inappropriate medication use after hospital discharge increases fall, readmission, and mortality risks. In the United States, home health care (HHC) serves up to 70% of community-dwelling older adults after hospitalization, yet no validated medication optimization intervention exists for this setting. HomeMED is a patient-centered medication optimization intervention for post-acute HHC that was co-designed with stakeholder engagement among HHC patients and clinicians in 15 U.S. states.

Objective:

This study examined the preliminary effects of HomeMED on medication-related outcomes in older adults receiving post-acute HHC.

Methods:

In this Stage 1B, one-group, pre-post, quasi-experimental pilot study, 22 older patients transitioning from the hospital to post-acute HHC were enrolled and 14 (64%) received the complete intervention (HomeMED). Components of HomeMED included: (1) home medication review to identify deprescribing targets, (2) patient/caregiver interview to assess willingness to deprescribe, (3) provider discussion (using electronic health record structured reports whenever possible), and (4) safety monitoring. Each component was delivered by research HHC nurses during 3-4 home visits with asynchronous pharmacist consultation. Data were collected at baseline, intervention completion and 2-month follow-up via in-home visits, patient/caregiver self-report and extraction from routine HHC assessments. Primary outcomes included the number of potentially inappropriate medications (PIMs) and number of medications associated with geriatric syndromes (MAGS). Secondary outcomes included total medication count and anticholinergic and sedative drug burden measured using the Drug Burden Index (DBI). Analyses were descriptive.

Results:

Of the 14 patients who completed HomeMED, 13 (93%) had recommendations to discontinue or reduce the dose of at least one medication (mean = 3.1, S.D.=2.36). Across all participants, there was a total of 45 medication reduction recommendations, and 51% (23/45) of these recommendations were implemented by the patients’ providers by intervention completion, and 72% (34/45) were implemented by two-month follow-up. Frequently deprescribed drugs included gabapentin (neuropathic analgesic), diphenhydramine (antihistamine), vitamin B12, celecoxib (NSAID), insulin glargine, tamsulosin (alpha blocker), prednisone (corticosteroid), and oxycodone (opioid). From baseline to follow-up, the average PIM count decreased from 4.4 to 3.5 per patient (20% reduction), and MAGS decreased from 7.6 to 6.6 per patient (13% reduction). The average total medication count also decreased from 19.3 to 16.2 per patient (16% reduction), and DBI score decreased from 1.6 to 1.0 (38% reduction).

Conclusions:

A patient-centered medication optimization intervention for post-acute HHC is feasible and acceptable with 72% of recommendations implemented by patients and their providers. This pilot evaluation among 14 HHC patients showed consistent trends in reducing inappropriate medication use based on primary and secondary outcome measures. Clinical Trial: NCT05630144