Biomedical subjects

Dennee Frey

Publications and source records attributed to Dennee Frey.

6 recordsLinked to original sources

PubMed2006

Implications of translating research into practice: a medication management intervention.

Through programs such as the Administration on Aging's Evidence-Based Prevention Initiative, researchers and practitioners are developing translational research studies seeking to implement rigorously tested, evidence-based interventions in new practice settings and evaluate the continuing effectiveness of these interventions. One such translational study is the Community-Based Medications Management Intervention (CBM Intervention), a collaborative effort to implement a medication management screening and intervention protocol in community-based waiver care management programs. The overall goals of the CBM Intervention are to implement an evidence-based medication management intervention in a California Medicaid waiver care management program, and to evaluate the effect of client-, intervention-, and organizational-level characteristics on resolving identified medication problems. This article presents the need for improved medication management in a frail, community-dwelling, older adult population and describes the CBM Intervention as an example of translating an evidence-based practice beyond its original efficacy trial in a home healthcare program into a care management program. It discusses critical factors involved in translating research into practice using a translational research framework, Promoting Action on Research Implementation in Health Services (PARIHS). Our experience suggests that although implementing research into practice can positively impact client care, professional skill enhancement and organizational effectiveness, this is very challenging work requiring signification facilitation for successful outcomes.

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PubMed2005

A quality improvement project to reduce falls and improve medication management.

This paper describes the implementation of a medication management model within a medical-center based home health agency. The model was integrated into the agency's quality improvement falls prevention program and was selected in part because it directly addressed two medication-related accreditation standards for home health care agencies. During a five-month period, a staff pharmacist conducted medication reviews for 228 HHA patients who met the program's inclusion criteria. Thirty-three percent of these patients required some type of follow-up to resolve potential medication-related problems. By far, falls were the most common reason for referral, with 71 patients, or 30% of all participating patients, referred to the pharmacist due to a recent fall. From a quality improvement standpoint, the program met and even exceeded expectations in that it enabled staff to identify a serious threat to patient safety-medication-related problems, especially falls--and gave them the tools to resolve these potential problems.

Accidental Falls↗

PubMed2005

Integration of a medication management model into outcome-based quality improvement: a pilot program in a rural propriety home healthcare agency.

This article describes a rural proprietary home health agency's successful initiative to adapt a previously tested medication management model and integrate it into existing processes of care. The rationale to improve medication management in response to current national fiscal, clinical and external quality measures and evolution of this process in the agency is detailed. The agency refined the model's screening procedures, incorporating them into the mandated OASIS assessment and then computerizing the medication risk analysis, in keeping with the original intent of the model. In a four-month pilot test of the computerized risk assessment procedure 1006 OASIS assessments were screened; risk factors for medication-related problems in 201 (19.9%) resulted in pharmacist review. Of these, 30 (17%) were ruled out as potential medication errors, 143 (82.6%) were found with potential MRP and 58 (33.5%) had evidence of problems warranting follow-up. With this computer-assisted process, the agency created a more comprehensive assessment that was in line with the new regulatory emphasis on patient outcomes. Consultant pharmacist services also transitioned from drug regimen review to more comprehensive medication therapy management. By enhancing efficiencies in its medication management program, an agency not only stands to improve quality of care, but also to maximize resources, making the intervention affordable to implement and decreasing burden on staff.

Health Facilities, Proprietary↗

PubMed2003

Medication management: an evidence-based model that decreases adverse events.

Four diverse home care agencies are implementing a new Medication Management Model that has proven effective in preventing medication errors in elderly patients. The Model, available to all agencies, consists of advice from a consultant pharmacist to the attending nurse based on established guidelines. The Model's benefits for clinicians, agencies, and patients and how agencies can use it are described in this article.

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PubMed2002

Improving medication use in newly admitted home healthcare patients: a randomized controlled trial.

OBJECTIVES: To test the efficacy of a medication use improvement program developed specifically for home health agencies. The program addressed four medication problems identified by an expert panel: unnecessary therapeutic duplication, cardiovascular medication problems, use of psychotropic drugs in patients with possible adverse psychomotor or adrenergic effects, and use of nonsteroidal antiinflammatory drugs (NSAIDs) in patients at high risk of peptic ulcer complications. It used a structured collaboration between a specially trained clinical pharmacist and the patients' home-care nurses to improve medication use. DESIGN: Parallel-group, randomized controlled trial. SETTING: Two of the largest home health agencies in the United States. PARTICIPANTS: Study subjects were consenting Medicare patients aged 65 and older admitted to participating agency offices from October 1996 through September 1998, with a projected home healthcare duration of at least 4 weeks and at least one study medication problem. INTERVENTION: Qualifying patients were randomized to usual care or usual care with the medication improvement program. MEASUREMENTS: Medication use was measured during an in-home interview, with container inspection at baseline and at follow-up (between 6 and 12 weeks) by interviewers unaware of treatment assignment. The trial endpoint was the proportion of patients with medication use improvement according to predefined criteria at follow-up. RESULTS: There were 259 randomized patients with completed follow-up interviews: 130 in the intervention group and 129 with usual care. Medication use improved for 50% of intervention patients and 38% of control patients, an attributable improvement of 12 patients per 100 (95% confidence interval (CI) = 0.0-24.0, P =.051). The intervention effect was greatest for therapeutic duplication, with improvement for 71% of intervention and 24% of control patients, an attributable improvement of 47 patients per 100 (95% CI = 20-74, P =.003). Use of cardiovascular medications also improved more frequently in intervention patients: 55% vs 18%, attributable improvement 37 patients per 100 (95% CI = 9-66, P =.017). There were no significant improvements for the psychotropic medication or NSAID problems. There was no evidence of adverse intervention effects: new medication problems, more agency nurse visits, or increased duration of home health care. CONCLUSIONS: A program congruent with existing personnel and practices of home health agencies improved medication use in a vulnerable population and was particularly effective in reducing therapeutic duplication.

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PubMed2002

Preventing medication errors in home care.

This practice brief highlights the results of two home health care studies on medication errors. The first study determined how often medication errors occur in home health care. The second study tested a strategy to reduce these errors. Although nearly one third of home care patients are at risk for potential medication errors, adding a simple, practical program can reduce the potential for errors. These results should encourage home care agencies to be more vigilant in monitoring medication errors and to institute programs that help prevent errors from occurring.

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