Medication Management Program Research Articles

Effects of clinical interventions through a comprehensive medication management program: A retrospective study among outpatients in a private hospital

IntroductionThe intricate nature of certain diseases necessitates complex medication regimens, utilization including high-cost medications, and continual vigilance to avoid potential complications. To address these exigencies, numerous healthcare institutions have instituted multidisciplinary management teams, exemplified in pharmaceutical care through Comprehensive Medication Management (CMM) programs. These programs oversee diverse facets such as patient education, medication adherence promotion, clinical monitoring, dose adjustments, and scrutiny of prescribed drug therapies. Given the emphasized significance, it is relevant to possess evidence to continue endorsing these initiatives from management positions within health centers, and it is for this reason that this study aims to evaluate the clinical and economic benefits provided by a CMM program within a private hospital in Latin America, by analyzing the effects of clinical interventions. MethodsA retrospective examination was conducted involving documented pharmaceutical interventions in an outpatient setting from January 2019 to September 2022. To assess the interventions' repercussions, a retrospective analysis was undertaken. The collated data included patients' basic characteristics, a comprehensive pharmacist-generated description of interventions, potential associated complications, and avoided medical services. Multiple clinical projections, which were endorsed by internal medicine physicians, were developed to explore potential scenarios in the absence of pharmaceutical care. These projections were associated with conceivable complications, aligned with the most plausible circumstances. Subsequently, utilizing the average cost of healthcare within a private hospital in Latin America, the cumulative savings were quantified. These savings were then attributed to the intrinsic advantages offered by pharmaceutical care. ResultsThe study discloses demographic trends among patients within distinct age groups in the CMM program. Rheumatology predominated as the main referral source, and interventions centering on monitoring emerged as the pivotal drug-related concern. This encompassed a collaborative approach, involving interdisciplinary efforts toward patient education and critical parameter monitoring. Of the total 347 pharmaceutical interventions, 66.3% (N = 230) specialty office visits, 14.1% (N = 49) general practitioner consultations, 12.4% (N = 43) hospitalizations, and 7.2% (N = 25) ER visits were avoided. The economic analysis underscores cost savings ensuing from pharmaceutical interventions, amounting to a cumulative 603,792.82 USD. Extrapolating these findings to a patient cohort of 400 enrolled in the pharmaceutical care program approximates per-patient savings of 361.47 USD. ConclusionThis study reveals the significant clinical and economic benefits of CMM programs, led by multidisciplinary pharmaceutical professionals. The findings provide compelling evidence for hospital management to consider promoting such programs, drawing from the patient-centered care model in the United States applicable to Latin America.

Patient Education and Decision Support for Long-Acting Injectable HIV Antiretroviral Therapy: Protocol for Tool Development and Pilot Testing with Ryan White HIV/AIDS Program Medical Case Management Programs in New York.

