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HomeMeds 

Program Description

HomeMeds is a medication use improvement program developed specifically for agencies providing in-home 

services and health care to older adults. The program addresses four common medication problems, as 

identified by an expert panel of researchers: (1) unnecessary therapeutic duplication, (2) cardiovascular 

medication problems (e.g., poorly controlled high or low blood pressure, drop in blood pressure upon standing, 

low pulse), (3) use of psychotropic drugs by patients with possible adverse psychomotor or adrenergic effects 

(e.g., falls, dizziness, confusion), and (4) use of nonsteroidal anti-inflammatory drugs (NSAIDs) by patients at high 

risk of peptic ulcer complications. HomeMeds involves a structured collaboration between a consultant 

pharmacist and the patient’s home health nurse or case manager (e.g., social worker or nurse), who assess the 

patient’s medication use and resolve common medication problems with the assistance of the patient’s primary 

care physician, as follows:

• An agency staff member (i.e., home health nurse or case manager) performs a comprehensive in-home 

assessment of the patient’s prescribed and over-the-counter medications and supplements. The staff 

member also documents the patient’s vital signs and looks for indicators of potential adverse effects (e.g., a 

history of falls in the preceding 3 months, dizziness, confusion). The staff member then enters this 

information into the program’s Web-based software, either during the home visit or in the office. 

• If the program’s computerized algorithm indicates a potential problem, the consultant pharmacist reviews 

the patient’s medication assessment.

• Using all data, the consultant pharmacist consults with agency staff and, as appropriate, the patient or 

patient’s family and develops a plan to address any medication problems that warrant reassessment by the 

patient’s primary care physician. 

• The consultant pharmacist contacts the patient’s primary care physician to present the medication 

problems, discuss the regimen, and obtain instructions for follow-up. 

• As appropriate, agency staff assist the patient with follow-up appointments with the primary care physician. 

Agency staff also document any medication changes and their effect.

Before implementing the program, agency staff and the consultant pharmacist must complete training.

Descriptive Information

Areas of Interest  Long-term services and supports

• In-home services

Outcomes

Review Date: December 2011

 Medication problems

 Therapeutic duplication

 Cardiovascular medication problems
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Ages 

 61–74 (Older adult)

 75–84 (Older adult)

 85+ (Older adult)

Genders  Female

 Male

Races/Ethnicities Data were not reported/available.

Settings Home

Geographic Locations Urban

CER Studies Evaluated in comparative effectiveness research studies

Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the 

developer.

Implementation History

HomeMeds was first implemented in October 1996 as a randomized controlled trial 

(RCT) with home health agencies in Los Angeles and New York City. Since then, 

HomeMeds has been implemented in approximately 35 sites in Arkansas, California, 

Connecticut, Florida, Illinois, Indiana, Minnesota, New York, Texas, and West Virginia, 

as well as in Arizona/California Indian tribal territory. The medications of more than 

8,000 older adults have been screened through HomeMeds.

Adaptations No population- or culture-specific adaptations were identified by the developer. 

Quality of Research

Review Date: December 2011 

Documents Reviewed 

The documents below were reviewed for Quality of Research. The research point of contact can provide 

information regarding the studies reviewed and the availability of additional materials, including those from 

more recent studies that may have been conducted. 

Study 1

Meredith, S., Feldman, P., Frey, D., Giammarco, L., Hall, K., Arnold, K., ... Ray, W. A. (2002). Improving medication 

use in newly admitted home healthcare patients: A randomized controlled trial. Journal of the American 

Geriatrics Society, 50(9), 1484–1491. PubMed abstract available at 

http://www.ncbi.nlm.nih.gov/pubmed/12383144

Supplementary Materials

Brown, N. J., Griffin, M. R., Ray, W. A., Meredith, S., Beers, M. H., Marren, J., ... Avorn, J. (1998). A model for 

improving medication use in home health care patients. Journal of the American Pharmaceutical Association, 

38(6), 696–702. PubMed abstract available at http://www.ncbi.nlm.nih.gov/pubmed/9861787
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Outcomes 

Outcome 1: Medication Problems 

Description of Measures

Medication problems were assessed through a determination of patients’ medication 

use. A home health nurse documented each patient’s medication inventory and 

completed a brief assessment. A research assistant then conducted a structured 

interview, asking the patient to indicate medications taken in the preceding 7 days 

and confirming the patient’s response by inspecting labels on the patient’s 

medication containers. Having a medication problem was defined as having one or 

more of the following four high-priority problems: (1) unnecessary therapeutic 

duplication, (2) cardiovascular medication problems, (3) use of psychotropic drugs by 

patients with possible adverse psychomotor or adrenergic effects, and (4) use of 

NSAIDs by patients at high risk of peptic ulcer complications.

