Patient case: 67-year-old female with Breast cancer. Genetic variant: FGFR1 Amplification, PTEN (Q171). Other conditions: Depression, Hypertension, Heart Disease.

Clinical trial: Home Care Medication Management Program for the Frail Elderly

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: 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

Relevance to patient case: not relevant