Long-acting injectable (LAI) HIV antiretroviral therapy (ART) presents a major opportunity to facilitate and sustain HIV viral suppression, thus improving health and survival among people living with HIV and reducing the risk of onward transmission. However, realizing the public health potential of LAI ART requires reaching patients who face barriers to daily oral ART adherence and thus can clinically benefit from alternative treatment modalities. Ryan White HIV/AIDS Program Part A medical case management (MCM) programs provide an array of services to address barriers to HIV care and treatment among economically and socially marginalized people living with HIV. These programs have demonstrated effectiveness in improving engagement along the continuum of care, but findings of limited program impact on durable viral suppression highlight the need to further innovate and hone strategies to support long-term ART adherence. This study aims to adapt and expand Ryan White MCM service strategies to integrate LAI ART regimen options, with the larger goal of improving health outcomes in the populations that could most benefit from alternatives to daily oral ART regimens. In 3 phases of work involving patient and provider participants, this study uses role-specific focus groups to elicit perceptions of LAI versus daily oral ART; discrete choice experiment (DCE) surveys to quantify preferences for different ART delivery options and related supports; and a nonrandomized trial to assess the implementation and utility of newly developed tools at 6 partnering Ryan White HIV/AIDS Program Part A MCM programs based in urban, suburban, and semirural areas of New York. Findings from the focus groups and DCEs, as well as feedback from advisory board meetings, informed the design and selection of the tools: a patient-facing, 2-page fact sheet, including frequently asked questions and a side-by-side comparison of LAI with daily oral ART; a patient-facing informational video available on YouTube (Google Inc); and a patient-provider decision aid. Implementation outcomes, measured through provider interviews, surveys, and service reporting, will guide further specification of strategies to integrate LAI ART options into MCM program workflows. The study was funded in late April 2021 and received approval from the institutional review board in May 2021 under protocol 20-096. Focus groups were conducted in late 2021 (n=21), DCEs ran from June 2022 to January 2023 (n=378), and tools for piloting were developed by May 2023. The trial (May 2023 through January 2024) has enrolled >200 patients. This study is designed to provide evidence regarding the acceptability, feasibility, appropriateness, and utility of a package of patient-oriented tools for comparing and deciding between LAI ART and daily oral ART options. Study strengths include formative work to guide tool development, a mixed methods approach, and the testing of tools in real-world safety-net service settings. Clinicaltrials.gov NCT05833542; https://clinicaltrials.gov/study/NCT05833542. DERR1-10.2196/56892.

Development of a multidisciplinary medication management program in nursing homes: protocol for a randomized controlled trial

BackgroundPolypharmacy and the use of potentially inappropriate medications are common among nursing home residents and are associated with negative outcomes. Although deprescribing has been proposed as a way to curtail these problems, the best way to implement multidisciplinary comprehensive medication review and deprescribing and its real impact in specific high-risk populations, such as nursing home residents, is still unclear. This multicenter randomized controlled clinical trial aims to assess the effects of a multidisciplinary mediation management program on medication use and health problems.MethodsA total of 1,672 residents aged ≥ 65 years from 22 nursing homes in South Korea who meet the targeted criteria, such as the use of ≥ 10 medications, are eligible to participate. The experimental group will receive a comprehensive medication review, deprescription, and multidisciplinary case conference with the help of platform. Outcomes will be measured at baseline, at the end of the intervention, as well as at 3, 6, 9, and 12 months after the end of the intervention. The primary endpoints will be the rate of adverse drug events, number of potentially inappropriate medications/potentially inappropriate medication users/two or more central nervous system drug/ central nervous system drug users, delirium, emergency department visits, hospitalization, and falls. The secondary endpoint will be the number of medications taken and polypharmacy users.DiscussionOur trial design is unique in that it aims to introduce a structured operationalized clinical program focused on reducing polypharmacy and potentially inappropriate medications in a nursing home setting with large samples.Trial registrationEthical approval was granted by the public institutional review board of the Ministry of Health and Welfare (2022-1092-009). The study is also registered with the Clinical Research Information Service (Identifier: KCT0008157, Development and evaluation of a multidisciplinary medication management program in long-term care facility residents Status: Approved First Submitted Date: 2023/01/18 Registered Date: 2023/02/03 Last Updated Date: 2023/01/18 (nih.go.kr) https://cris.nih.go.kr/), which includes all items from the World Health Organization Trial Registration Dataset.

Obesity Medicine Intervention at an Academic Medical Center in a Resource-Limited Population Shows Promise

Abstract: Introduction. Obesity disproportionately affects some non-White and low-socioeconomic-status Americans. Medical obesity treatment includes aggressive lifestyle interventions with medications when applicable. We evaluated a physician-led, resource-limited obesity medicine program. Methods. This retrospective review included 98 adults with BMI >30 completing three or more obesity medicine physician visits, without bariatric surgery before or during Oct 2019–Feb 2022 at an academic medical center in Newark, N.J. Outcomes included changes in weight, HbA1c, blood pressure, and lipids. Results. Sixty-eight percent (68%) of patients lost weight, with one-third losing 5% or more of total weight. Almost 30% (29.3%) gained and 2.4% maintained weight. Number of visits (p<.01) and GLP-1 receptor agonist use predicted weight loss (p<.05). Hemoglobin A1c decreased (p<.01); blood pressure and lipids did not. Conclusion. Our study shows that medical weight management programs can achieve meaningful weight loss, despite resource limitations. Patients using GLP-1 receptor agonists lost more weight compared with other agents, even on suboptimal doses.

