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Urinary tract infections (UTIs) are one of the most common infections found in adults age 65 and older, including PACE participants. Unlike in younger adults, UTIs are often overlooked or mistaken for other conditions in seniors because older adults are less likely to present with typical symptoms. Because of this, it’s essential for PACE pharmacy providers and other members of the PACE center’s multidisciplinary team to know the symptoms associated with these infections, as well as how best to treat them. Let’s take a look at how UTIs uniquely affect seniors and how these infections can be effectively prevented and treated. [Tweet “#UTIs often present different symptoms in older adults than in younger adults.”]

A Closer Look at UTIs Among PACE Participants

Many providers are aware of some of the most tell-tale signs of a UTI, such as changes in urine color, scent, and frequency, pain or burning during urination, and a low-grade fever.
However, the elderly very often present with atypical symptoms, including:

Sometimes, these are the only symptoms that present in seniors, making it vital to keep an eye out for these sudden cognitive and behavioral changes.

UTI Risk Factors and Types Among PACE Participants

There are a variety of risk factors that make older adults—including PACE participants— more susceptible to UTIs than other populations. These risk factors include decreased immune function, weakened bladder and pelvic floor muscle, and comorbidities such as diabetes, Parkinson’s disease, and dementia.

Because UTIs stem from a number of different causes and they come in multiple forms, treating these infections must be handled on an individual basis. UTI diagnoses are usually broken down into two variations:

Within each category, there is further differentiation, characterized by complicated and uncomplicated diseases. The most common form of UTI is uncomplicated cystitis, which may be characterized by the following:

It’s important to note that only female participants with no urologic abnormalities and no known kidney/bladder dysfunction or comorbidities can develop this type of UTI.

Complicated cystitis is characterized by the same symptoms as those of uncomplicated cystitis. However, complicated cystitis also includes additional criteria, such as having:

Similar to uncomplicated cystitis, gender plays a role in complicated cystitis: Whereas only females can get the former, only males can develop complicated cystitis.

For both UTI types, the first wave of antibiotic therapy, known as empiric therapy, can be provided based on symptoms alone. Empiric therapy aims to start fighting the infection and reduce the risk of further complications, and usually consists of broad-spectrum antibiotics, such as ciprofloxacin (Cipro®) and doxycycline (Vibramycin®, Adoxa®), that can fight against many different strains of bacteria. In addition to starting antibiotic therapy, a urine culture/analysis is often collected, providing more in-depth results to help guide treatment.

Antibiotic treatment of either two types depends on a variety of factors, including the severity of disease, previous history of infections, resistance rates in the local population, and kidney function, among others.

Pyelonephritis is a form of UTI that reaches the kidneys, causing inflammation in the region. Similar to cystitis, this diagnosis can be classified as either complicated or uncomplicated.

Uncomplicated pyelonephritis displays similar symptoms found in cystitis, but also presents:

The good news, though, is that other than these symptoms, the participant is generally healthy and can receive antibiotic treatment on an outpatient basis.

Complicated pyelonephritis, on the other hand, is extremely serious. In this case, the participant is hemodynamically unstable and immunosuppressed, has a form of anatomic abnormality or urologic dysfunction, and/or has a multiple-drug-resistant (MDR) strain of bacterial infection. Any participant falling into this criteria should be referred to the hospital immediately for evaluation and treatment.

Appropriate Use of Antibiotics to Treat UTIs in PACE Participants

Effectively treating a UTI entails eliminating the bacterial infection, providing supportive therapy to relieve pain and symptoms, and employing strategies to reduce recurrence of these infections.

For symptomatic relief of dysuria, phenazopyridine (Azo®, Pyridium®) can be given to residents without renal impairment. Moreover, non-pharmacologic treatment options—such as proper hydration, timed voiding, and heat-pad therapy—can help relieve symptoms and discomfort.

Preventive options to reduce recurrence of UTIs involve employing pharmacologic options, such as taking lactobacillus probiotics (Florajen 3®), maintaining hydration, and treating underlying diseases, like BPH or low estrogen levels in indicated participants.

While antibiotic therapy is used to treat UTIs, antibiotics generally aren’t chosen for preventive therapy, unless specific criteria is met.