Key Findings

In an RCT, Medicare patients who had been admitted to medical and surgical services 

of two home health agencies from October 1996 through September 1998 were 

screened for the four high-priority medication problems. Patients identified as having 

a medication problem were randomly assigned to the intervention group or the 

control group. Both groups received care as usual, which included review of 

medications and potential medication adverse effects; however, the intervention 

group also received HomeMeds. 

Assessments occurred at baseline (within 2 weeks of admission) and at follow-up 

(between 6 and 12 weeks after the baseline assessment). At follow-up, the 

percentage of patients with an improvement in medication problems was higher for 

the intervention group (50%) than the control group (38%) (p = .05).

Studies Measuring 

Outcome Study 1

Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.2

Outcome 2: Therapeutic Duplication 

Description of Measures

Therapeutic duplication, the concurrent use of two or more different drugs for the 

same therapeutic purpose or the use of two or more versions of the same drug (e.g., 

generic and brand name), was assessed through a determination of patients’ 

medication use. A home health nurse documented each patient’s medication 

inventory and completed a brief assessment. A research assistant then conducted a 

structured interview, asking the patient to indicate medications taken in the 

preceding 7 days and confirming the patient’s response by inspecting labels on the 

patient’s medication containers.

Key Findings

In an RCT, Medicare patients who had been admitted to medical and surgical services 

of two home health agencies from October 1996 through September 1998 were 

screened for four high-priority medication problems: (1) unnecessary therapeutic 
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duplication, (2) cardiovascular medication problems, (3) use of psychotropic drugs by 

patients with possible adverse psychomotor or adrenergic effects, and (4) use of 

NSAIDs by patients at high risk of peptic ulcer complications. Patients identified as 

having a medication problem were randomly assigned to the intervention group or 

the control group. Both groups received care as usual, which included review of 

medications and potential medication adverse effects; however, the intervention 

group also received HomeMeds. 

Assessments occurred at baseline (within 2 weeks of admission) and at follow-up 

(between 6 and 12 weeks after the baseline assessment). At follow-up, the 

percentage of patients who stopped using at least one duplicative drug was higher 

for the intervention group (71%) than the control group (24%) (p = .003).

Studies Measuring 

Outcome Study 1

Study Designs Experimental

Quality of Research Rating

(0.0–4.0 scale) 3.1

Outcome 3: Cardiovascular Medication Problems 

Description of Measures

Cardiovascular medication problems were assessed through a determination of 

patients’ medication use. A home health nurse documented each patient’s medication 

inventory and completed a brief assessment. A research assistant then conducted a 

structured interview, asking the patient to indicate medications taken in the 

preceding 7 days and confirming the patient’s response by inspecting labels on the 

patient’s medication containers.

Key Findings

In an RCT, Medicare patients who had been admitted to medical and surgical services 

of two home health agencies from October 1996 through September 1998 were 

screened for four high-priority medication problems: (1) unnecessary therapeutic 

duplication, (2) cardiovascular medication problems, (3) use of psychotropic drugs by 

patients with possible adverse psychomotor or adrenergic effects, and (4) use of

NSAIDs by patients at high risk of peptic ulcer complications. Patients identified as 

having a medication problem were randomly assigned to the intervention group or 

the control group. Both groups received care as usual, which included review of 

medications and potential medication adverse effects; however, the intervention 

group also received HomeMeds. 

Assessments occurred at baseline (within 2 weeks of admission) and at follow-up 

(between 6 and 12 weeks after the baseline assessment). At follow-up, the percentage 

of patients with an improvement in cardiovascular medication problems was higher 

for the intervention group (55%) than the control group (18%) (p = .017).

Studies Measuring 

Outcome Study 1
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Study Designs Experimental

Quality of Research Rating 

(0.0–4.0 scale) 3.1

Study Populations 

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity 

Study 1

 61–74 (Older adult)

 75–84 (Older adult)

 85+ (Older adult)

 75% Female

 25% Male

Data not reported/available

Quality of Research Ratings by Criteria (0.0–4.0 scale) 

Criterion 

Ratings 

Outcome 1 Outcome 2 Outcome 3 

Reliability of Measures 2.8 2.8 2.8

Validity of Measures 3.1 3.1 3.1

Intervention Fidelity 3.3 3.3 3.3

Missing Data and Attrition 3.3 2.8 2.8

Potential Confounding 

Variables 3.3 3.3 3.3

Appropriateness of Analysis 3.8 3.5 3.5

Overall Rating 3.2 3.1 3.1

Study Strengths 

The outcomes are concepts easily grasped by nurses, elderly beneficiaries, and family caregivers. The program is based 

on a standardized protocol that specifically identifies how to define outcomes and that maximizes intervention fidelity. 

