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

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.