If, for example, a participant is diagnosed with three or more UTIs within a year and proper non-pharmacologic steps have been unsuccessful, the participant may be a candidate for continuous, low-dose antibiotic preventive therapy. It’s important to note, though, that, if this care path is chosen, the participant must be monitored for potential side effects, prevention of symptoms, and necessity of antibiotic therapy.

Finally, once a PACE participant completes antibiotic therapy for a UTI infection, a follow-up urine culture is generally not recommended. A follow-up is only necessary if the participant complains of recurrence of symptoms, at which point an alternative antibiotic therapy and urine culture can be provided.

By taking preventive measures and properly following treatment guidelines, we can work to reduce the recurrence and symptoms of UTIs in PACE participants, and, ultimately, decrease the number of antibiotics prescribed and improve health outcomes in our participants.

Seniors, including PACE participants, have unique and specialized needs. Our Grane Rx team of geriatric-specialized pharmacists understands those challenges and works with PACE centers to overcome them. Partner with us today by calling (412) 449-0504 or emailing paceteam@granerx.com.

In PACE pharmacy, medications are typically dispensed to participants in monthly increments that are either picked up at the PACE center or delivered to the home. But what happens when a participant’s medication regimen needs to change in the middle of a cycle? Because PACE participants usually take multiple medications for a variety of medical conditions, it isn’t uncommon for physicians to switch out a medication or change its dosing. It also isn’t a problem. We’ve created a seamless process designed to handle medication regimen changes when they occur—without compromising participant safety or health. Read on to learn more. Let’s first take a look at the “why” behind our packaging. Medication nonadherence is a significant problem among the senior population and is especially critical for PACE participants. With this in mind, Grane Rx uses innovative packaging called SimplePacks when dispensing PACE pharmacy medications. This packaging is just one part of the overall Grane Rx PACE Pharmacy Solution, which is designed specifically with seniors in mind—featuring clear, understandable information about medications to encourage adherence. Each month, participant’s medications are packaged together inside two color-coded boxes: one for everyday medications and one for medications that are taken as necessary. Within those boxes, medications are packaged in SimplePacks, which are easily opened perforated packs of medications taken at the same time of day, whether morning, noon, evening or at night. This unique PACE pharmacy solution offers a much better medication management system than the bingo cards typically used by long term care pharmacy and other PACE pharmacy providers. The very thing that makes our packaging unique and innovative—our SimplePacks perforated pill packs—can seem like it would be tricky when medication changes are needed. But actually, that isn’t the case. [Tweet “A simple #PACEpharmacy process can make medication changes seamless”]

“Immediate Change” Medications in PACE Pharmacy

The first step in managing medication changes is identifying medications that must be immediately changed. The vast majority of medication changes, including dosage changes, don’t need to be made immediately. Those changes can simply wait until a participant’s medications are dispensed again. Our PACE pharmacy worked with a team of physician and pharmacy experts to compile a list of medications that need to be changed immediately, along with medications that are more subjective in nature. When Grane Rx partners with a new PACE center, we review this list with the center’s medical staff to ensure it aligns with their practices. The center-specific list is adjusted as necessary at that time. Prescriptions identified as immediate change medications are placed in separate SimplePacks and not commingled with other medications. This typically includes certain classes of medications, such as anti-hypertensive drugs, that require periodic adjustments to dosage or to determine which medication works best for a participant. Because these medications are automatically packaged separately from the rest of a participant’s medication regimen, those pill packs can simply be removed and the replacement medication incorporated—at any time. In the case that a new, non-immediate change medication is prescribed for a participant, that medication is packaged as a one-off and then incorporated into the participant’s normal SimplePacks the following month. When it comes to PACE pharmacy services, Grane Rx thinks through all the possibilities and offers the solutions your PACE center needs. Get started today by calling (412) 449-0504 or emailing paceteam@granerx.com. ]]>

By Jennifer Devinney, RPh, PharmD Polypharmacy is an often silent, but very serious, problem in PACE pharmacy today. It is defined as the administration of more medication than is clinically indicated, which represents unnecessary medication use. Thorough PACE medication management is key to limiting polypharmacy. Polypharmacy is especially prevalent in elder care where it has been estimated that approximately a quarter of patients are prescribed nine or more medications, with some studies showing much higher percentages of patients exceeding five, nine or ten medications.

