Coordinating Care Vital to Older Patients

Too many doctor’s visits, too many prescription drugs — potential for problems can be eased by coordinated care, experts say

By Deborah Jeanne Sergeant

Older adults get sick more often, have to see more doctors more frequently and usually take a great deal of prescription medicines — much more than young people.

Four out of five older adults have at least one ongoing health condition and — despite being only 13 percent of the general population — they consume 34 percent of all prescription medicine and 30 percent of all over-the-counter drugs, according to the National Council on Patient Information and Education (NCPIE).

No wonder older adults experience higher risk of drug-related complications. To make things worse, nearly 40 percent of older adults cannot read prescription labels and 67 percent cannot understand the information accompanying their prescriptions, according to the NCPIE.

Coordinating care among providers can help reduce risk of medical complication, local experts say.

Programs such as Loretto’s PACE CNY program, for example, offers older Onondaga County residents primary care and medication management through its central pharmacy.

“It sometimes takes more than one person or one group,” said physician Douglas Tucker, PACE chief medical officer. We have the advantage of an interdisciplinary team.”

Older patients can also hire independent health care managers or enlist a trusted family member to help.

“As health care continues to change in the US, it becomes increasingly important for care to be coordinated among the patient and his or her primary care physician and treating specialist physicians,” said Anne E. Zaccheo, practice director at Nephrology Associates of Syracuse, P.C. She is also president of the Central New York branch of the New York Medical Group Management Association.

Practices using electronic medical records (EMRs) may help improve care coordination; however, if a patient uses providers from different health systems or private practice providers, their information may not exist on all the EMRs. Zaccheo explained that providers use different EMR vendors and the different EMRs aren’t compatible.

Regionally, providers share EMRs through the Regional Health Information Organization (RHIO), HealtheConnections in Central New York, but since each region uses its own RHIO, people seeking care in different regions won’t have seamless records.

“A number of groups are trying to build an effective health information exchange for a uniform database,” Tucker said. “But the EMRs aren’t there yet. About nine different zones statewide have EMRs. It’s better than it was, but not 100 percent.”

New York is working on developing the State Regional Health Information Network (SHIN-NY).

Patient’s Role in Improving Coordination of Care

What is the patient’s role in improving coordination of care? Here is what experts say:

“Your health care provider is only as good as the information the family and patient shares. Have a medication list that’s up-to-date. If you travel or go to a different pharmacy, that’s very important.

“Have a list of questions when you’re seeing different doctors. Fragmentation can happen pretty quickly.”
Stephanie Button, PACE executive director

“Tell the doctors about over-the-counter medication and supplements.

“Diet, in general, is important as well as some foods can interact with medications.”

Physician Douglas Tucker, PACE chief medical officer

“It is very important for patients to communicate and let their physicians know issues related to medications, hospitalizations, travel and dietary changes.

“Often, older patients may have an advocate, spouse/partner, or adult child or other caregiver who has been authorized by the patient to be involved in his/her care and can assist to lend support and be actively involved in communication with the physicians/providers providing care to the patient.”

Anne E. Zaccheo, practice director at Nephrology Associates of Syracuse, P.C.