Episode 3: Breaking Barriers: Medication Access in LTC

Andie Cartwright

Welcome to the Better Living Through Data podcast. I'm your host, Andie Cartwright and today Anthony and I will be speaking about something that's been a persistent challenge in long-term care—barriers to medication access. We often frame it as a systemic issue, but what we're really dealing with here is a series of interconnected roadblocks but specifically disparities in healthcare delivery. And, uh, one thing that stands out to me is how age and ethnicity play such huge roles. It's, it’s complicated, right?

Anthony Pero

Oh, absolutely. I mean, the data really jumps out at you when you start looking at it. Take the 19 million nursing home residents from the electronic health records our team analyzed. The disparities are stark. Older adults are far less likely to receive newer medications. And the reasons aren't always clear-cut—sometimes it's funding, sometimes it's cultural, sometimes it's just baked into the system in ways that are, well, kind of invisible unless you really dig into the data.

Andie Cartwright

And when you say baked into the system, you're really hitting on something important; healthcare access for older adults

Anthony Pero

What we've found, over and over, was that older patients weren't even being told about newer treatments. It wasn't malice or anything, just this assumption—often unspoken—that, you know, someone in their 80s might not benefit from newer interventions.

Andie Cartwright

Wow. That assumption itself is such a barrier. And the thing is, when we look at the data today, it still tells the same kind of story. Take chronic conditions like dementia—we’re seeing treatment rates way lower than we’d expect. And it's not just about access; it's also about the complexity of managing multiple medications. Multimorbidity, polypharmacy... all those factors make things harder, especially for older adults facing cultural and systemic barriers.

Anthony Pero

Right, and when we talk about disparities, it’s not just about the numbers, but what they represent—how systems tend to leave certain groups behind. You’ve heard about this from our data, too, right?

Andie Cartwright

Oh, yeah. For instance, we know that many residents in our long-term care facilities do not have access to the latest diabetes medications - specifically GLP 1s, even though these drugs are proven to lower both complications and costs. And actually, it’s even more complex—

Anthony Pero

Hold that thought. This is exactly where the conversation starts getting really interesting.

Andie Cartwright

Picking up where we left off, Anthony, when our team dug deeper into the data, the disparities become even more striking. Take chronic conditions, for example—did you know that only 41 percent of residents with these conditions are receiving any sort of treatment at all? That number is just incredible, right?

Anthony Pero

Wow yes, and it’s even more striking when you dig into specific conditions. Take chronic kidney disease, for example. That treatment rate? Only 15 percent. And ischemic heart disease? Just 21 percent. Those numbers are, honestly, kind of shocking. And to your point, it’s not always about resources being unavailable. Sometimes it’s about the complexity of managing these cases—polypharmacy, multimorbidity, and all the challenges that come with it.

Andie Cartwright

Right. It’s like, once you hit a certain threshold of complexity, the entire system kind of - struggles to respond appropriately. And that really shows up in the numbers, doesn’t it?

Anthony Pero

Absolutely. And there’s something else too. You see, residents with multiple chronic conditions often have these overlapping treatments, right? So, healthcare providers are navigating this delicate balancing act: trying to give them what they need without creating risks for adverse interactions. And that’s where polypharmacy really becomes a significant barrier.

Andie Cartwright

And yet, when we talk about best practices or even treatment guidelines, they’re often not designed for, you know, the real-world scenario of somebody managing five or six different conditions.

Anthony Pero

Exactly! Which is why—you’ll love this—it’s so critical to update those guidelines with input directly relevant to long-term care residents. Take Alzheimer's treatments, for instance. Preliminary data shows that treatment rates for dementia remain alarmingly low, even today. That’s despite decades of clinical breakthroughs.

Andie Cartwright

It’s so counterintuitive, isn’t it? You’d think that after all the awareness campaigns and research efforts, we’d have, like, way higher adoption rates at this point.