Defining Necessity

For a medication to be considered necessary, it should be prescribed with a clear diagnosis that is supported by practice guidelines, clinical research or standards of care at a dose, duration, frequency and route of administration in concurrence with these guidelines. Additionally, medications should be used at the lowest effective dose for the shortest duration possible, avoiding duplication of therapy with other agents. The medication should be monitored according to practice guidelines, including periodic lab levels as well as clinical monitoring for therapeutic response and the development of adverse effects. When prescribing a medication, definitive therapeutic goals should be established in addition to the indication for use. Having clear therapeutic goals is vital in order to appropriately assess whether a medication is beneficial as therapy progresses. It also enables the healthcare team to create a larger and more comprehensive care plan for the participant. [Tweet “With seniors taking multiple medications, #polypharmacy is a growing concern in #PACEpharmacy”]

The Role of Medication Review

A thorough medication review when a participant is accepted is one of the most important PACE pharmacy practices to help eliminate unnecessary medications. It’s important to determine why a participant is using a particular medication and to match each medication to an appropriate diagnosis. Often, medications are associated with a general diagnosis, no diagnosis or a diagnosis that is not an FDA-approved indication. In these cases, clinical judgment should be utilized to determine whether the off-label use is appropriately supported based upon the participant’s medical history and if the benefits of therapy outweigh the risks of adverse effects. The psychotropic medication class, which includes antipsychotics, anxiolytics and sedative/hypnotics, is one of the highest risk medication classes for the geriatric population. The risk of adverse events, including increased mortality, is very high in the elderly—making the risk versus benefit line with psychotropic medications extremely tenuous. When psychotropic medications are used outside of their FDA-approved indications, the literature supporting their use is lacking. In fact, most literature does not recommend off-label use due to lack of positive outcomes. Due to inherent risks, psychoactive medications need to have a clear goal of therapy, which includes specific target behaviors that support the use of the medication. Adverse effect monitoring is extremely important for this class since these medications carry substantial risks, and periodic dose reductions are necessary to provide evidence that the lowest effective dose is being utilized. Optimizing medication regimens when more than one agent is being used to treat a condition is another important practice for preventing polypharmacy. The most prevalent example of this would be using multiple agents to manage hypertension. It’s not uncommon to see as many as four or five antihypertensive medications ordered for the same participant. One of the fundamental guidelines in treating a disease state that may require more than one medication is to start with one medication and maximize the dose until either the maximum recommended dose is reached or the maximum dose without adverse effects is reached. After the maximum dose is reached, then another agent can be added and titrated if better control is needed. participants on multiple medications at suboptimal doses should have their regimen evaluated and, if clinically acceptable, have a medication discontinued while adjusting the doses of the other medications.

Drug Classes of Particular Concern

Proton pump inhibitors (PPIs) are one of the most commonly prescribed unnecessary medications. PPIs are frequently utilized for treatment of GERD in the elderly. Practice guidelines recommend treating GERD initially with PPIs for eight to 12 weeks and then evaluating whether the GERD has improved. Often, the evaluation does not occur and many participants will remain on PPIs for years without any dose reductions to see if the dose or medication is still needed. Long term use of PPIs increases the risk of certain complications, such as osteoporosis and clostridium difficile infection. Allergy medications prescribed for long term chronic use are another commonly seen unnecessary medication. Many times allergy symptoms such as runny nose and itchy eyes are often seasonal or otherwise short-lived, yet the participant is ordered a long term scheduled dose of an antihistamine medication. It’s important to periodically evaluate whether these medications are still necessary since they have adverse effects such as drowsiness. Trial, as-needed orders are a good way to check whether this type of medication is still necessary. Some other more commonly seen unnecessary medications include:

Limiting Polypharmacy in PACE Pharmacy

One of our consistent clinical goals in the PACE pharmacy solutions we offer is to assist our partners in reducing unnecessary medication orders per participant by ensuring that each medication has a clear purpose, is meeting clinical goals and is necessary to maintain the overall well-being of that participant. Reports that outline the numbers of scheduled and PRN medications each participant is ordered are available to assist with these efforts and to trend progress. Our goal is to help reduce polypharmacy and the potential dangers associated with it, while optimizing medication administration and pharmaceutical spending.]]>

When compared with long term care pharmacy, PACE pharmacy presents its own unique set of challenges. Because participants are in the home environment rather than in a long term care setting with clinicians on hand, questions, concerns and needs may arise at any hour of the day. That’s why around-the-clock PACE pharmacy staffing is vital. Having PACE pharmacy providers available 24 hours a day, seven days a week means that there’s always a geriatric pharmacy expert on hand who can help PACE center staff meet participant needs. This allows for a smoother process for PACE medication management. So what are the distinct advantages of having around-the-clock PACE pharmacy staffing for your PACE center? There are three main benefits.

