PRISM Geriatrics and Accountable Care

With over a third of Connecticut greater than 50 years of age, the state is grappling with how to meet the care needs of a rapidly aging population.  Additionally, Connecticut has more nursing home beds than are needed which has resulted in an abnormally high rate of skilled nursing facility utilization, the costs of which are staggering.  With nursing facilities costing upwards of $150,000 per resident per year, the State of Connecticut needs innovative strategies to ensure only those most in need receive skilled nursing facility care.  With increasing age come increasing use of prescription medications.  The elderly use more medications than any other age group. Older adults are at increased risk of medication related problems like polypharmacy, falls, delirium, and adverse drug reactions.  Pharmacists are vitally important in protecting the health and safety of seniors from unintended medication harm.  The role of the pharmacist in post-acute care is now more important than ever with the advent of bundled payments for episodes of care, the revised CMS Megarule, and MSSP programs that largely serve seniors. Medication care coordination and streamlined transitions in care are areas where pharmacists can save lives. Pharmacists are the distinct medication management experts on the interdisciplinary healthcare team. They optimize medication therapy across the healthcare continuum to improve outcomes and reduce hospital readmissions that would otherwise require more extensive interventions and expensive utilization of services. At the UConn School of Pharmacy we are training the next generation of senior care pharmacists.

  • Our faculty are internationally recognized experts in senior care pharmacy. They have extensive experience working with seniors, advocating on their behalf and advancing the profession of geriatric pharmacy.
  • Faculty have created specialized geriatric pharmacist post graduate residency programs, developed geriatric pharmacy curriculum, and served in a variety of medication safety and advocacy roles.
  • The school has also had a faculty member serve as President of the American Society of Consultant Pharmacists, the professional pharmacy organization dedicated to caring for seniors.
  • Our faculty are actively involved in innovative payment models where they develop and implement initiatives to improve prescribing practices, provide direct patient care for seniors, and educate the healthcare team on pharmacy-related metrics to improve cost and quality.

Dr. Nathaniel Rickles has and currently involved in several pilot projects exploring community pharmacist roles in the screening and intervention of various physical and mental health needs of older adults.   For example, he found that screening of Alzheimer’s Disease in community pharmacies was feasible and led to many referrals for follow-up of those at risk for the disease.  He also has explored policy related work evaluating the impact of individual characteristics served by Medicare programs on medication adherence quality measures.  Dr. Rickles is currently completing a small pilot of community pharmacist roles in exercise promotion among physically inactive older adults with cardiovascular conditions.

Publications in this area include:

Michele Heisler, MD, MPA, Jennifer Burgess, MPH, Jeffrey Cass, PsyD, John F Chardos, MD Alexander B Guirguis, PharmD, BCPS, Sean M Jeffery, PharmD, Lorrie A Strohecker, MD, Adam S Tremblay, MD, Wen-Chih Wu, MD, Donna M Zulman, MD, MS.  The Shared Health Appointments and Reciprocal Enhanced Support (SHARES) study: study protocol for a randomized trial.  In Press for Trials

Jeffery S. Stemming the Tide of Dementia in Practice. IPJ – The official Journal of the International Pharmacy Federation (FIP); October 2016

Young GA, Rickles NM, Chou CH, Raver E. Influence of enrollee socio-economic characteristics on Medicare Part D Contractors’ performance ratings on medication adherence. Health Affairs 2014;33(1).

Rickles NM, Skelton JB, Davis J, Hopson J. Cognitive Memory Screening and Referral Program (CMSRP) in Community Pharmacies in the United States. International Journal of Clinical Pharmacy 2013 (DOI) 10.1007/s11096-013-9904-7.

Orwig D, Rickles NM, Martin LG. Methodological issues in pharmacy research in older adults. American Journal of Geriatric Pharmacotherapy. 2011;9:173-189.

Howard EP, Rickles NM, Nannini A, Harvey R, O’Neil-Pirozzi TM, Kirwin J, Lowe S. Establishing an Interdisciplinary Geriatric Education Center.  Journal of Allied Health 2009;38:e125-e129.

Funded grant projects in this area include:

A Community Pharmacy Exercise and Health Promotion Program: Stepping Up to Improve Medication Adherence in Older Adults. Sponsor: National Institute of Aging- P30 pilot through Brandeis Roybal Center of Active Lifestyle Interventions ($25,000, June 2015 to present): Project PI: Nathaniel Rickles and Carmen Sceppa (Northeastern University).

Preventing medication-associated delirium.  Sponsor:  The Donaghue Foundation ($110,000 January 2016 – present):  Project PI: Sean M. Jeffery

Impact of an Embedded Geriatric Clinical Pharmacist on Medication Management within a Skilled Nursing Facility.  Sponsor:  The Jefferson House Foundation ($411,945 January 2016 – present); Project PI:  Sean M. Jeffery

Senior Care Continuum Expansion Grant.  Sponsor:  The Main Street Foundation ($35,000 2016); Project PI: Sean M. Jeffery

Southington Senior Care Coalition.  Sponsor: The Main Street Foundation ($20,000 2017); Project PI:  Wendy Martinson and Sean M Jeffery

Peer Support to Enhance Diabetes Shared Medical Appointments: Examining Comparative Effectiveness in VA Health Systems.  Sponsor: Veterans Affairs Health Services Research and Development (IIR 15-321) ($121,455 January 2016 – January 2020) PI: Michele Heisler, MD, Local Site Investigator: Sean M Jeffery