Medication Management Through Collaborative Practice for Children With Medical Complexity: A Prospective Case Series | JoVE Visualize

Area of Science:

Pharmacotherapy
Pediatric Long-Term Care
Health Services Research

Background:

Medication management for children and youth with special health care needs and medical complexity (CYSHCN-CMC) presents significant challenges for providers, families, and patients.
Effective care coordination, particularly for pharmacotherapy, is crucial for improving health outcomes and reducing healthcare utilization in this population.

Purpose of the Study:

To describe the implementation of a clinical pharmacotherapy practice within a pediatric long-term care facility (pLTCF).
To detail the application of standard operating procedures for comprehensive medication management (CMM) guided by a collaborative practice agreement (CPA).
To evaluate the impact of pharmacist-led CMM on drug therapy problems (DTPs), medication burden, healthcare costs, and hospital readmissions in CYSHCN-CMC.

Main Methods:

A prospective case series design was employed over a 9-month period.
102 patients identified as CYSHCN-CMC were enrolled in this quality improvement project at a pLTCF.
Pharmacists utilized a CPA to conduct CMM, identifying and resolving DTPs, and assessing medication regimens.

Main Results:

Pharmacists identified, prevented, or resolved 1355 DTPs (average 13 per patient), reducing the average number of medications per patient from 23 to 20.
Significant cost savings and avoidance were observed, totaling $44,304 monthly in direct cost savings and $48,835 monthly in cost avoidance.
The intervention led to a 44% reduction in hospital readmissions, avoidance of 28 ED visits/admissions, and 61 clinic/urgent care visits. Pharmacist recommendations were accepted at a 98% rate.

Conclusions:

Implementing a CPA for CMM in CYSHCN-CMC effectively decreased medication burden and resolved/prevented adverse drug events.
The collaborative pharmacotherapy practice resulted in substantial reductions in healthcare-related costs and hospital readmissions.
The model was well-accepted and collaboratively implemented by pLTCF providers, demonstrating its feasibility and value.