Chapter 10- Pharmacist in LTC Role

Question 1

What is the main reason for the increase in the elder segment of the population?

Answer 1

decrease in mortality rates

Question 2

What facts contribute to the decline in mortality rates (4)

Answer 2

• improvements in sanitation and nutrition
• better diagnostic technique and surgical procedures
• new medications
• use of chronic medications

Question 3

What is the Pareto principle used for?

Answer 3

to describe the demand for health care services. to improve health-care outcomes and to decrease cost.

Question 4

What is used to predict hospitalization?

Answer 4

PRA- Probability of Repeated Admission

Question 5

What can PRA be used to determine

Answer 5

• predicting hospitalization
• chronic illness
• risk of functional decline
• nursing home use
• doctor visits
• total cost of care

Question 6

Medicare type ____?
- provides a bundled payment to acute care hospitals,
subacute nursing home care, and hospice that includes those medications
needed by older adults for that stay.

Answer 6

Part A

Question 7

Medicare type ____?
the program
that provides services through managed care plans.

Answer 7

Part C

Question 8

Medicare type ____?
provides coverage for certain vaccines, such as pneumococcal
pneumonia, influenza, hepatitis B, and tetanus under certain conditions.
Part B also covers medications dispensed through a device such as
a nebulizer, as well as medications purchased by a physician for a patient.

Answer 8

Part B

Question 9

Medicare type ____?

the prescription drug program that provides coverage for medications to older adults.

Answer 9

Part D

Question 10

Which Medicare plan often calls upon consultant pharmacists to assist in the management
of pharmaceuticals.

Answer 10

Part A

Question 11

T/F?
ACA reduced patient out of pocket cost from 100% to 25% by covering 50% of the cost of medications during the “dough-nut hole”.

Answer 11

true

Question 12

What does the term frailty refer to?

Answer 12

loss of physiologic reserve that makes a person susceptible to disability from minor stresses

Question 13

What is stressful aging?

Answer 13

process by which deleterious effects are minimized and function is preserved.

Question 14

T/F?

Chronological age is not as descriptive as physiological when assessing health.

Answer 14

true

Question 15

What are the 4 barriers of health?

Answer 15

• lack of transportation
• being too ill and immobile to seek treatment
• misperception that symptoms are caused by aging
• perceived unresponsiveness by medical system
• under recognition and underreporting of disease
• lack of adequate health insurance

Question 16

DRPs-

Answer 16

Drug related problems

Question 17

ADE

Answer 17

adverse drug event

Question 18

What is the most consistently reported risk factor for ADEs?

Answer 18

polypharmacy
other risks below
- changes in pharmacokinetics and pharmacodynamics
-non-adherence 
-fragmented healthcare

Question 19

MIA-Medication Appropriateness Index

Answer 19

tool used to determine medication appropriateness implicitly on a per patient basis.

Question 20

Beers criteria

Answer 20

an explicit criteria for use in prescribing medications for older patients and identified several commonly used drugs that should be considered potentially inappropriate for use in older adults

Question 21

Goal of pharmacotherapy?

Answer 21

• promote successful aging by maintaining functional independence
• preventing disability and iatrogenic disease
• increasing patients’ quality of life

Question 22

CCGP- The commission for certification in geriatric pharmacy

Answer 22

• was created by American Society of Consultant RPHs
• accredited by Nation commission of certifying agencies
• RPH must have 2 years of experience

Question 23

What settings can a pharmacist consult in?

Answer 23

• NFs
  
  • nursing homes, skilled nursing facilities and intermediate care facilities
• sub acute care and assisted living facilities
• psychiatric hospitals
• intermediate care facilities for mentally retarded
• correctional facilities
• adult day care
• continuing care retirement communities
• PACE
• home care
• hospice

Question 24

State Medicaid programs predominately pay for what services?

Answer 24

-nursing facilities

Question 25

Federal law requires all nursing homes to have a contract with who?

Answer 25

consultant pharmacist

- DHHS regulations

Question 26

Consultant pharmacist in the nursing facilities are responsible for what?

Answer 26

• ensuring that resident drug use in safe and effective

- facilities are in compliance with federal and state regulatory requirements.

Question 27

Payments to SNFs (24-hour skilled care) are made predominantly through?

Answer 27

Medicare programs beginning 3 days after acute-hospital stay.
NF- placed at risk for the medications

Question 28

DHHS requires what of contract consultant RPH? (3)

Answer 28

• consultations
• establish a system of records of receipt and disposition of all controlled drugs
• determines the drug records to account for controls-reconciliation

Question 29

DRR- Drug regimen review must be conducted how often?

Answer 29

• at least once a month in a NF

- at least quarterly in intermediate care facilities for the mentally challenged or developmentally disabled

Question 30

MDS

- minimum data set for residents after admission

Answer 30

• upon admission and yearly

- shortened version: quarterly and when resident changes status

Question 31

The consultant pharmacist, in his or her DRR, is responsible for communicating irregularities with who? (2)

Answer 31

• attending physician

- Director of Nursing

Question 32

Do the attending physician or director of nursing have to accept the RPH recommendation?

Answer 32

• NO

- OBRA mandated that the recommendations must be followed by ACTION BUT physician doesn’t have to accept recommendation.

Question 33

Evidence of positive outcomes w/ consultant pharmacist?

Answer 33

Fleetwood project

-conducted by ASCP’s Research and Education Foundation.