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Polypharmacy, An Issue of Clinics in Geriatric Medicine, E-Book

Polypharmacy, An Issue of Clinics in Geriatric Medicine, E-Book

Mary Ann E. Zagaria

(2017)

Additional Information

Abstract

This issue of Clinics in Geriatric Medicine, guest edited by Mary Ann Zagaria, PharmD, is devoted to Polypharmacy. Articles in this outstanding issue include: Centers for Medicare and Medicaid Services Support for Medication Therapy Management (Enhanced Medication Therapy Management): Testing Strategies for Improving Medication Use Among Beneficiaries Enrolled in Medicare Part D; The Role of Patient Preferences in Deprescribing; Polypharmacy Reduction Strategies: Tips on Incorporating American Geriatrics Society Beers and Screening Tool of Older People’s Prescriptions Criteria; Polypharmacy and Delirium in Critically Ill Older Adults: Recognition and Prevention; Geriatric Polypharmacy: Pharmacist as Key Facilitator in Assessing for Falls Risk;  Medication Reconciliation in Long-Term Care and Assisted Living Facilities: Opportunity for Pharmacists to Minimize Risks Associated with Transitions of Care; Can Managed Care Manage Polypharmacy?; Medication Risk Mitigation: Coordinating and Collaborating with Health Care Systems, Universities, and Researchers to Facilitate the Design and Execution of Practice-Based Research; and Geriatric Polypharmacy: Two Physicians’ Personal Perspectives.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Polypharmacy\r i
Copyright\r ii
Contributors iii
EDITOR iii
AUTHORS iii
Contents v
Preface: Inroads into Polypharmacy: Moving Forward with Tools, Deprescribing, and Philosophical Reflection\r v
Centers for Medicare and Medicaid Services Support for Medication Therapy Management (Enhanced Medication Therapy Managemen ...\r v
The Role of Patient Preferences in Deprescribing\r v
Polypharmacy Reduction Strategies: Tips on Incorporating American Geriatrics Society Beers and Screening Tool of Older Peop ... v
Polypharmacy and Delirium in Critically Ill Older Adults: Recognition and Prevention vi
Geriatric Polypharmacy: Pharmacist as Key Facilitator in Assessing for Falls Risk vi
Medication Reconciliation in Long-Term Care and Assisted Living Facilities: Opportunity for Pharmacists to Minimize Risks A ... vi
Can Managed Care Manage Polypharmacy? vi
Medication Risk Mitigation: Coordinating and Collaborating with Health Care Systems, Universities, and Researchers to Facil ... vii
Geriatric Polypharmacy: Two Physicians' Personal Perspectives vii
CLINICS IN GERIATRIC MEDICINE\r viii
FORTHCOMING ISSUES viii
August 2017 viii
November 2017 viii
February 2018 viii
RECENT ISSUES viii
February 2017 viii
November 2016 viii
August 2016 viii
Preface\r ix
Inroads into Polypharmacy: Moving Forward with Tools, Deprescribing, and Philosophical Reflection\r ix
Centers for Medicare and Medicaid Services Support for Medication Therapy Management (Enhanced Medication Therapy Management) 153
Key points 153
BACKGROUND 154
MEDICATION THERAPY MANAGEMENT PROGRAM TARGETING REQUIREMENTS 154
Multiple Chronic Conditions 154
Multiple Covered Part D Drugs 155
Anticipated Part D Drug Costs 155
MEDICATION THERAPY MANAGEMENT PROGRAM DOCUMENTATION AFTER A COMPREHENSIVE MEDICATION REVIEW: THE STANDARDIZED FORMAT 156
MEDICATION THERAPY MANAGEMENT WITHIN THE LONG-TERM CARE SETTING: COMPREHENSIVE MEDICATION REVIEW AND BENEFICIARIES 157
INCREASING BENEFICIARY AWARENESS OF MEDICATION THERAPY MANAGEMENT 158
MEDICATION THERAPY MANAGEMENT PROGRAMS IMPACTED BY CENTERS FOR MEDICARE AND MEDICAID SERVICES STAR MEASURE RATINGS 158
THE FUTURE OF MEDICATION THERAPY MANAGEMENT: THE “ENHANCED” MEDICATION THERAPY MANAGEMENT MODEL 159
CLINICAL IMPLICATIONS FOR OLDER ADULTS 161
SUMMARY 162
REFERENCES 162
The Role of Patient Preferences in Deprescribing 165
Key points 165
INTRODUCTION 165