A Novel Home-Based Medication Management Program and Its Influence on Hospitalization Rates among Home Health Care Recipients

Patients do not take their medicine as prescribed 50% of the time, and of medication-related hospital admissions in the United States, 33% to 69% are due to poor medication adherence, at a cost of approximately $100 billion a year. Continue CareRx (CCRx) is a novel home-based medication management program that includes adherence packaging alongside medication reconciliation, review, and education by clinicians. We hypothesized that home health patients receiving the CCRx service may have a lower hospitalization rate than control home health patients. Between May 1, 2021, and March 31, 2023, 113 home health patients whose insurance covered the program were enrolled in CCRx. Home health patients not eligible for the program due to a noncovered pharmacy insurance benefit made up the control group (n = 21,304), which was matched with the CCRx group on age range (45-99 years old) and gender (67% women). Hospitalization rate was calculated in both groups and compared using generalized estimating equations analysis. The control group had a total of 7015 hospitalizations during the study period during 2,128,738 total managed days, whereas the CCRx group had 21 hospitalizations during 23,622 total managed days. These translated into rates of 1203 hospitalizations per 1000 per year for the control group, and 324 hospitalizations per 1000 per year for the CCRx group. The results showed that there was a significant main effect of group in predicting individual annual hospitalization rate (Wald χ2 = 56.415, P < .01). Specifically, being in the control group was associated with a 43.42-fold increase in the likelihood of a higher hospitalization rate (95% Wald CI for odds ratios: 7.24-230.44). Home health recipients enrolled in CCRx experienced a 73.1% lower hospitalization rate than controls. Making the program more widely available to patients receiving home health care may present a significant opportunity to reduce hospitalizations in this group.

Abstract 16521: Using Electronic Health Record Data to Identify and Prioritize Patients With Heart Failure With Reduced Ejection Fraction for a Remote Medication Optimization Program

Introduction: Remote medication management programs (RMMP) might be effective in optimizing guideline directed medical therapy (GDMT) for HFrEF. Identification of patients that can be safely managed remotely and prioritization of those with the highest need for medication optimization is crucial, especially in the setting of constrained resources. Methods: We analyzed records from our institutional enterprise data warehouse to identify patients with HFrEF in whom GDMT can be safely optimized by an RMMP within the Mass General Brigham health system between May 2021 and May 2023. After identifying a population with HFrEF, we excluded patients with contraindications to GDMT and with higher risk of adverse medication reactions. Next, we identified active and past medications by using medication discontinuation data (Figure). We performed chart review on a random sample of 100 patients to validate our analysis. Results: We have identified 1771 patients with HFrEF who are actively receiving care and are eligible for remote medication optimization. Only 7% (129/1771) of patients were prescribed all four GDMT, however in 4% (78/1771) at least one of these prescriptions was discontinued. Of all patients, 45% (801/1771) had stopped at least one GDMT, including 50% of SGLT2i, 30% of MRA, and 46% of ARNI. Patients who were never prescribed GDMT were identified as top priority for the RMMP. Conclusion: EHR data can effectively identify and prioritize HFrEF patients for medication optimization. Similar to prior HFrEF registries, our study showed poor utilization of GDMT. However, it also revealed a significant number of patients who had their GDMT prescriptions discontinued. Investigating the reasons for discontinuations may elucidate barriers to GDMT optimization. This study can be expanded to patients with HFpEF and HFmEF, and refined further by using natural language processing, machine learning, and by incorporating data for medication refill, claims, and dosages.

