DeprescribingJessica Visco, PharmD, CGP

SeniorPharmAssist

August 24, 2016

Deprescribing

Jessica Visco, PharmD,

CGP

SeniorPharmAssist

Webinar #1

Webinar #11

Interagency Care Team: Helping Your Geriatric Patients Remain Safe and Healthy at Home

Geri Kanne, MSN, RN, ANP-BC

Mitchell T. Heflin, MD, MHS

Melissa Black, MPH

Michael Patterson, BS

Disclosures No commercial support has influenced the planning of the

educational objectives and content of the activity. Any

commercial support will be used for events that are not CE

related.

There is no endorsement of any product by DUHS

associated with the session.

No influential financial relationships have been disclosed by

planners or presenters which would influence the planning of

the activity. If any arise, an announcement will be made at

the beginning of the session.

This program is supported by a Geriatric Workforce

Enhancement Program (GWEP) grant (U1QHP28708) from

the U.S. Bureau of Health Professions Health Resources

and Services Administration (HRSA).

Case-1

Ms. F is a 76 y/o widowed AAF

Lives by herself in Durham

Worked as a cook at a local diner until retired

Daughter lives locally, but works full-time

Does not drive and relies on a neighbor for

transportation

Case-2Medical history

Cognitive impairment (no formal assessment)

HTN

Depression

Asthma

Other concerns: Urinary incontinence and intermittent

insomnia

Meds: oxybutynin, atenolol, paroxetine, albuterol

inhaler, promethazine, diphenhydramine

Case-3

Recently:

Misses PCP appointments

Blood pressure elevated in clinic

Trouble affording her medications

Traditional Medicare but not enrolled in part D

$23/month from Food and Nutrition Services

Case-Questions

What are YOUR priorities from a medical

perspective?

What are HER priorities in terms of her day to

day challenges and stressors?

How can we account for BOTH in providing her

care?

Objectives for Today:

Define purpose of Interagency Care Team (ICT)

Describe services provided

Decide which patients are most appropriate for ICT

How to refer your geriatric patients

What to expect after the referral

The GWEP: Who are we?

Partners:

Duke faculty—Nursing, Medicine, PA, RD, Epi, Educ, SW

Triangle J AAA

Community Resource Connection (CRC)

Senior PharmAssist

Durham Partnership for Seniors

Duke Connected Care

identify current

resources

identify needs and

gaps

Connect practices, geriatrics,

and community agencies

The GWEP: What do we Do?

Activities:

Form partnerships

Host CE programs to develop geriatric expertise in primary care (GRTs)

Provide virtual geriatric consultations (ICTs)

Train A-GNP and MD fellows in geriatrics

Evaluate impact on trainees and outcomes at population level

identify current

resources

identify needs and

gaps

Connect practices, geriatrics,

and community agencies

Improved care

of older adults

GWEP Faculty

and community

partners

GRT Educational Program

Communication:

IPCP trainingworkshop

Competencies:Best practices: dementia care, medications, transitions

Continuous Improvement: Focused projects

Connections: Referrals to ICT, community agencies

ICT Consultation

GWEP/ICT

PACE

Duke Outpatient

Clinic

Just For Us

LincolnDurham Family

Medicine

Walltown

Triangle Family

Practice

• Virtual Consultation:

“Geri Rounds”

• Focus on resource

needs

• EHR tools

• Identify “at risk”

seniors

• Reimbursement

Who Makes Up the Team? Geri Kanne, NP

Mitch Heflin, M.D., MHS

Marilyn Disco, pharmD

Melissa Black, Coordinator, Durham Community

Resource Connections for Aging and Disabilities

Rhonda Mack-Minnifield, Health Resources

Coordinator

Katie Huffman, Community Services Director

Geriatric NP and MD fellows

Whom Should You Refer?

Patients aged 60 and older with complex care

needs who would benefit from community

resources to help them remain safe and

healthy at home

Issues: cognitive impairment, medication

management, insurance/access, transitions in

care, level of care/caregiving, transportation,

food insecurity, social isolation

GET clinic or ICT?

What is the Process for

Making a Referral?

What is the Process for

Making a Referral?

Primary Care site without access to Epic:

(919) 684-9507 (Geri Kanne, NP)

What Happens Next?

Chart review by ICT lead, pharmacist

Phone call to pt./HCPOA

ICT group meets

Consult note into Epic

Patient-friendly recommendations to patient in

the mail

Back to the Case

PCP Concerns

Uncontrolled BP

Cognition

Depression

Transportation

Lack of drug plan

Patient Concerns

Incontinence supplies

Food Insecurity

Depression

Transportation

Insomnia

Back to the case

Medication review by a geriatric pharmacist from Senior PharmAssist

Drug insurance review to ensure she is paying the least amount for her medication regimen

Connection to transportation services

Referral to meals on wheels, information on area food banks, Double Bucks at Durham Farmer’s Market

Facilitation of socialization through Durham Center for Senior Life

Connection to free incontinence supplies

Referral to Silver Linings for counseling

ICT Consult Note

ISSUE ACTION NEEDED TO COMPLETE ASSIGNED

1. A) Medications: not on part

D drug plan

B) Misses doses

A) Make appointment with Senior PharmAssist to

enroll in part D drug plan

B) Discuss switching to pharmacy that delivers prefilled

meds in pill pack.

