Healthier seniors, lower health-care costs are possible, study shows

by Maria Lironi

“You know the cliché ‘An ounce of prevention is worth a pound of cure?’” asks Dr. Patrick McGowan, the Centre on Aging’s newest research affiliate. “Well, when it comes to keeping seniors healthy nothing could be truer.”

For the past three years McGowan has led a team of investigators—including former centre director and UVic sociologist Dr. Neena Chappell and investigators at UBC, the Registered Nurses Association of B.C., Peace Arch Hospital, and the Ministry of Health Planning—in the High Risk Patient Intervention Program Evaluation. Funded by the Medical Research Council of Canada, the study revealed that keeping seniors out of the hospital can be as simple as making sure they receive home visits from a pharmacist and a nurse.

High-risk seniors in the South Surrey-White Rock area, who had been discharged from the hospital or the emergency department and who were also on six or more prescription medications, were studied. The mean age of the 225 subjects was 78 years.

From September 1999 to October 2000 McGowan’s intervention teams made home visits to the seniors in the experimental group. They conducted a thorough needs assessment and went through the patients’ medicine cabinets. What they found was lots of outdated medication, drugs that didn’t go together, and medicine prescribed in too high or too low a dose.

“In these cases the pharmacist would call the patients’ doctors and get things straightened out,” says McGowan. “The intervention team also developed plans, each with a monitoring component, to ensure that every senior in the experimental group received optimal medication therapy.”
In all, the intervention team contacted the seniors’ doctors 136 times and made 255 medication-related recommendations, of which 206 (81 per cent) were accepted. These recommendations included: changing medicine, discontinuing a prescription, adding a treatment, and increasing or decreasing the dose of a drug.

The seniors’ community pharmacists were contacted 39 times. Of the 56 recommendations made by McGowan’s intervention team, 51 (91 per cent) were accepted. The team also made changes in how the medication was delivered. They removed outdated or unused medication, contacted community resources, provided a booklet where seniors recorded their medications, dispensed snap caps, furnished a list of medications, supplied written information about drugs, provided medication schedules, changed the times that drugs were administered, and simplified the drug regime. The seniors’ progress was followed for a year after their discharge from the program.

“What we discovered was that seniors who received attention from the high-risk intervention team experienced significantly fewer hospitalizations and used other costly medical services less often than seniors in the control group,” says McGowan. “It cost $680 less to have the intervention team help high-risk seniors in the experimental group with their health issues than it did for seniors in the control group to function without the intervention team.”

“We now have the methodology to make huge positive changes in the way home care and pharmacist duties are implemented,” says McGowan. “Whether our current health care environment is conducive to the health authorities making any sort of positive change is another matter.”