LOS ANGELES-California's Medi-Cai program pays about $36 a day for 24-hour nursing home care. New York's Medicaid program pays $67. And although New York and 28 other states pay more, California says it can't afford to do better.
The findings of a recently completed study suggest several ways for California and other states to improve the quality of nursing home care - at no additional cost.
Researchers from the University of Southern California report that, when patients in round-the-clock facilities are cared for by physician/pharmacist teams and encouraged to talk about day-to-day concerns, their drug use can be reduced greatly and their chances for discharge from the facility are increased.
Not only do the patients benefit, but fewer medications and fewer patients needing roundthe-clock care mean reduced expenses for the state.
The two-year study also found that death rates are reduced among nursing home patients for whom drugs are prescribed by a clinical pharmacist (with a physician's supervision).
The USC researchers studied 127 patients, including 62 subjects and 65 controls, in Southem California. Both facilities provide round-the-clock nursing care. The average patient age was 81 , and women outnumbered men by three to one.
The USC researchers were John F. Thompson, PharmD; Richard Ruffalo, PharmD; and William McGhan, Phd.
The team spent the first year of the study simply observing the prescribing habits of the nursing-home physicians including their use of laboratory tests, and assessing the quality of medical care the 127 subjects and controls received.
During the second year, Drs. Thompson and Ruffalo participated in the care of the 62 subjects. Under the auspices of Assembly Bill 717, a California bill allowing pharmacists to prescribe drugs, Thompson and Ruffalo worked under the supervision of the subjects' physician to assess patient -needs , prescribe drug therapy, and order laboratory tests. They communicated their findings to the physician and, in general, functioned as physician associates.
Each of the 62 patients was visited by Thompson or Ruffalo for about 45 minutes each month. In comparison, studies show that most nursing home physicians see their patients, on the average, for only three to five minutes per month.