Medication-related problems exact a heavy toll on American public health. Indeed, medication errors are a leading cause of death in America. Older adults, especially home health patients, are especially vulnerable to medication errors because of the number of medications they take and the biological changes of aging and disease.

Medication Management Improvement System (MMIS) is designed specifically for home health agencies and was proven effective in a recent clinical trial. The Model uses guidelines established by an expert panel for resolving high-risk medication problems such as unnecessary therapeutic duplication, cardiovascular medication problems, use of psychotropic drugs in patients with a reported recent fall and/or confusion, and use of non-steroidal anti-inflammatory drugs (NSAID) in patients at high risk of peptic ulcer complications.

The model uses computerized risk assessment screening and an alert process has been developed, using the medication list and clinical indicators (vital signs, falls, dizziness and confusion) to identify potential medication problems. Care managers then work with a consulting pharmacist to 1) verify the accuracy and appropriateness of the client's current medication list, 2) identify problems that warrant re-evaluation by the physician, and 3) follow through with the client and physician to resolve identified problems.

The goal of this program is to reduce medication-related problems among senior home health patients.

The initial study demonstrated that medication errors can be avoided and prescribing practices can be improved in this vulnerable population. Medication use improved in 50% of intervention patients, compared to 38% of controls (p=.05). There was no evidence of adverse intervention effects: new medication problems, more agency nurse visits, or increased duration of home health care. The Model has since been implemented in several different home health agencies.