Facilitating Aging in Place by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9780323299435
Publisher: Elsevier Health Sciences
Published: 2014-09-15T00:00:00+00:00

New directions: policy

Most recent literature remains focused on interventions aimed at patients, such as reminder systems and education. One systematic review purposefully sought to explore provider, systems, and policy interventions that were aimed to improve medication adherence.7 Overall results were consistent with previous studies: a combination of education and behavioral interventions offers the most evidence of improvement. This review of 62 studies, however, also reported on positive results from case management for adults with diabetes, hypertension, heart failure, and depression. In addition, 9 studies were included that addressed policy interventions, all measuring adherence by the number of insurance claims for processing prescriptions. The interventions for each of these 9 studies decreased out-of-pocket expenses through reducing copayments or improving prescription drug coverage. Although results were inconsistent across studies, there was robust evidence to support that reduced out-of-pocket expenses improves medication adherence. The investigators further contend that such policy measures can benefit more individuals because these approaches are less complex, are less labor-intensive than many other interventions, and they can reach more patients geographically. The mean age of the participants in these studies was not provided; however, the focus of the studies was chronic illness. According to the American Hospital Association,45 60% of older adults will manage more than 1 chronic condition by 2030.

Since 2006, Medicare Part D providers have been required to offer a medication therapy management (MTM) plan for eligible beneficiaries.46 Although implementation varies, the Centers for Medicare & Medicaid Services (CMS) provide guidelines for these plans.46 Since 2013, everyone who is eligible must be offered a plan. To be eligible, an older adult should have between 2 and 3 chronic diseases, take 2 to 8 medications covered by Medicare Part D, and have estimated annual out-of-pocket expenses of $3144. The CMS requires programs to annually review all medications, prescription and otherwise, and prepare a written summary of that review within 2 weeks for patients, encouraging patients to share the review with their provider. Targeted quarterly reviews are then required. A study of Medicare beneficiaries in 2010 compared those with and without MTM plans.47 Patients who were studied had either heart failure or chronic obstructive pulmonary disease. Results demonstrated that benefits of the plan often included an increased use of medications. The patients who also received comprehensive medication reviews had greater benefits. Limitations to analysis in this study included inconsistency in design, with extra services included by some organizations. Given the increased use of medications observed by those with MTM plans, however, nurses need to know to counsel patients as to the services offered from these plans; eligible gerontological nurse specialists may oversee these plans and bill Medicare accordingly.

As more nurses expand their roles into health policy, nurses need to advocate for policy measures to decrease out-of-pocket expenses for older adults. The Affordable Care Act48 is currently in a state of flux as to the details of implementation; it cannot be known what the Affordable Care Act will mean for patients with chronic illness, especially the older adult population. Therefore, nurses must remain politically savvy and policy focused to influence these decisions.

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