Rigorous steps were taken to ensure intervention fidelity. Missing data and attrition patterns were comparable in 

intervention and control groups. Statistical analysis largely accounted for potential confounding variables. In addition, 
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statistical analyses were adjusted for the possible clustering effect of nurses with more than one patient and tested for 

homogeneity of intervention effect across patient characteristics. The sample size was adequate as evidenced by a 

power analysis, and intention-to-treat analyses were conducted according to RCT best-practice methods. 

Study Weaknesses 

There are limited data on the psychometric properties of the self-reported outcome measures. In terms of reliability, 

it was not noted how often the container inspections to confirm self-reported medication use produced discrepancies 

and how these discrepancies were resolved. Information on attrition for subgroups (defined by specific medication 

problem) is not provided.

Readiness for Dissemination

Review Date: December 2011 

Materials Reviewed 

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can 

provide information regarding implementation of the program and the availability of additional, updated, or 

new materials.

HomeMeds Risk Screening Web-based software, https://homemeds.homemeds.org/

Partners in Care Foundation. (n.d.). Getting started with HomeMeds: Outreach and national dissemination 

materials. San Fernando, CA: Author. 

Partners in Care Foundation. (n.d.). Getting started with HomeMeds: Readiness, decisions and planning. San 

Fernando, CA: Author.

Partners in Care Foundation. (n.d.). Getting started with HomeMeds: Training and implementation. San 

Fernando, CA: Author. 

Program Web site, http://www.homemeds.org

Readiness for Dissemination Ratings by Criteria (0.0–4.0 scale) 

Criterion Rating 

Implementation Materials 4.0

Training and Support 4.0

Quality Assurance 4.0

Overall Rating 4.0
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Dissemination Strengths 

The developer provides a well-thought-out and easy-to-understand readiness survey to assist implementers in 

assessing their readiness to adopt the program. The implementation manual, forms, sample contracts, flow charts, 

and other support materials are well developed and easy to understand. The developer conducts initial training and 

provides continued program support through periodic site visits and follow-up interviews. The materials included in 

the appendix of the training manual are particularly useful during caregiver-patient interaction, and they are 

presented in an easy-to-use format. To ensure fidelity to the model, the developer maintains communication with new 

sites during their first year of implementation, answers questions, and reviews procedures and protocols. The Webbased risk assessment screening and alert system is periodically updated on the basis of internal quality assurance and 

user feedback. The developer also reviews each implementer’s individual and aggregated data to identify 

inconsistencies and notifies the implementer if any inconsistencies are found.

Dissemination Weaknesses 

No weaknesses were identified by reviewers.

Costs

The cost information below was provided by the developer. Although this cost information may have been 

updated by the developer since the time of review, it may not reflect the current costs or availability of items 

(including newly developed or discontinued items). The implementation point of contact can provide current 

information and discuss implementation requirements.

Implementation Materials 

Item Description Cost 

Required by 

Developer 

HomeMeds Risk Screening Web-based software license 

(includes software tools for monitoring clients, alerts, 

actions, resolutions, and medication changes; creating 

administrative reports; and conducting quality 

assurance)

Varies depending 

on user’s business 

sector (e.g., 

nonprofit, social 

service, hospital), 

volume of use, 

and complexity of 

user’s needs 

(minimum of 

$200 per month)

Yes

Start-up planning and implementation consultation 

(includes readiness survey, the implementation manual, 

and other support materials), training (includes the 

training manual), and first-year technical support 

(includes monthly calls)

$2,500 for training 

via Webinar and 

teleconference or 

$5,000 plus travel 

expenses for onsite training

Yes
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Item Description Cost 

Required by 

Developer 

1-hour teleconference after the first year of program 

implementation $250 No

2-hour refresher Webinar after the first year of program 

implementation $500 No

Program support site visit (includes evaluation, quality 

improvement, and refresher training)

$1,500 plus travel 

expenses

No

Additional Information

Each site must make local arrangements for qualified personnel (licensed pharmacist, nurse practitioner, or 

physician, preferably with geriatric certification or special training) to conduct the clinical consultation and 

review of the medication-related problems identified by the HomeMeds software. The cost for a licensed

pharmacist is estimated at $75 per hour.

