Community pharmacies provide an ideal setting for identification of patients at risk for falls. North Carolina Medicaid claims data indicate that the population most in need of medication management services visit the pharmacy an average of 35 times annually, while only seeing their primary care physician 2-4 times annually. In the proposed project, we will use a prospective, cohort design to investigate an outpatient care model that links a network of community pharmacies (CPESN) with primary care practices. The CPESN pharmacies in the intervention group will (1) screen for risk of falling using questions from the STEADI Tool Kit, (2) conduct a comprehensive medication review with fall prevention education, and (3) refer to other members of the health care team for additional falls assessment. The CPESN intervention group will use a monthly attribution report to identify older adults at high risk for falls. This report includes the total number of medications and high-risk medications that each patient is taking as well as if the patient had a recent fall-related emergency department visit. CPESN pharmacies will use a shared software application, PHARMACeHOME, to communicate with primary care practices. In this project, PHARMACeHOME will be used for two primary purposes. First, pharmacists will make recommendations to minimize exposure to medications associated with an increased risk of falls identified in the comprehensive medication review. Second, pharmacists will refer for additional falls assessment that are beyond the scope of pharmacy practice. By utilizing the shared software application, we hope to alleviate several barriers to coordination of care. Outcomes achieved in the network (CPESN) pharmacies that implement the intervention will be compared to those achieved in two comparison groups: (1) CPESN pharmacies that do not implement the intervention, and (2) non-CPESN pharmacies in North Carolina. Data from the three cohorts will be analyzed to evaluate the falls intervention program on: (1) use of high-risk medications (primary outcome variable) and (2) the rate of fall-related emergency department visits (secondary outcome variable). For all patients, data will be collected 1-year before and 1-year after the index date, determined on the basis of when the patient is identified as using medications associated with an increased risk of falling. If successful, this community pharmacy-primary care linkage model could have huge implications on the health benefits, costs and sustainability to health care.
This project will increase our knowledge and understanding of how community pharmacists can identify older adults at risk for falls and collaborate with members of a patient's health care team, including primary care providers, on fall prevention efforts. Previous research has demonstrated that community pharmacists can significantly impact medication regimens for patients at high risk for falls. This research will expand upon the medication optimization research. Community pharmacists will test a community care management strategy to integrate other members of the health care team to provide comprehensive fall risk assessments and management strategies for high-risk patients.
