The Quality Of Care And Medication Management In Home Environment

Medication Management In Home Environment

June 8th, 2019   |   Updated on March 3rd, 2020

Home health care services have different set of goals and the multidisciplinary nature of it presents a unique set of challenges when it comes to measuring the quality of it. This however is significantly different from those provided in a typical and more traditional clinic or hospital settings.

However, the CMS mandates some quality standards that should be met by all home health care service providers regarding reporting and working closely with the physician of the patient. This helps significantly in measuring the outcome of this home health care and its quality.

The CMS has formulated the Outcome Based Quality Monitoring or OBQM program that helps them to monitor, report, and benchmark any adverse event. These events include:

  • Emergency care for injuries caused due to accident or fall
  • An increase in the number of pressure ulcers and
  • Significant decline in the three or more ADLs.

When you hire a professional home care agency you primarily pay for their performance. This is one of the most significant quality initiatives of the CMD which is anticipated to be more stringent in the near future. This is a definite mechanism that links with the part of reimbursement to the agency for the delivery of services and care to the patient.

As the prep work for this, there are several organizations and providers working together to identify better ways for quality improvement and develop a specific and well defined set of performance measures that are proven to be effective especially in the home care scene.

According to the 2006 report of Medicare Payment Advisory Commission presented to the Congress patient safety is identified as the most important constituent of quality of home care. It has also emphasized on the need to expand all available quality measurement techniques so that it can facilitate a better and more effective process and structural measures.

The report has also specified that such expanded approach for measuring the quality of home care must achieve a few specific goals such as:

  • Expand the sorts of quality measures
  • Broaden the patient population to be evaluated
  • Reduce the variances in practice
  • Capture all aspects of home care directly under the control of the care providers and
  • Improve information technology and its use.

In January the following year, different health care leaders, home health communities and quality-improvement administrations launched the Home Health Quality Improvement National Campaign. Specific features of this campaign include:

  • The primary focus which is on improving the quality of home health care provided to patients and
  • Providing monthly best practice intervention tools to the home health care service providers.

The primary objective of such provision is to prevent any avoidable situations that may lead to the hospitalizations for the home health care patients. For this the Home Health Quality Improvement National Campaign follows a unique multidisciplinary approach to ensure quality improvement. This includes:

  • Hospitals
  • Key home health care service providers and
  • Physician stakeholders.

The research evidence in different respects show that different home health care clinicians as well as those working in other environments has analogous concerns regarding the safety of the patients as well as the quality of care.

For example, a patient may fall both in home and in a hospital setting. There may be some dedicated measures in place aimed at preventing such accidents and these measures are equally applicable to both these settings.

However, it is due to the major differences between other types of healthcare and a home health care that calls for specific interventions that are tailored according to the home health care setting.

Analysis Of Medication Management

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A proper analysis in required based on the research evidence regarding patient safety and quality of health care, so that the problems that arise frequently in home health care can be reduced and if possible, eliminated. There are several areas of concern such as:

  • Medication management
  • Nurse work environment
  • Fall prevention
  • Functional outcomes and quality of life
  • Unplanned hospital admissions
  • Wound and pressure ulcer management.

In all these areas adverse events can occur for sure but the most significant one amongst these that can jeopardize the care system and prevent achieving one or all of the home health care goals is medication management.
According to research it is found that:

  • Around one-third of older patients needing home health care have a potential issue with taking their medication on time
  • Another significant portion of them are found to be taking medicines that are considered to be inappropriate and even dangerous for older patients
  • A major part of these elderly home health care patients are particularly vulnerable to the common adverse effects of medication errors
  • Most of the meven take multiple medications often for a variety of medical issues and comorbidities that may be provided by one or more providers and
  • Almost all of the older home health care patients deviate from their actually prescribed medication regime.

All these are the results of an unstructured environment and communication challenges that are unique in most of the home health care system.

Further research on the matter and the available literature showed that there are actually only three studies that tested the intrusions to develop medication management and the home health care patient adherence.

These studies are conducted using a controlled experimental design.

The Summary Of Evidence

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With relation to medication management, all interventions tested were based on several areas including:

  • Patient education
  • Nurse follow up
  • Medication review
  • Collaboration among physicians, providers and patient.

The specific outcomes of the tests showed duplicate and unnecessary medication, use of certain categories of medication such as psychotropic or cardiovascular drugs, use of non-steroidal anti-inflammatory drugs or NSAIDs.

The efficacy of the intercessions was measured by value added medication management and the need to drug protocol adherence.

This can be estimated quantitatively from the medication refill history and monitoring of medication events.

It must be measured instinctively from the understanding of the patient about the disease, self-report scores, pre and post intervention questionnaires and degree of adherence.

All these indicates apart from the nurses being vigilant more effective methods are required to prevent medication errors in home health care setting.

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