Translational Work

HomeMeds, previously known as the Medication Management Improvement System, is a collaborative 

approach for identifying, assessing, and resolving medication problems experienced by older adults receiving inhome services. HomeMeds is being implemented at multiple sites throughout the United States, and a range of 

translational efforts have been documented and published. Translational efforts have been carried out in urban 

and rural settings as well as with private and public agencies. Implementation of the intervention has included 

comprehensive adoption as well as innovative collaboration and adaptation. HomeMeds targets practices at the 

organization and staff levels only and does not involve the recruiting of individual participants. Community 

partnerships enhance the program but are not essential. However, a deep sense of collaboration within the 

implementing organization is necessary. 

The HomeMeds algorithm used to identify high-risk patients was initially implemented through pen-and-paper 

data collection, but the program has been computerized and is now implemented as a Web-based risk 

assessment and screening tool. HomeMeds includes a standardized procedure and guidelines. Adaptation and 

flexibility are encouraged in efforts to integrate HomeMeds into preexisting practice. For example, program 

adopters can add components to the algorithm (e.g., suboptimal pain management, measures associated with 

an increased risk of falls) to address specific quality assurance initiatives, novel health care delivery system 

strategies, and accrediting agency requirements. Program adopters also have created unique partnerships (e.g., 

between a home health agency and a college of pharmacy) to ensure ongoing implementation. 

Results from program translation in different settings indicate that between 22% and 33% of patients screened 

had medication problems serious enough for the consultant pharmacist to recommend reassessment by the 

primary care physician, and up to 61% of these reassessments resulted in changes in medication. Individual-level 

characteristics were not found to be associated with the adoption of recommended medication changes. Most 

care managers surveyed acknowledged that the intervention was useful and worthwhile and thought it should 

be available as an ongoing service in care.
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Site With 

Translational 

Work 

Articles Describing Site’s Translational Work, by Category 

Planning/ 

Partners Adoption 

Reach/ 

Recruitment Implementation Effectiveness Maintenance 

California 

Medicaid 

waiver care 

program

Article 1 Articles 1 

and 3 Article 1 Articles 1–3 Articles 2 and 3 — 

Home health 

agency based 

in a medical 

center

— Article 4 — Article 4 Article 4 — 

Collaboration 

between home 

health agency 

and college of 

pharmacy 

(rural area)

Article 5 Article 5 Article 5 Article 5 Article 5 — 

Rural 

proprietary 

home health 

agency

Article 6 Article 6 — Article 6 Article 6 — 

Article 

Number Article Reference 

1 Partners in Care Foundation. (2007). Medication Management Improvement System: Replication 

report. San Fernando, CA: Author.

2 

Alkema, G. E., Enguidanos, S. M., Wilber, K. H., Trufasiu, M., Simmons, W. J., & Frey, D. (2009). The 

role of consultant pharmacists in reducing medication problems among older adults receiving 

Medicaid waiver services. Consultant Pharmacist, 24(2), 121–133. PubMed abstract available at 

http://www.ncbi.nlm.nih.gov/pubmed/19275454

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Alkema, G. E., & Frey, D. (2006). Implications of translating research into practice: A medication 

management intervention. Home Health Care Services Quarterly, 25(1–2), 33–54. PubMed abstract 

available at http://www.ncbi.nlm.nih.gov/pubmed/16803737

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Sperling, S., Neal, K., Hales, K., Adams, D., & Frey, D. (2005). A quality improvement project to 

reduce falls and improve medication management. Home Health Care Services Quarterly, 24(1–2), 

13–38. PubMed abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16236656
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Article 

Number Article Reference 

5 

Triller, D. M. (2005). Medication Management Model as experiential education tool for students of 

pharmacy. Home Health Care Services Quarterly, 24(1–2), 47–59. PubMed abstract available at 

http://www.ncbi.nlm.nih.gov/pubmed/16236658

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Atkinson, W. L., & Frey, D. (2005). Integration of a medication management model into outcomebased quality improvement: A pilot program in a rural proprietary home healthcare agency. Journal 

of Home Health Care Services Quarterly, 24(1–2), 29–44. PubMed abstract available at 

http://www.ncbi.nlm.nih.gov/pubmed/16236657

Contacts

To learn more about implementation, contact:

Sandy Atkins, M.P.A.

Institute for Change, Partners in Care Foundation

(818) 837-3775, ext. 111

homemeds@picf.org

To learn more about implementation or research, 

contact:

Dennee Frey, Pharm.D.

Partners in Care Foundation

(323) 934-6082

homemeds@picf.org

Additional program information can be obtained through the following Web site:

http://www.homemeds.org