For the past seven years, an Annapolis-based pharmacy has been using patented technology to make it easier for people who take medication for behavioral health issues to never miss a dose. A local homeless services provider now aims to bring those benefits to some of the District’s most vulnerable residents.
In 2007,Terrapin Pharmacy adopted a robotic system that puts together custom strips of labeled, single-dose packets containing all of the prescription pills a patient is prescribed to take at a given time, ordered chronologically to allow for different regimens for different days or times of day.
Since 2012, the pharmacy has been piloting a wall-mounted, dispensing device called Medherent that notifies clients when they should take medication. It also provides clients access to a live video chat with a case manager or a nurse practitioner.
“Ultimately, it’s to make sure they have the right medication in the right dose at the right time,” said Joel Feldman, the president of Terrapin Pharmacy. “We manage the medication administration from many agencies, whose primary mission is to provide care for people with severe and persistent mental illness.”
Tools to help with medication management have proven essential for patients with prolonged and severe mental illness, according to Feldman. He emphasized that although Medherent targets people who struggle with mental health, it addresses any individual who needs frequent medication, for physical or mental health conditions. Feldman noted that some people with mental health problems might also have other physical health-related diseases such as diabetes.
More than 100 clients have registered for the Medherent service by installing mobile software. This technology is proven helpful to increase medication adherence rates, improve patients’ well-being, and reduce overall medical costs. Each year, medication non-adherence and adverse drug effects result in 1.3 million emergency room visits. Nearly $200 billion is spent every year on avoidable hospitalization because of medical non-compliance, which is roughly 10 percent of total healthcare expenditure.
But this service remains exclusive to people with stable housing. So Others Might Eat — a nonprofit that provides daily meals, housing programs, job training and more — is partnering with Terrapin Pharmacy to make these technology-based healthcare services accessible to D.C.’s homeless population.
Richard Bebout, the project director for Together4Health at So Others Might Eat, said his team plans to look into data from the city’s Homeless Management Information System database to identify people who live with chronic physical health issues, behavioral health issues and/or substance abuse. They will also reach out to shelters, day centers, and meal programs.
According to Bebout, the pilot project is designed to have 25 clients for high-intensity case management, and up to 40 people for the lower-intensity “maintenance” phase. Bebout said the client selection process prioritizes people based on how vulnerable they are, similar to how the city triages housing placements.
Bebout told Street Sense Media that there are already ten people enrolled for treatment with the application on their cell phones installed. He has personally focused on reaching out to 801 East Men’s Shelter and D.C. General Family Shelter.
This project targets people who are high-utilizers of healthcare. Bebout added that the people he serves are all members of AmeriHealth, which is one of the highest-spending insurers in the District and is also funding the project.
A crucial element in this project will be pharmacy support, according to Bebout. Terrapin Pharmacy is responsible for staying in touch with health care providers to keep the packaging process in operation. Bebout said his team is sensitive to the potential for errors that might occur in the absence of constant communication between the pharmacy and health providers. As a psychologist, Bebout has seen first-hand that taking the wrong medication or having an incorrect treatment regimen for psychiatric diseases can result in serious side effects for patients.
His team will be paid based on the quality of their outcomes, rather than the number of people served. The project aims to lower medical costs in other areas, such as emergency room visits, symptom deterioration, and hospital readmission.
Bebout said his team initially encountered a lot of skepticism from potential clients, but the community are now more eager to support the work.
Outside of the So Others Might Eat pilot project, The University of Maryland School of Social Work has been conducting a study to assessing the Medherent program and has interviewed several users of this technology. The initial feedback shows Medherent was widely embraced by users.
“One thing that’s effective is people have my cell phone number,” Bebout said of the close connections he has made with clients in this very hands on, or “high-touch,” project. “They called me and we maintained contact. I found this really unusual.”
Medherent can enable caregivers and the pharmacy to keep track of medication delivery and the time people are taking their medicine through both a private app on the patient’s cell phone and a tablet on the wall. However, Feldman is concerned that the instability that goes with homelessness may undermine adherence to treatment.
He worries that when patients do not have stable housing, it will be harder to track the delivery and the time the patients take the medication. This may lead to medical non-adherence, which has many unexpected drawbacks for the individual and their caregivers.
Homeless people are likely to incur costs for healthcare due to the complexity of managing physical conditions such as diabetes and hypertension, or mental health conditions such as substance abuse. Bebout acknowledged the challenges facing the homeless community and said having more housing is an important step to resolve the homeless crisis. He also confirmed that participants in the SOME program will only be using the mobile application and the custom-sorted dosage packs, not the wall-mounted distribution machine.
Feldman believes Medherent may prevent people at-risk for medical non-adherence from becoming homeless and may help others stay in housing once they get off the streets. He is confident that Medherent ensures that people who live with mental illness take the right medication on time to prevent deterioration. The way he sees it, Medherent could help alleviate the affordable housing crisis in D.C.
“If you can greatly improve medication adherence and reduce the overall cost of caring for people with mental health issues on a per capita basis, then you have more funding left to expand the services,” Feldman said.
This article has been updated to make it clear the Homeless Management Information System database does not track medication adherence. It has also been updated to reflect that Terrapin Pharmacy did not invent the robotic packaging system, but they have integrated it into their work.