ICP Geriatrics Pharmacy Expert Puts 'Eyes in the Home'
Dr. Sean Jeffery, a pharmacist specializing in geriatrics, does something most pharmacists don’t do: He sometimes makes house calls.
Through ICP’s partnership with the University of Connecticut School of Pharmacy, Jeffery, a clinical professor at UCONN, also is director of ICP’s Clinical Pharmacy Services. He collaborates closely with ICP care managers as they help high-risk patients manage their chronic illnesses more effectively, which includes coordinating care and identifying patients who might benefit from the higher level of medication management Jeffery provides. ICP is among a growing number of healthcare organizations integrating medication management directly into patient care.
Jeffery initially collaborates on pharmacy issues with providers via email and phone consultations. When possible, he sees patients at the provider’s office and, when necessary, will visit the patient at home. “These visits, which are an exception, often are the only way to fully appreciate the challenges the patient faces in adhering to a medication regimen,” he said. Monica Leone, a nurse and care transitions manager with Hartford HealthCare at Home, also goes on the home visits to determine what other services the patient might need.
“I’m like Special Operations,” Jeffery said. “I put eyes in the home so I can provide the primary care provider with tailored pharmacy recommendations. I help find ways for patients to adhere to their medications. Sometimes, less is better.”
Jeffery tells the story of a 76-year-old patient, living alone, who brought his 12 medications to an office visit with Jeffery after admitting to a care manager he was having trouble managing them. When it quickly became apparent the patient was very confused, Jeffery convinced him that a home visit would be beneficial.
When Jeffery and Leone went to the patient’s home, they saw that the patient was “managing” his medications by using the lid from a Cool Whip container to line up his pills in a circle in the order he took them. He used pliers to split pills and an old gavel to crush them. His pill containers were stuffed into an overflowing kitchen drawer, the tops of the bottles labeled in black magic marker in a code only he understood. The patient’s walker was too wide to navigate through the clutter so he used an old office chair on wheels to move around.
“When we go out to a home, I do a head-to-toe assessment of the patient,” Leone said. “We saw from our visit that the patient needed additional services. There are patients out there who don’t have home care but qualify for home care. Based on our home assessment, the patient’s needs and finances, I determine what services they need in order to keep them safe.”
“We see the patient holistically and help the provider understand that the patient’s health situation won’t improve unless other changes are made,” Jeffery said. “There are no ICD [payment] codes for these visits, for cleaning out a patient’s house or for some of the other services certain patients might need to get on the right track in managing their care. We don’t have a huge number of resources so for home visits, so we select patients with high, but modifiable, risk. I often see people taking 14 or 15 medications, so there’s a lot of opportunity for a pharmacist to reduce the cost of care, improve outcomes and improve the patient’s quality of life by keeping medications simple and helping people take their medication regimen seriously.”