Benefit 1: PACE Pharmacy Providers Can Answer Clinician Questions

There are many scenarios in which questions arise related to PACE participants and their medication regimens. When a provider is preparing to prescribe a new medication, he or she may have questions about what medications are in stock or what medications are on the preferred list. Or someone on the PACE center staff may need clarification in order to answer a question posed by a PACE participant or caregiver about a medication regimen. That’s where Grane Rx’s commitment to 24/7 PACE pharmacy staffing makes an impact. Whether during the day or in the middle of the night, a certified geriatric pharmacist is available to answer questions promptly either by phone or through the EHR system, making the process of medication dispensing more seamless. And when participants and their caregivers fully understand their medication regimens, they’re more likely to adhere to them. [Tweet “Around-the-clock staffing for #PACEpharmacy services benefits participants and staff”]

Benefit 2: PACE Pharmacy Providers Can Make Adjustments to Medication Regimens

Sometimes changes to a participant’s medication regimen can’t wait until standard business hours. If medications have been added to a participant’s regimen and the participant begins to experience side effects, Grane Rx PharmDs are available to perform a medication review. During this review, the pharmacist can help determine what medication or interaction could be causing the effects, as well as make suggestions to a provider about an appropriate alternative medication. This benefit is especially important when a PACE participant is first admitted and begins working with PACE center staff. As PACE medications are initially prescribed, there’s typically a need for adjustment. Having PACE pharmacy providers available 24 hours a day allows for those adjustments to be made quickly and efficiently.

Benefit 3: PACE Pharmacy Providers Can Promptly Fill Emergent Prescriptions

The final benefit may in fact be the most significant. When a PACE participant has emergency medical needs, such as that for an illness or injury, he or she needs medication promptly. With Grane Rx’s around-the-clock PACE pharmacy staffing, participants have quick access to medications when they need it most. This prompt access allows participants, for example, to begin antibiotic or antiviral regimens quickly, which begins the process of limiting an illness’ effects. The sooner a participant can begin taking medication for an emergent need the better, making 24/7 access to PACE pharmacy services essential. Our commitment to 24/7 staffing is just one part of Grane Rx’s approach to PACE pharmacy services. Make the transition to Grane Rx today by calling (866) 824-MEDS (6337).]]>

When you’re switching to a new pharmacy services provider, you want the transition to be seamless, so that staff and residents alike experience little or no negative impact. In choosing a new pharmacy services provider, it’s important to consider multiple factors, including the depth and thoroughness of a provider’s transition plan.
Grane Rx understands the importance of getting started on the right foot. When we partner with a new Skilled Nursing Facility or PACE program, we rely on a tried-and-true formula with several key components to pave the way toward a seamless transition.
 

Part 1: Kick-off Pharmacy Services Meeting

The first step in the Grane Rx transition process is, quite simply, to thoroughly explain the process. In a kick-off meeting, our team meets with the center’s team to review the transition plan in detail and clarify any areas of concern or questions.
During this meeting, our teams also work together to establish a communication plan and schedule for the transition itself.  
 

Part 2: Analysis of Pharmacy Services

The second phase of the process includes a look at the current status of pharmacy services at the SNF or PACE program. During this stage, the Grane Rx team develops a gap analysis, comparing actual performance with desired performance.
This analysis helps us formulate a framework for pharmacy services moving forward, one that makes the best use of capabilities and cultivates optimal performance.
[Tweet “A strong transition plan for #pharmacyservices can help you get started on the right foot”]

Part 3: Training With Pharmacy Services Team

Pharmacy orders play an integral role in the everyday functionality of pharmacy services, and our goal is to make placing them simple for your team. In order to do this, our electronic health record adapts to integrate with the EHR already in place in your center. This allows data to transfer in real time from your center to our pharmacy.
During this phase, our IT team tests the functionality of EHR data integration to ensure the kinks are worked out before services go live and then configures the pharmacy information system.
Following this step, we begin to work with the center’s personnel to review processes and formulate implementation plans, which will include comprehensive, interdisciplinary training. As we begin the final stages of preparation, our team will also review final processes.
 