A) Information to pt.

B) Information to patient

2. Food Insecurity Receives $23/month from FNS. Would like information

on Double Bucks with Durham Farmer’s Market and

food banks

2. Information mailed to

pt.

3. Depression: feels isolated and

lonely since husband died

She would like to talk to someone about her ongoing

grief and depression. Agrees to referral to Silver Linings

3. ICT put in referral to

Silver Linings

ICT Referral: Results (N=27)

Issue Addressed # of

Cases

Referral Agencies

Cognition/Depression/

Social Isolation

21 Behavioral Health; Senior Centers; Duke Family

Support; Silver Linings

Med Management 21 Pharmacy consult; SPA; Information to pt; RN home

visit to check meds

Food Insecurity 15 Meals on Wheels; Food Bank; More in My Basket;

SNAP

Personal Safety 15 PT/OT; DSS/in home aide; Duke Vestibular Rehab

Adv. Directives 14 POA form located in chart-mailed to pt/HCPOA;

Home health RN; SW at PCP office

Transportation 9 DSS/CapDA; Helping Hand; GoDurhamACCESS; Let’s

All Go/Alliance of Disability Advocates

Incontinence products 9 Diaper Bank; Caswell Co Senior Ctr

Financial assist/Rx 6 SPA (same pt referred for med mgemt);

LIS/application by DCSL; PAP; SW to assist with Duke

Hardship

Durham Center for Senior

LifeOur mission is to enhance the lives of older

adults (55 and older) through Education,

Recreation, Nutrition and Social Services in a

welcoming community setting.

Membership is no cost, Come Join the Fun!

DCSL Point of Contacts Maggie Perez – Social Services Coordinator

Mperez@DCSLNC.org 919-688-8247 ext. 104

Transportation, Weatherization / Home Repair, Housing Assistance, Legal Aid

Telephone Reassurance, Information and Assistance / Referrals, Latino Outreach

Michael Patterson – Support Services Manager

Mpatterson@DCSLNC.org 919-688-8247 ext. 122

Family Caregiver/ Respite Care/ Group Support

Food / Hygiene / Diaper Pantry, Utility Assistance

Information and Assistance / Referrals / Options Counseling, Outreach

Alvonia Baldwin – Center Director

Abaldwin@DCSLNC.org 919-688-8247 ext. 120

Congregate Nutrition / Satellite Senior Centers, Health Promotions

Center Programming / Presentations

mailto:Mperez@DCSLNC.orgmailto:Mpatterson@DCSLNC.orgmailto:Abaldwin@DCSLNC.org

Durham Partnership for

Seniors Advocates for senior issues

Promotes and facilitates partnerships

Identifies opportunities that may improve the quality of

life for Durham’s seniors and adults with disabilities

Home and Community Care Block Grant Advisory Role

Durham Community Resource Connections for Aging & Disabilities

Durham County Board of Commissioners

Home and Community Care Block Grant

Advisory Role

Durham’s Partnership for Seniors

Triangle J Area Agency

on Aging

Dementia Inclusive Durham

Durham’s Partnership for Seniors Organizational Structure

FY 2017 - 2018

Duke Geriatric Workforce

Enhancement Project

Legend:

Blue Boxes = Initiatives

Red Boxes = Funding Sources

Funding Direction

Specific DPfS

Initiatives

Collaboration

Senior Hunger & Nutrition

Age-Friendly Initiative

Future Plans for ICT Evaluation:

Feedback: GRTs, patients and caregivers

Process: Were referrals completed?

Clinical: ED visits, hospitalization, aging in place

Efficiency:

Documentation during meetings

Realtime referrals to CBO’s?

Access:

Increase frequency and # reviews

Closing Remarks Consider ICT for any complex geriatric patient that you

feel would benefit from geriatric evaluation, especially

those in need of community services.

Maestro Referral tab: E-Communication for Geriatrics

OR

Geri Kanne, NP (919) 684-9507

Questions?

Continuing Education Credits 1 hour of CE credit is being offered for this webinar.

For the live webinar, to obtain the credit you must:

Add your name to the chat box (to verify attendance)

Complete the survey. The survey will open automatically at the end of the webinar and the link will be sent in a follow-up email.

If you did not register for this webinar and would like CE credit, contact gero@duke.edu

mailto:gero@duke.edu