PMU72 EVALUATION OF MEDICATION-RELATED PROBLEMS AMONG RURAL COMMUNITY-DWELLING PATIENTS RECEIVING MEDICATION THERAPY MANAGEMENT FOR DIABETES AND/OR HYPERTENSION

Abstract

To assess whether differences exist in medication-related problems (MRPs) between urban, micropolitan, and small town patients receiving medication therapy management (MTM) services for diabetes and/or hypertension. Participants were aged 18 years and older, residing in rural Arizona counties (per Arizona statute), diagnosed with diabetes and/or hypertension, and receiving pharmacist-delivered, telephonic MTM from an academic-based center. Data on MRPs were collected for: drug-disease and drug-drug interactions; therapy duplications; dose-related safety concerns: adverse drug reactions (ADRs); and high-risk medications. The pharmacist made recommendations to address problems identified and determined, during a follow-up consultation, whether prescribers resolved recommendations. For this descriptive analysis, subjects were categorized using Rural-Urban Commuting Area (RUCA) codes (1-3=urban; 4-6=micropolitan; 7-10=small town). A total of 384 patients were included in this study. Participants were predominantly female (66%), white (73%), and non-Hispanic (52%); one-third were older (65-74 years, 33%). Twenty-three patients had a therapy duplication; 19 of these were resolved during the initial consultation. Fifteen patients had drug-disease interactions; fewer of these individuals resided in small towns (n=3) versus micropolitan areas (n=7, p=0.02). Three of the six drug-disease interactions referred to the prescriber were resolved. Drug-drug interactions were identified for 31 patients while 33 had dose-related safety concerns. Of these, 10 drug-drug interactions and 28 dose-related safety concerns referred to the prescriber, were resolved. Fifty-one patients had ADRs that were resolved during the initial consultation. Thirty-nine patients with high-risk medications were identified among older adults (>65 years); 30 were referred to the provider and of these, nine were resolved. Pharmacists identified over 200 MRPs among this sample of rural-residing patients with diabetes and/or hypertension. While variation existed in the number of pharmacists’ recommendations resolved by prescribers, these differences were less apparent between RUCA areas. Further work is needed to increase prescribers’ acceptance of national guideline recommendations.