Part 4: Pharmacy Services Provider Meetings With Residents

When pharmacy services go live, the Grane Rx pharmacy team will be onsite to ensure a smooth transition. This continues past the initial days—during the first 90 days after going live, key members of the Grane Rx team remain onsite to work with staff.
In addition to working with staff members to ensure things start on the right foot, our team also meets one-on-one with residents or PACE participants. These meetings give residents the opportunity to gain familiarity and comfort with the expertise of our team.

Interested in learning more about the pharmacy services Grane Rx can provide for your Skilled Nursing Facility or PACE program? Call (866) 244-MEDS (6337) or reach out to us here.]]>

In recent years, the older population and their caregivers have increasingly turned to long term care programs that allow them to age within their own communities, such as PACE centers. When evaluating options, potential participants consider a number of categories, including pharmacy services.   So what are participants and their families seeking in a PACE pharmacy? Read on for a look at three criteria they’re evaluating:  

PACE Pharmacy Evaluation Criteria #1: Medication Safety

For PACE participants and their families, safety is of the utmost concern. And with good reason. A 2012 study found that each year in the United States, the inappropriate use of medication — such as misuse of antibiotics or mismanaged polypharmacy — leads to approximately 10 million avoidable hospital admissions and 4 million emergency room visits.   Participants and their families want a PACE pharmacy that prioritizes safety and helps ensure the appropriate use of medication. Grane Rx utilizes brightly colored boxes to enable a quick and easy distinction between everyday meds vs. meds that are taken on an as needed basis. People look for three key criteria in a PACE pharmacy   Grane Rx promotes medication safety in a number of ways, including:     [Tweet “3 criteria people look for in a #PACEpharmacy”]

PACE Pharmacy Evaluation Criteria #2: Simplicity and Convenience

Participants in PACE programs typically have a large number of chronic or acute medical conditions. To care for those conditions, participants may have dozens of medications to take on a daily basis.   Keeping track of those medications and ensuring they’re taken correctly can be challenging. Participants and their families want ways to simplify medication therapy.   Grane Rx offers a unique solution set to meet that need. As part of the PACE Pharmacy Solution, Grane Rx dispenses medications in prepackaged SimplePacks. This packaging uses automation to prepackage medications together so that they can be taken at morning, noon, evening, at bedtime, and on an as needed basis, simplifying the process of taking medication and replacing outdated, less functional punch cards.   In addition, Grane Rx’s PACE Pharmacy program delivers medications directly to each participant’s home, alleviating the need for the PACE site to manage medications at the center or worry about medication deliveries.  

PACE Pharmacy Evaluation Criteria #3: Education

As important as clinical reviews and safety protocols are, participant education plays an equally important role in promoting the appropriate use of medications. To help ensure medication adherence, participants and their families need to have a thorough understanding of medications, including what purpose the medications are prescribed for and what the dosages are.   Education is a significant part of the Grane Rx dispensing process. SimplePacks are paired with EasyReadTM medication summaries that help participants have more informed about their medications. Providers can counsel participants and their family members about medications and any potential barriers to taking medications correctly.   The packaging itself helps reinforce participant education. SimplePacks are labeled with written information about medications paired with visual representations of what each medication looks like.   Grane Rx provides comprehensive PACE pharmacy solutions to help you meet participant needs. ]]>

Nursing Home Pharmacy Services Improve Med Adherence Medication adherence means taking the right dose of the right medication at the right time—always. Patients are at risk of problems if they:  

  Grane Rx Meds2Home™ program can help. SimplePacks, prepackaged daily doses help people take the all of the right medications, every day. Multi-checkpoint systems in the packaging process mimic checkpoints in the medication administration process and reduce errors. Clear labeling helps people know what they are taking and how to take it. SimplePacks make safe and effective medication taking easy for people at home.  