Development and effectiveness of an integrated medication management program centered on senior welfare centers for older adults with hypertension: A cross-sectional study

Purpose: Purposes of this study were to develop an integrated online and offline medication management program and to examine effects of the program for older adults with hypertension residing in the community. Methods: A nonequivalent control group pretest-posttest design was used. Participants were 57 older adults with hypertension (Intervention group: 29, control group: 28). The experimental group participated in the medication management program, which included the following, verbal and video education, individual counseling and using medication note over three weeks. Collected data were analyzed using the SPSS/WIN 22.0 program. The data were analyzed by Generalized Estimation Equation. Results: Statistically significant differences were found between the experimental and control groups in terms of their knowledge of hypertension and self-efficacy for appropriate medication. Conclusion: The integrated medication management program was effective as indicated in knowledge of hypertension and self-efficacy for appropriate medication. Future studies are required to explore the medication management program’s effects on older adults with hypertension using more rigorous research methods.

Exploring patient participation in an interprofessional medication management program in primary care

Exploring patient participation in an interprofessional medication management program in primary care

A-36 Performance of Children with Attention Deficit/Hyperactivity Disorder on the Sway Medical Mobile Balance and Cognitive Tests

Abstract Purpose There is a recognized need for more research relating to preseason balance and cognitive testing, as part of a sport-related concussion medical management program, for middle school children. We examined if preseason baseline performance on the Sway Medical Mobile Balance and Cognitive Tests differs by self-reported ADHD diagnosis in 12- and 13-year-old children. Methods Data from 2,501 children (49.1% girls) between 12- and 13-years-old (mean=13.64 years, standard deviation=0.48), tested in 2022, without a self-reported concussion in the past 6 months, were examined. Mann-Whitney U tests were used to compare balance and four cognitive test scores between children with and without self-reported ADHD, stratified by gender, and significance was set at p&amp;lt;.01. Results There were no significant differences on balance testing for boys or girls with ADHD compared to those without ADHD. Boys with ADHD performed slightly slower on the Impulse Control (p=.001, Hedge’s g=.14) and Inspection Time (p=.002, g=.22) tests than boys without ADHD. Girls with ADHD performed slightly slower on the Reaction Time test (p=.001, g=.33) than girls without ADHD. No differences were found on the Memory test for girls or boys. Conclusions Middle school aged boys and girls with ADHD did not perform worse on balance testing and some of the cognitive tests compared to children without ADHD. There were small magnitude differences on timed tests of Impulse Control and Inspection Time for boys and Reaction Time for girls, with youth who self-reported having ADHD performing slower than youth without ADHD.

Optimizing Multidisciplinary Care of Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus.

Diabetes is the leading cause of chronic kidney disease (CKD), a condition associated with significant morbidity and mortality. As these patients have a high risk of developing cardiovascular disease and end-stage kidney disease, there is a need for early detection and early initiation of appropriate therapeutic interventions that slow disease progression and prevent adverse outcomes. Due to the complex nature of diabetes and CKD management, a holistic, patient-centered, collaborative care approach delivered by a coordinated multidisciplinary team (ideally including a clinical pharmacist as part of a comprehensive medication management program) is needed. In this review, we discuss the barriers to effective care, the current multidisciplinary approach used for CKD prevention and treatment, and the potential ways that the multidisciplinary management of CKD associated with type 2 diabetes mellitus can be refined to improve patient outcomes.

An assessment of information needs and workflows for emergency service providers and caregivers of children with medical complexity

