July 19, 2024

Dr. Antoinette Coe looks at improvements needed during transitions of care, vast need for medication reviews

 

By: Markie Heideman, Content Marketing Manager

 

Improving the Transition of Care 

After many older adults are discharged from the hospital, there is often a miscommunication that takes place – especially around which medications they need once they transition back home. Antoinette Coe, Assistant Professor of Clinical Pharmacy at the U-M College of Pharmacy, is trying to change that through research, particularly in aging populations who live in rural or low-income areas. 

 

“One of the major findings is that there are a lot of medication problems that happen during the transition of care,” Coe explains. “Oftentimes, new medications started in the hospital are continued after a patient is discharged, even though they may no longer need it, or their medications for chronic conditions aren’t restarted after they get home. It can be confusing to know what medications to start, stop, and continue after they return home, especially for those without caregivers to manage their medications.” 

 

Frequently, medications like antipsychotics or sleeping medications are prescribed in a hospital setting to control the confusion or emotional distress of a patient. Coe says more likely than not, most of these patients do not need to continue them when they are back home, in a familiar setting. 

 

Coe’s research also suggests that, even with a caretaker, because of the high-stress and fast-paced nature of a hospital discharge or after an emergency department visit, miscommunication may occur when the provider explains the new medications to patients. 

 

To help move the needle in this space, Coe partnered with the Region VII Agency on Aging through an ongoing academic collaboration to evaluate their care transitions program. She helped the organization evaluate their telehealth visits including a pharmacist-provided medication review coupled with a community health worker home visit after hospitalization. The care transition program addressed medication, social and health issues, and provided follow-up for rural older adults after the transition home. She hopes this becomes a model for other organizations to adopt. 

 

“Looking at transitions of care isn’t anything new, it’s been a focus for researchers for a long time, but I have found that there is a lot of room for improvement.” 

 

A Comprehensive Approach to Medications

Coe’s clinical research also dives into understanding which medications a patient is taking, and how it’s tracked to ensure patient safety. She says the way the medical records and the healthcare system are set up doesn’t lend to easy access to a comprehensive list of medications a patient may be taking.

 

“There’s a great need for a universal way to see what medications a person is on. If you’re getting your medications paid for by a health plan and filled at one pharmacy, you can see which prescriptions are being covered through there, but if someone is paying out of pocket or taking something over the counter, it’s tough to know exactly what they’re taking.”

 

Doctors and health care providers typically log which medications a patient is taking based on what information the patient freely gives, but if different providers aren’t communicating about the patient, they may not get the full picture. Therefore, it’s tough to understand different drug interactions or answer questions about medications for a patient. Additionally, if patients opt to fill their prescriptions at different pharmacies, it’s difficult to track. 

 

“I think much of the care in the United States is still fragmented,” Coe explains. “Someone has a primary care physician, and maybe a cardiologist, or neurologist, but that doesn’t mean everyone or every system is talking.” 

 

Coe says a Comprehensive Medication Review, or CMR, can drastically help this issue. A CMR is a process, done by a qualified provider (oftentimes a pharmacist), that collects patient-specific information and assesses their medication, asks questions about medication-related problems and creates a plan to resolve them. Although a CMR has been a service available for years through Medicare Part D Medication Therapy Management programs for eligible beneficiaries, Coe’s research finds that a majority of patients do not take advantage of it for two reasons: many do not know about it, and others who do know about it do not realize that their insurance or medicare plan may cover it. 

 

According to her research published in the Journal of Gerontology, of the adults surveyed, 77% are on two or more prescription medications, but of that group, only one in five had received a CMR, but many were interested in one. Coe concludes that more targeted strategies to increase awareness and education about this service are necessary. 

 

Right now, Medicare Part D plans require patients who spend more than $5,000 on medications per year and who meet the eligibility requirements with regards to number of chronic conditions and medications, or who are part of a drug management program, to be offered a CMR. The star ratings for Part D plans include the completion rate of CMRs. But changes to lower that cost threshold for eligibility are coming as soon as 2025 – a change that Coe welcomes, saying that this will help reach more people and increase equity and access to CMRs. 

 

Coe’s Hopes for Patient Care

Her research has not gone unnoticed. Earlier this year, Coe was selected as an American Pharmacists Association Academy of Pharmaceutical Research and Science (APhA-APRS) Fellow and was selected as an Emerging Scholar from the University of Michigan’s Institute for Healthcare Policy and Innovation. 

 

This award honors APhA members for exemplary professional achievements in professional practice and/or research and outstanding service to the profession.

Coe will continue looking into Medicare requirements for medication reviews, advocate for patients experiencing a transition of care, and push for better support systems for older adults living alone and less connected to healthcare systems.

“Safe medication use is crucial, implementing more ways to streamline communication between providers and patients, and helping patients and caregivers manage their medications is the goal of the research I do.”