AIM:
Improve Patient Outcomes through Optimal Medication Management Leveraging the Medication A.R.E.A.S. Bundle Resources
What is the Medication A.R.E.A.S. Bundle?
The Medication A.R.E.A.S. Bundle is a prescription solution to optimize healthcare value by improving patient health outcomes; reducing total costs; improving organization performance; and making the Triple Aim a reality in the new value-based healthcare system - Nationally and Worldwide
Over the last two to three decades, international, national, local organizations, and team members have worked independently and interdependently to understand the barriers that contribute to poor medication use and the evidence-based interventions that have been shown to consistently and effectively optimize appropriate medication use in patients especially those with multiple chronic conditions - regardless of the disease condition.
Based on the ample evidence, research, and studies on appropriate medication use and management, a set of medication practice elements has been identified. The evidence is strong, and there is general acceptance that these practice elements will optimize patient care and health outcomes in a consistent manner across the continuum of care. They are expected to reduce the total cost of healthcare, improve the health and well being of the communities served, and improve organizational performance in quality, affordability, service, access, and other critical measures.
These elements have been condensed and integrated into a bundle known as the Medication A.R.E.A.S. (adherence, reconciliation, engagement, affordability, and safe medication use) Bundle or MAB.
Below are descriptive components of Medication A.R.E.A.S. Bundle (MAB):
Medication adherence is generally defined as the patient’s conformance with the provider’s recommendation with respect to timing, dosage, and frequency of medication taking during the prescribed length of time. Patients are generally considered adherent to their medication if their Proportion of Days Covered (PDC) is equal to or greater than 0.8 (or 80%). Eighty percent is the goal for patients on most classes of chronic medications (antiretrovirals for HIV/AIDS and some cancer oral therapies have an approx. 0.95 or 95% threshold).
Medication reconciliation is the process of identifying errors and acting on discrepancies in patients’ medication histories by obtaining and maintaining accurate and complete medication information for a patient and using this information to ensure safe and effective medication use. Medication reconciliation is a key aspect of patient safety, as it promotes the focus for providers and patients to verify patient medication lists at key transition points to identify which medications have been added, discontinued, or changed, compared to pre-admission medication lists.
Patient and family engagement strategies have shown such promise that they have been incorporated into the majority of recent efforts to improve healthcare quality. CMS describes patients and their families as essential partners in the effort to improve the quality and safety of health care.
With the focus on healthcare value, patient engagement and education has gained increased prominence and is recognized as a crucial component of high-quality healthcare services and better patient outcomes. Patient engagement is also a critical procurer to successfully educating patients about their medications. When patients are engaged, they are more likely to understand what is being taught about their medications and ask questions when they do not.
Prescription drugs play a critical role in helping to prevent, manage, and cure disease, yet they are a key factor pushing up healthcare costs. While the rate of growth of health spending in the US continues to increase, the rate of prescription drug spending has far outpaced healthcare spending. According to the IQVIA, the rapid growth in drug costs over the last decade has been primarily due to increased spending for new medications, especially specialty drugs used to treat complicated conditions like cancer, rare conditions, and rheumatoid arthritis.
This rapid growth in prescription medication prices over the last few years has become a national issue and the subject of a number of congressional hearings and probes.
In the IOM “To Err Is Human: Building a Safer Health System” report, medication-related errors were a significant cause of morbidity and mortality as they accounted for at least 1.5 million medication-related events, or preventable medication related injuries that occur yearly in the US. Medication errors have been estimated to account for 1.9 million hospital stays, increased length of hospital stays, the most common causes of inpatient complications, and about $3.5 billion in hospital costs. In outpatient/ambulatory settings, medication errors are the most common post discharge complication, resulting in 3.5 million office/ambulatory visits, and 1 million emergency department visits.
Medication errors also account for one out of every 131 outpatient deaths, and one out of 854 inpatient deaths, totaling more than 7,000 deaths annually. Based on these and other findings, the IOM issued a report in 2007 on medication safety called “Preventing Medication Errors.” This report focused on many issues including the importance of reducing medication errors, providing clinicians with information and decision-support tools, and processes to reduce medication errors and adverse outcomes.