BackgroundThe goal of Project Austin, an initiative to improve emergency care for rural children who are medically complex (CMC), is to provide an Emergency Information Form (EIF) to their parents/caregivers, to local Emergency Medical Services, and Emergency Departments. EIFs are standard forms recommended by the American Academy of Pediatrics that provide pre-planned rapid response instructions, including medical conditions, medications, and care recommendations, for emergency providers. Our objective is to describe the workflows and perceived utility of the provided emergency information forms (EIFs) in the acute medical management of CMC.MethodsWe sampled from two key stakeholder groups in the acute management of CMC: four focus groups with emergency medical providers from rural and urban settings and eight key informant interviews with parents/caregivers enrolled in an emergency medical management program for CMC. Transcripts were thematically analyzed in NVivo© by two coders using a content analysis approach. The thematic codes were combined into a codebook and revised the themes present through combining relevant themes and developing of sub-themes until they reached consensus.ResultsAll parents/caregivers interviewed were enrolled in Project Austin and had an EIF. Emergency medical providers and parents/caregivers supported the usage of EIFs for CMC. Parents/caregivers also felt EIFs made emergency medical providers more prepared for their child. Providers identified that EIFs helped provide individualized care, however they were not confident the data was current and so felt unsure they could rely on the recommendations on the EIF.ConclusionEIFs are an easy way to engage parents, caregivers, and emergency medical providers about the specifics of a care for CMC during an emergency. Timely updates and electronic access to EIFs could improve their value for medical providers.

An Analysis of the Cost Benefits of Establishing a Regional Maintenance Center for Health Services

Objective : The limitations of the Health Office in managing medical equipment management programs are compared to hospitals, as are the efficiency of the resources needed by the Regional Maintenance Center in assisting the Health Office to carry out the program. So an analysis is needed to see what the resulting costs and benefits are. Method: The research is accompanied by observations and observations of documents related to medical device maintenance and calibration analysis using cost-benefit analysis. The study was carried out in 2021 at the Pasuruan District Health Office in East Java Province, Indonesia. Results : After doing research, it was found that in the financial aspect, when viewed from the NPV, the IRR value is found to be 2.34%, the BCR is greater than one, which is 6.95%, and the PI is 8.5. The health facility maintenance unit is feasible to establish and develop in terms of both financial and effectiveness. Conclusion : Various regulations were issued by the Ministry of Health to manage the management of health equipment. The Regional Maintenance Center is believed to be able to run well if all parties support it, starting with regional leaders, then support from human resources, financial resources, officer competence, infrastructure, and management information systems. so that health services can be available in both quantity and quality.

Mortality and Hospitalizations Among Patients Enrolled in an Interprofessional Medication Management Program-Results of the Medicines Initiative Saxony- Thuringia (Arzneimittelinitiative Sachsen-Thüringen, ARMIN).

Measures for improving medication safety in outpatient care are often complex and involve medication reviews. Over the period 2016-2022 (with a preceeding one-year pilot phase), an interprofessional medication management program-the Medicines Initiative Saxony-Thuringia (Arzneimittelinitiative Sachsen-Thüringen, ARMIN)-was implemented in two German federal states. More than 5000 patients received a medication review by the end of 2019 by a team composed of physicians and pharmacists and were provides with joint, continuous care thereafter. In the framework of a retrospectively registered cohort study, the mortality and hospitalizations of this population (5033 patients) were studied using routine data from a statutory health insurer (observation period 2015-2019) and compared with those of a control group (10 039 patients) determined from the routine data by propensity score matching. Mortality was compared by survival analysis (Cox regression), and hospitalization rates were compared in terms of event probabilities within two years of enrollment in the medication management program. Robustness was tested in multiple sensitivity analyses. Over the observation period, 9.3% of the ARMIN participants and 12.9% of persons in the control group died (hazard ratio of the adjusted Cox regression, 0.84; 95% confidence interval [0.76; 0.94], P = 0.001). In the first two years after inclusion, the ARMIN participants were hospitalized just as often as the persons in the control group (52.4% versus 53.4%; odds ratio from the adjusted model, 1.04 [0.96; 1.11], P = 0.347). The effects were consistent in sensitivity analyses. In this retrospective cohort study, participation in the ARMIN program was associated with a lower risk of death. Exploratory analyses provide clues to the potential origin of this association.

Social needs of dual-enrolled Medicare-Medicaid patients with medication nonadherence in a telehealth medication therapy management program.

