2008 Access to Medications for Rural Kentuckians

Approximately 500,000 Kentuckians lack adequate health and prescription drug insurance. These people need safe and effective access to medications. Poverty and un- or underinsurance leave these patients more vulnerable than the general population to poor health. Failure to treat, late treatment, and inconsistent or uncoordinated treatment tend to worsen medical conditions and require more to address them and their complications.

Kentucky Homeplace has served uninsured and underinsured rural Kentuckians since 1994 by assisting their access to prescription medications. Often this means that lay workers from Kentucky Homeplace contact local physicians to order medications through pharmaceutical manufacturer assistance programs or refer them to one of the few pharmacies that serve only indigent patients.

Kentucky Homeplace has been successful in providing rural Kentuckians with access to prescription medications. The downside has been that many un- or underinsured patients receive medications through multiple sources, including generics from local pharmacies, physician samples, and medications upon release from hospitalization. Often, too, multiple physicians prescribe individual medications without full knowledge of patients’ medical histories or of concurrently taken medications. As a result, patients may be simultaneously treated with multiple drugs in the same therapeutic class or at risk of potentially severe drug interactions. Others lack medication important to maintaining control of their disease.

David Nau of the UK College of Pharmacy, is working in a collaborative effort with Kentucky Homeplace and the Kentucky Pharmacists Association to address these problems. The Rural Medication Management initiative will track use of medication by Kentucky Homeplace clients, determine those with therapeutic duplication, those with potentially severe drug interactions, those with asthma, diabetes, or heart failure who lack a drug necessary for control of their chronic disease, and those with significant gaps in treatment due to difficulty in accessing medications for chronic diseases. It will create comprehensive medication records accessible to all providers for that patient.

The effort will begin in two to three southeastern Kentucky counties and will expand to all counties served by Kentucky Homeplace within three to five years. Rural Healthcare Management is expected to improve the health of rural communities through reduced rates of adverse medication-related events, better communication between healthcare providers, and improved access to medications in a safe, coordinated program.