home care medication management program for the frail elderly

Conditions: Chronic Illness; Cognitive Impairment

Summary: the purpose of this study is to determine whether a home care medication management program which includes nurse coordination and use of the md.2 medication-dispensing machine will affect older adults' health outcomes, satisfaction, use of health care services, and health care costs over a one year period. the investigators propose a longitudinal three group repeated measures design, enrolling, and randomly assigning, clients who are discharged from a home health care agency with documented problems in medication management. one group will receive the md.2 medication dispensing device and nurse coordination, the second group will receive a medplanner: a simple box that has separate compartments for individual medication times over the course of a week plus nurse coordination, and the final group will receive usual care. the study hypotheses are the following: h1: with respect to health status outcomes, the md.2 group will exhibit a more positive trajectory in physical and mental health status, functional status, cognitive status and depressive symptoms over the course of a year than will the medplanner group. h2: with respect to health status outcomes, the medplanner group will exhibit a more positive trajectory in physical and mental health status, functional status, cognitive status and depressive symptoms over the course of a year than will the usual care group. h3: the rate of hospitalization, hospital days and emergency department visits will be significantly lower for the md.2 group as compared to the medplanner group. h4: the rate of hospitalization, hospital days and emergency department visits will be significantly lower for the medplanner group as compared to the usual care group. h5: the nursing home admission rate will be significantly lower for the md.2 group as compared to the medplanner group. h6: the nursing home admission rate will be significantly lower for the medplanner group as compared to the usual care group. h7: the total cost of care will be significantly lower for the md.2 group as compared to the medplanner group. h8: the total cost of care will be significantly lower for the medplanner group as compared to the usual care group. h9: there will be incremental savings in terms of costs per quality adjusted life year (qaly) gained in the md.2 group compared with the medplanner group. h10: there will be incremental savings in terms of costs per qaly gained in the medplanner group compared with the usual care group.


Eligibility criteria:
inclusion criteria: * age 60 and older * medicare primary payer * impaired medication management ability as indicated by a score of 1 or higher on oasis discharge assessment item m0780 * impaired cognitive functioning but able to follow directions with prompting as indicated by a score of 1 or 2 on oasis discharge assessment item m0560 * working telephone line * discharge from home health care exclusion criteria: * not english speaking * terminal diagnosis or hospice care * use of other device for medications * medicare via managed care * use of private home care agency for medication management

Keywords: home health care medication management cognitive impairment medication adherence older adults care coordination management