Anthony Pero

You’d think! But what the data suggests, honestly, is that these gaps are systemic. It’s not necessarily that prescribers are ignoring best practices. It’s that those practices weren’t designed with long-term care facilities in mind. There’s a real disconnect between the idealized version of care and the nuts-and-bolts reality on the ground.

Andie Cartwright

And that disconnect really gets amplified in these systems that are already stretched thin. It’s not just about Alzheimer’s either. You’ve brought up diabetes before—what’s going on there?

Anthony Pero

Oh, it’s a very similar story. Diabetes is one of the conditions with higher treatment rates—69 percent, which is, you know, better. But when you break it down by types of medications, it gets interesting. GLP-1s and SGLT-2 inhibitors, those newer classes of drugs that perform so well? They’re nowhere near as widely adopted as they should be in long-term care.

Andie Cartwright

Hold on—these are the drugs that can reduce complications and save on overall costs, right?

Anthony Pero

Exactly. And yet, we’re seeing a lag in adoption. It’s partly because of complexity—managing comorbidities, potential side effects—but also because these residents are often left out of the trials that set the prescribing guidelines in the first place.

Andie Cartwright

It’s such a catch-22. The people who could benefit the most from these medications are being excluded under the guise of protecting them, but in doing so, we’re perpetuating the very issues those treatments are designed to solve.

Anthony Pero

Exactly. It’s all connected. And, honestly, this brings us to one of the most important pieces of the puzzle—

Andie Cartwright

You’re absolutely right, Anthony. This piece you’re referring to—it’s critical. We’ve gone over the data and the barriers, but if we really want to move the needle, we need to focus on what changes can realistically be made to see real progress here.

Anthony Pero

Exactly, Andie. And I think the key word you just used is 'realistically.' We aren't just talking about idealized guidelines here. What we need are evidence-based solutions that actually consider the day-to-day challenges healthcare providers face in long-term care settings. Things like, you know, the overwhelming complexity of patients' cases and even logistical barriers, like funding or insurance limitations.

Andie Cartwright

Right. And that’s where, I think, communication between healthcare providers becomes so critical. If you’ve got a facility manager, prescribers, consultants, and even pharmacists all working in silos, you’re never going to get the kind of coordinated care that these residents need. That collaboration—real-time, informed collaboration—could make all the difference, don't you think?

Anthony Pero

Oh, 100 percent. And we’re starting to see glimpses of that in some studies. For example, the work being done around Alzheimer's treatments? It’s identifying where those communication breakdowns are happening and then looking to develop tailored guidelines for coordinating care between all caregivers. It’s all about adaptability and flexibility.

Andie Cartwright

And it feels like one piece of the puzzle that’s often overlooked is the role of funding and insurance. It’s not, you know, just an academic problem. If medications aren’t accessible or affordable, none of these breakthroughs are going to make it to the residents who need them.

Anthony Pero

Absolutely! And what’s kind of eye-opening is that no one study has really drilled down into how funding shapes access in these facilities. That’s why, honestly, one of our biggest next steps has to be a dedicated look at those factors—formularies, reimbursement policies, resource allocation, all of it. It’s such a huge knowledge gap.

Andie Cartwright

Yeah, and filling that gap could redefine how we think about care in long-term facilities. But, you know, even beyond the numbers and the access issues, it all kind of comes back to the human side of this. At the heart of this is a population that’s been, well, overlooked in so many ways. How we move forward says a lot about our priorities as a healthcare system.

Anthony Pero

It really does. And that’s why this isn’t just about data analytics or new medications—it’s about building a system that supports every resident, regardless of age, background, or health complexity. That’s how we break these barriers for good.

Andie Cartwright

Well said, Anthony. And I think that’s the note we should end on today—a challenge to rethink, rebuild, and really, to care better. That’s the ultimate goal.

Anthony Pero

Couldn’t agree more. This has been such a great conversation, Andie. And to everyone listening, thanks for joining us on this journey. There’s so much work left to do, but it starts with conversations like these.

Andie Cartwright

Absolutely. On that note, we’ll wrap it up here. Take care, everyone, and we’ll see you next time.