Background: Both medical and social issues can negatively affect health outcomes, especially for vulnerable populations. Assessing risk from these two perspectives independently, two non-profit organizations each developed a decision support program to identify medication-risk that could negatively impact health outcomes. This raises the question, could a combined program have greater potential for improved outcomes.
Methods: HomeMeds℠ (HM), a social health program in which trained social services staff make home visits to vulnerable clients, was combined with MedSafety Scan (MSS), a medical health, clinical decision support tool. Data captured in the home visit were entered into the HM and MSS programs to analyze each patient’s drug risk profile and their list of medicines to detect those patients at greatest risk of adverse health outcomes caused by medications.
Results: One hundred and eight patients (mean age 77 with multiple co-morbidities and LACE+ score >29) received a post-discharge home visit by trained social services staff. The number of drugs reported as being taken was 10.4 ± 5.1 (range 1-26) which was less than prescribed at discharge in 62% of patients (range 1-8). Both programs detected serious risk of medication-induced harm, mostly from different causes. HomeMeds detected medically relevant events such as unreported falls (24), dizziness (37), confusion (27) and uncontrolled pain (37). MedSafety Scan identified 22 patients with moderate to very high risk of cardiac arrhythmia due to their medicines. In 65% of patients, an average of 6.2 ± 5.6 potentially serious drug interactions were detected by MedSafety Scan but not HomeMeds.
Conclusions: Combined analyses of data from these two decision support programs that approach health issues and patient needs from different perspectives yielded complementary findings that address both medical and social determinants of health after hospital discharge. These have the potential to reduce medication-induced harm, costly re-hospitalization and/or emergency room visits. The results of this quality improvement project are encouraging and support the further evaluation of this combined approach in other vulnerable populations such as the seriously mentally ill, frail, those confined to home, opiate-dependent or otherwise impaired.