Nursing Home Pharmacy Services Provide Oversight

With many elderly people on multiple meds, polypharmacy is a significant risk factor. While polypharmacy itself isn’t a problem, multiple medications increases the risk of medication interactions, missing medications, or taking medication incorrectly.   Pharmacists identify potentially contraindicated medications. They know which medications are of concern in aging bodies that process drugs differently. They also advise on ways to streamline pill load, which is yet another way to help with medication adherence. Grane Rx solutions allow people living at home with simple packaging and easy to read labels. [Tweet “Elderly patients need better #pharmacy services at home”]

Nursing Home Pharmacy Services Reduce Rehospitalization

Better medication adherence and reduced adverse drug events aren’t just numbers. They’re important factors in both quality of life and keeping people healthy at home. Medication mismanagement is the number one reason for hospital readmissions. Having medications delivered home through the Grane Rx Meds2Home program is a big step to reducing reducing medication mismanagement and thus lowering hospital readmissions. Patients don’t have to stop at the local drug store to pick up medications — they often leave the Skilled Nursing Facility with medications in hand. This has a clear impact on the elderly served. It also has a significant impact on managing costs for your center. There are many factors that go into successful outcomes for people living at home. Pharmacy is one of them. Bringing the best of nursing home pharmacy services home can be the difference between staying at home and rehospitalization for the elderly in a PACE program or those needing meds after a stay in a skilled nursing facility.]]>

PACE pharmacy solutions are SIMPLE when they:

 

 
 

PACE Pharmacy Solutions Simplify Regimens

Participants with complex medical needs have complex medication regimens. They need to know how much medication to take, how often to take it, why they take it, when to take it, and any special instructions for taking it. Any steps providers can take to streamline and simplify medication regimens go a long way toward improving adherence.
 
Grane Rx addresses this issue with its prepackaged SimplePacks. Pharmacy packaging is critical to the success of your participants and our SimplePacks make all medications accessible together (when medically possible), reducing the risk that clients will take too much or too little.
 

PACE Pharmacy Solutions Impart Knowledge

Information helps participants understand what they are taking and why they are taking medication. Clear information also makes med passing easier and safer. Clear labeling, like Grane Rx’s with names and dosage clearly printed on the outside of pre-packaged doses, is a critical vehicle for imparting knowledge.
 

PACE Pharmacy Solutions Modify Beliefs and Behaviors

Allowing people to make decisions about routines, including when to take medication, is part of a client-centered organization and can help improve medication adherence. Shifting from set med pass times is enhanced by Grane Rx’s use of the Universal Medication Schedule allows for greater flexibility.
 

PACE Pharmacy Solutions Provide Communication and Trust

At each step of the process, Grane Rx builds communication and trust. Certified Geriatric pharmacists provide summaries for each resident to help avoid drug interactions. This information is paired with prepackaged daily dosages. These SimplePacks go through 12 security checkpoints before they are ready for delivery to individuals. This process reduces medication errors and builds trust in the system.
 
[Tweet “Grane Rx PACE #pharmacy solutions keep adherence SIMPLE”]
 

PACE Pharmacy Solutions Leave Bias Behind

Cultural and language barriers can also inhibit medication adherence. Patient education is critical. Providers must make sure participants understand their medications and that all barriers to taking it correctly are addressed. Our simplified packaging and labeling help reinforce patient education. Participants can get visual cues about medication appearance in addition to written information.
 

PACE Pharmacy Solutions Evaluate Adherence

Are PACE pharmacy solutions actually working? It’s important to evaluate for medication adherence. This starts with asking directly if people have been taking their medication as they are supposed to be.
 
Questions may be direct and more specific—are you taking your medication every day? Do you take all of it? If non-adherence is indicated or suspected, it is critical to get at the root of the issue quickly. Is there confusion about the dosage, side effects? Financial concerns? Does the person understand why they are taking the medication and what will happen if they don’t? Is there mistrust that needs to be overcome?
 
The answers to these questions may require a review of some of the other SIMPLE steps, such as good communication, providing information, or building trust.
 
Medication adherence at-home is challenging but essential for the health of participants and the bottomline. Grane Rx understands how critical the right PACE pharmacy solutions are to meeting the challenge; that’s why we’re a leader in technological advances to improve outcomes.]]>

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