BACKGROUND: Telehealth services that identify and address the social needs of patients can improve access to health care and social services. The social needs of medication therapy management (MTM)-eligible Medicare-Medicaid dual-enrolled patients are unknown. OBJECTIVE: To describe the social needs of Medicare-Medicaid dual-enrolled patients participating in a telephonic MTM program. METHODS: This study evaluated the findings of a social needs survey implemented within a telehealth MTM program. Surveys were offered telephonically to eligible Medicare-Medicaid patients of one insurance plan who were identified with medication nonadherence between July 13, 2020, and December 31, 2020. This study described patients who completed the survey during provision of a comprehensive medication review (CMR). Questions screened for social needs in the following social determinant of health domains: community and social context, economic stability, and neighborhood and physical environment. Descriptive statistics were used to describe results. RESULTS: Among 461 patients who completed CMRs, 358 completed the social needs survey. The most prevalent needs and concerns identified included lacking support to perform daily activities (165 [47%]), lacking companionship (81 [23%]), feeling left out (71 [20%]), feeling isolated (81 [23%]), not having enough money to pay bills (177 [49%]), worrying about running out of food (77 [22%]), or having run out of food within the last 12 months (81 [23%]). In this sample, 54 (15%) patients reported avoiding a provider visit because of transportation barriers. Certain individuals were without a steady place to live or were worried about losing their home (40 [11%]) and 35 (10%) reported struggling to keep a job. CONCLUSIONS: The identification of social needs among patient populations is necessary to reduce barriers to medication adherence and optimize health care utilization. This study described important social needs identified during the provision of a telehealth CMR among MTM-eligible Medicare-Medicaid dual-enrolled patients. DISCLOSURES: Dr Nahata was supported in part by the Avatar Foundation. Dr Silva Almodóvar works as a research pharmacist within a medication management program, which provides medication therapy management services.

Impact of a comprehensive medication management program on ambulatory care patients with noncommunicable diseases in a Latin American hospital: A retrospective study

Background Noncommunicable diseases are the leading causes of death and disability in the world, harming life conditions and increasing expenditures within the health care system. Comprehensive Medication Management (CMM) may improve patient safety, adherence, and clinical outcomes by preventing or intervening in drug-related problems (DRPs). Methods Retrospective, cross-sectional study conducted between October 2017 and July 2022 in a CMM of a hospital in Costa Rica. Patients 3–106 years old diagnosed with at least one chronic disease and had risk factors for DRP were included. A clinical pharmacist (CP) identified DRPs and proposed interventions to resolve them. DRPs were classified into four categories: indication, effectiveness, safety, and adherence. Additionally, the severity of the problem was determined by using a scale of potential clinical consequences avoided related to DRPs and medication errors (MEs). The adherence rate was determined by applying validated questionnaires and traceability control of dispensing medication dates. Clinical outcomes were classified as resolved, improved, stable, worsened, and therapeutic failure according to the condition of the DRP until the last appointment by the patient. Results Pharmacotherapy interventions had an overall acceptance rate of 98.3%. Interventions made by the CP were related to effectiveness (38.9%, n = 253), safety (29.6%, n = 193), adherence (20.90%, n = 136), and therapy indications (10.60%, n = 69). The patient adherence rate improved, with a mean value of 74% on the first appointment compared with 88% as the last value calculated after the pharmacist's interventions. Predominant determinants of medication nonadherence were therapy-related factors (30.88%) and patient-related factors (30.15%). In the clinical status assessment of 651 DRPs, 490 (75.3%) resolved, 105 (16.1%) improved, 43 (6.6%) remained stable, 5 (0.8%) worsened, and 8 (1.2%) patients presented with therapeutic failure. Conclusions CPs can help resolve DRPs/MEs which enable patients to achieve medication-related therapeutic goals. The clinical interventions made were characterized according to the outcomes of each patient to obtain the optimal management of a patient's medications.