WHAT IS DEPRESCRIBING? 166
THE PROCESS OF DEPRESCRIBING 167
PATIENT PREFERENCES FOR DEPRESCRIBING 167
BARRIERS AND PITFALLS TO DEPRESCRIBING 171
SUMMARY 172
REFERENCES 173
Polypharmacy Reduction Strategies 177
Key points 177
INTRODUCTION 177
DEFINING POLYPHARMACY 178
CONSEQUENCES OF POLYPHARMACY 179
POLYPHARMACY REDUCTION STRATEGIES 179
INCORPORATING EXPLICIT CRITERIA INTO POLYPHARMACY REDUCTION STRATEGIES 180
American Geriatrics Society Beers and Screening Tool of Older People’s Prescriptions 180
Tips for Incorporating the Explicit Criteria 181
LIMITATIONS TO USING THE EXPLICIT CRITERIA 185
SUMMARY 185
REFERENCES 186
Polypharmacy and Delirium in Critically Ill Older Adults 189
Key points 189
INTRODUCTION 189
POLYPHARMACY IN CRITICALLY ILL OLDER ADULTS 190
DELIRIUM IN CRITICALLY ILL OLDER ADULTS 191
POLYPHARMACY AS A RISK FACTOR FOR DELIRIUM 192
POLYPHARMACY AS A SEQUELAE OF DELIRIUM TREATMENT 195
STRATEGIES TO REDUCE THE POLYPHARMACY-DELIRIUM CYCLE 197
SUMMARY 199
REFERENCES 199
Geriatric Polypharmacy 205
Key points 205
INTRODUCTION 205
TOOLS FOR FALLS ASSESSMENT 207
PHARMACIST ASSESSMENT FOR FALLS 208
Step 1 208
Step 2 208
Step 3 209
Step 4 209
Step 5 211
Step 6 211
OPERATIONALIZING PHARMACIST-CONDUCTED FALLS ASSESSMENT 211
SUMMARY 216
REFERENCES 216
Medication Reconciliation in Long-Term Care and Assisted Living Facilities 225
Key points 225
INTRODUCTION 226
STATISTICS 226
GUIDING PRINCIPLES OF MEDICATION RECONCILIATION 227
FOCUS ON TRANSITION OF CARE FROM HEALTH CARE ORGANIZATIONS 228
GOVERNMENT FOCUS OF TRANSITION OF CARE IN SKILLED NURSING FACILITIES 228
THE PROCESS OF MEDICATION RECONCILIATION FROM HOSPITAL TO NURSING HOME AND/OR ASSISTED LIVING 230
MEDICATION HISTORY PROCESS QUESTIONS 230
COMMON BARRIERS TO MEDICATION RECONCILIATION 230
ELECTRONIC HEALTH RECORDS 231
MEDICATION REGIMEN REVIEWS DURING TRANSITION OF CARE BY THE CONSULTANT PHARMACIST 231
MEDICATION REGIMEN REVIEWS FOR STAYS UNDER 30 DAYS AND CHANGES IN CONDITION 233
FINANCIAL INCENTIVES FOR MEDICATION RECONCILIATION 235
SUMMARY 236
REFERENCES 236
Can Managed Care Manage Polypharmacy? 241
Key points 241
Why Managed Care Should Be Used to Manage Polypharmacy 243
What Is Managed Care? 244
What Are the Key Opportunities for Managed Care to Manage Polypharmacy? 245
Managed Care’s Role in Managing Polypharmacy 246
Dementia and behavioral and psychological symptoms of dementia 249
Screening and medication management 250
Antimicrobial stewardship 250
Diabetes management 251
Nutritional support 252
The Future of Managed Care Management of Polypharmacy 253
REFERENCES 253
Medication Risk Mitigation 257
Key points 257
INTRODUCTION 258
TRADITIONAL MEDICATION RISK MITIGATION STRATEGIES 258
Traditional Medication Therapy Management 259
Background 259
Evidence 260
Future directions 260
Tools to Facilitate Traditional Medication Therapy Management 261
Drug interaction tools 261
Medication appropriateness tools 262
ENHANCED MEDICATION RISK MITIGATION STRATEGIES 262
Enhanced Medication Therapy Management 262
Background 262
Future directions 263
Innovative Strategies for Enhanced Medication Therapy Management 263
Drug interaction tools 263
Background 263
Evidence 264
Future directions 265
Pharmacogenomics 266
Background 266
Evidence 266
Future directions 267
INTEGRATING ENHANCED MEDICATION RISK MITIGATION STRATEGIES INTO CLINICAL PRACTICE 267
FOCUS ON PHARMACOGENOMICS 268
Barriers to Integration 268
Health care system–related barriers 268
Patient-related barriers 268
Health care professional–related barriers 268
Enablers for Integration 270
Health care system–related enablers 270
Patient-related enablers 270
Health care professional–related enablers 271
POWER OF INTEGRATION 272
Patient Case Scenario 272
Patient Case Explanation 272
SUMMARY 274
ACKNOWLEDGMENTS 274
REFERENCES 274
Geriatric Polypharmacy 283
Key points 283
DR CHEN 284
DR BUONANNO 285
REFERENCES 288
Index 289