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Maryland Hospital Touts Success of Community Paramedicine Program

Analysis  |  By Eric Wicklund  
   December 07, 2022

The University of Maryland Medical Center's mobile integrated health community paramedicine (MIH-CP) program, which sends specially trained paramedics to the homes of selected patients after hospital discharge, saw increases in first-fill prescription rates and medication adherence, according to a study.

A mobile integrated health community paramedicine (MIH-CP) program launched in Baltimore by the University of Maryland Medical Center helped improve medication adherence for patients with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD), according to a new study.

As reported in a recent issue of Exploratory Research in Social and Clinical Pharmacy, an MIH-CP program, which sends specially trained paramedics to the homes of selected chronic care patients following discharge from a hospital, increased first-fill prescription rates by almost 20% for CHF patients and 25% for COPD patients in the first 30 days. In addition, the program boosted medication adherence by 8% to 14% over 60 days.

The results show promise for an innovative program that's designed to improve chronic care management at home, reduce adverse health events and cut back on 911 calls by so-called "frequent flyers," or patients who often need emergency healthcare services and rack up large healthcare bills.

[See also: Innovative Partnerships Power Mobile Integrated Health Programs.]

The Maryland program was coordinated through the health system's Epic electronic health record platform in a partnership with digital health company DrFirst, and focused on pharmacist-led interventions.

“These results are particularly exciting because patients with chronic health conditions are at greater risk of poor outcomes if they don’t take their medications as prescribed,” Colin Banas, MD, MHA, chief medical officer for DrFirst and one of the study’s authors, said in a press release. “Pharmacist-led programs like this have a long history of improving medication use. As value-based care and risk-based contracts grow in prominence, healthcare organizations are turning to innovative ways to manage care for high-risk patients, so they have better health outcomes and stay out of the hospital as much as possible.”

The health system identified high-risk patients with CHF or COPD as they were discharged from the hospital and assigned them to the MIH-CP program for follow-up care. That care includes home visits by a team of community paramedics and a pharmacy technician and a virtual care link to pharmacists, community health workers and a physician or nurse practitioner.

Some 83 patients took part in the six-month study, with 43 assigned to the MIH-CP program and 40 to traditional follow-up care.

The study's authors note that patients with CHF or COPD run a high risk of hospital readmission due to acute exacerbation, leading to high healthcare costs and penalties from the Centers for Medicare & Medicaid Services for preventable rehospitalizations. Part of the problem is that many of these patients don’t follow doctors' orders on medication management.

"Efforts to integrate inpatient and outpatient medication regimens remain critical for the prevention of medication non-adherence during transitions of care and help to identify medication non-adherence at timepoints," the study concluded. "Transition of care programs such as MIH-CP, which incorporate pharmacists as part of the team, support the identification and resolution of critical medication-related problems and medication non-adherence. These types of programs can provide much-needed care and support for a largely underserved community."

Health systems across the country are experimenting with MIH and CP program in various forms and targeting different patient populations. Some create a program through their own EMS services, while others partner with local EMS providers and other community health programs.

Home visits run the gamut as well, with care providers offering chronic care management services, addressing social determinants of health, even just chatting for a while with someone who might be home-bound and lonely.

Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.


KEY TAKEAWAYS

The University of Maryland Medical Center has launched a mobile integrated health community paramedicine (MIH-CP) program for high-risk CHF and COPD patients.

The university assigns these patients to the program after hospital discharge, sending specially trained paramedics and other care providers to their homes for follow-up care and connecting them via telehealth with a care team at the hospital.

The program has seen first-fill prescription rates rise by 20% for CHF patients and 25% for COPD patients in 30 days, while also boosting medication adherence over 60 days.


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