Abstract
BackgroundMedication reviews have become part of pharmacy practice across developed countries. This study aimed to identify factors affecting the likelihood of eligible Ontario seniors receiving a pharmacy-led medication review called MedsCheck annual (MCA).MethodsWe designed a cohort study using a random sample of pharmacy claims for MCA-eligible Ontario seniors using linked administrative data from April 2012 to March 2013. Guided by a conceptual framework, we constructed a generalized-estimating-equations model to estimate the effect of patient, pharmacy and community factors on the likelihood of receiving MCA.ResultsOf the 2,878,958 eligible claim-dates, 65,605 included an MCA. Compared to eligible individuals who did not receive an MCA, recipients were more likely to have a prior MCA (OR = 3.03), receive a new medication on the claim-date (OR = 1.78), be hypertensive (OR = 1.18) or have a recent hospitalization (OR = 1.07). MCA recipients had fewer medications (e.g., OR = 0.44 for ≥12 medications versus 0–4 medications), and were less likely to receive an MCA in a rural (OR = 0.74) or high-volume pharmacy (OR = 0.65).ConclusionsThe most important determinant of receiving an MCA was having had a prior MCA. Overall, MCA recipients were healthier, younger, urban-dwelling, and taking fewer medications than non-recipients. Policies regarding current and future medication review programs may need to evolve to ensure that those at greatest need receive timely and comprehensive medication reviews.
Highlights
Medication reviews have become part of pharmacy practice across developed countries
Conceptual framework and predictor variables After reviewing relevant policy documents and the published literature, we developed a conceptual framework that summarized potential factors associated with the likelihood of receiving an MedsCheck annual (MCA) (Fig. 1)
In order to evaluate the independent effects of patient, pharmacy- and community-level factors on the likelihood of receiving an MCA, we used a Generalized Estimating Equations (GEE) framework to take into account the repeated nature of the data, since there can be multiple claim-dates for each patient, and multiple patients within each pharmacy [24, 25]
Summary
This study aimed to identify factors affecting the likelihood of eligible Ontario seniors receiving a pharmacy-led medication review called MedsCheck annual (MCA). Public drug plans in several countries reimburse community pharmacies for one-on-one reviews of patients’ list of medications [4,5,6,7]. Pechlivanoglou et al BMC Health Services Research (2016) 16:666 practices, knowledge and beliefs); and clinical medication review (conducted with access to patients’ medical record and with the patient present) [7]. In 2007, the Ontario Ministry of Health and LongTerm Care (MOHLTC) launched MedsCheck (MC), the first government-funded, community pharmacy-led medication review program in Canada [5]. There are no additional eligibility requirements for the patient, pharmacist, or community pharmacy. Over time the scope of MC expanded, with MC Follow up, MC Diabetes, MC at Home and MC Long-term Care (LTC) medication reviews being introduced at different fee levels
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