An “In” at the Drug Store

Nurse-pharmacist collaboration can cut costs and improve care for community-dwelling older adults

By Manka Nkimbeng

It is difficult enough keeping yourself comfortable, safe, and healthy in your own home as an elderly member of a community. Add in the complexity of multiple chronic conditions associated with aging and an alphabet soup of medicines to treat them and everyday living can become a confusing puzzle. This is why a nurse-pharmacist collaboration was added to the CAPABLE program (for Community Aging in Place Advancing Better Living for Elders).

Nurse-pharmacist collaborations are not new, but collaboration for care of patients who live in the community is still rare. This blog post briefly describes a study of such a collaboration and its implications. In CAPABLE, a nurse collaborated with a pharmacist in the care regimens of 1 in 3 participants. CAPABLE was a controlled, home-based trial in Baltimore City testing whether an interdisciplinary team of occupational therapists, nurses, and handymen improved quality of life and reduced disability and health expenditures for community-dwelling older adults with functional difficulties.

Following in-home assessment and review of participant’s medications, nurses identified concerns that were forwarded for pharmacist consult. The study offers a detailed description of this process by offering a closer look at the primary intervention nurses’ caseload. Medication reconciliation and management is well within the nurses’ role, so per protocol, nurses forwarded only more complex concerns to the pharmacist: For example, could the combination of aspirin and furosemide be contributing to a participant’s kidney disease?

What we learned offers a starting point for future studies aimed at improving medication management for community dwelling older adults.

There is no doubt that collaboration among health professionals including nurses and pharmacists in the care of patients is beneficial for all involved. Collaborations between nurses and pharmacists in hospitals and institutionalized settings is not new either. However, details of how these collaborations happen are limited, so this study adds to this limited literature and offers a unique dimension of nurse-pharmacist collaborations.

Community-based collaborations between nurses and pharmacists have implications for improved care of older adults and health care savings. Medication non-adherence costs the health system between $100 billion and $300 billion annually. And falls, also related to poor medication management in older adults, can cost about $3,476 for falls with no complications to $26,483 for those requiring hospitalization. It also should be highlighted, as the article does, that prescribed medications are expensive: about $4,500 (insurer and out-of-pocket) for an older adult with three to four chronic conditions. Our participants were on a median of 11 medications.

Improved medication management, then, has implications for better health outcomes through enhanced medication adherence and reduced costs (for both the patients and health systems).

Like all research studies, the article described also has its strengths and limitations. While the reader gets a detailed description of the nurse-pharmacist collaboration process, this information is provided for only one of the four nurses in the project and so the types of collaboration between the other nurses and pharmacists may not be represented. A highlighted strength is the fact that the nurses gathered information about medications, use behavior, and adherence in the participant’s home and so they had access to more information including pill bottles and knowledge of home environments. This provided a unique understanding of the potential interactions of medication concerns and the home environments.

Further examination of this collaboration and its benefits is needed because its potential to improve care of community-dwelling older adults is significant. In the future, programs that offer in-home care to older adults (such as home health nurses and/or public health departments) may consider including nurse-pharmacist collaboration to facilitate in-depth review and education of participants about medication management. Health policies, reimbursement for these services, and funding for research with such approaches is critical to enable further implementation and sustainability.

View the full research article.

Manka Nkimbeng, MPH, RN, is a PhD candidate at the Johns Hopkins School of Nursing.