Contextual importance of leadership and management training in undergraduate medical education: Literature review

Leadership is recently known to be necessary at all levels within an organization, causing it to be extremely important for new graduates to understand what leadership is and to be familiar with different key leadership and management competencies. Leadership is also an integral part of medical practice. However, at present several medical colleges do not have a leadership and management curriculum, and thus, our medical college is not preparing its undergraduates in such skills as effective communication, conflict resolution, and time management. The search terms used were undergraduate medical leadership and management programs, undergraduate medical student leadership development programs, student leadership, and management training, clinical leadership, challenges of leadership and management programs in medical colleges, and skills needed for leadership and management course development. The review has shed light on skills needed for proposing a program on leadership and management for students at medical universities. The review also provided a rich combination of definitions of leadership, challenges to the type of leadership as well as how other medical organizations approach leadership and management. The theories suggest approaching competencies for leadership rather than building on pure theoretical knowledge of leadership. Furthermore, the research suggests differentiating the leadership training for undergraduate students based on how to add value to their career/study progressions, standardization, and organizational contribution. The literature further revealed the different challenges and barriers to developing leadership and management programs in medical colleges.

Patient pathways to bariatric surgery: What preoperative medical weight management programs exist globally – Results of an international survey

Patient pathways to bariatric surgery: What preoperative medical weight management programs exist globally – Results of an international survey

Abstract A065: Prospective cohort study of a pharmacist-driven medication management program to improve oral cancer therapy adherence in an underserved, diverse urban setting

Abstract Introduction: Patient adherence is critical to the efficacy of oral cancer chemotherapy. At a major safety net hospital, we sought to define the adherence to oral cancer therapy amongst our diverse and socioeconomically disadvantaged patient population. We designed a high-touch, pharmacist driven program called Boston Medical Center’s Specialty Pharmacy Adherence Program (B-SPAP), to see if this intervention could improve adherence to oral cancer treatment. Methods: We conducted a prospective intervention study of adult patients undergoing treatment with an oral oncology agent for advanced cancer or hematologic malignancy. The intervention incorporated the Multinational Association of Supportive Care in Cancer Oral Agent Teaching Tool by a clinical pharmacist for 30-60 minutes at initial, 3, 6, and 12 month study visits. Patients completed Patient Activation Measure (PAM) and Trust in Physician (TIP) surveys during visits. The primary endpoints were adherence (medication adherence ratio (MAR) (= sum of days’ supply for all fills in period/number of days in period) x100), and persistence (presence or absence of a &amp;gt;/= 45 day treatment gap). We utilized a 2:1 matched historical control design on type of chemotherapy agent. Linear regression models examined differences in adherence and persistence between intervention and controls. Data: There were 218 patients, 74 intervention and 144 historical controls. 54% of patients identified as Black, 28% Caucasian, 7% Asian, 6% other, 17% as Hispanic/Latino. 37% do not use English as their preferred language. 24% reported finishing high school. 30% are on Medicaid, 42% on Medicare, 10% had commercial insurance. The MAR in the intervention group was 92 (SD 14.6) compared with 93 (SD 10.8) in the historical control group (p=0.4). 78% of patients in the intervention group were persistent compared with 80% of historical controls (p=0.9). Non-English speaking patients had higher MAR=94.5 than English speaking patients, MAR=91 (β 3.5, SE 1.7, p=0.04). There were no differences in MAR in relation to age, marital status, or charlson comorbidity index. For the intervention patients, the average TIP Score was 48 (max of 55). TIP score did not differ by race (white=47, non-white 49, p=0.4) or language (English=49, non-English=47, p=0.3). The average PAM score was 43 (max of 52). Conclusions: Adherence to oral cancer therapies amongst our diverse patient population is high, over 90 adherent days in a 100 day period. Our high-touch, pharmacist driven intervention did not improve adherence or persistence between controls and intervention due to high rates in the control population. Interestingly we found that non-English speaking patients were more likely to be adherent than English speaking patients. Our findings suggest that equal access among a diverse patient population at a safety net institution can result in high adherence and positive outcomes despite socio-demographic factors that often lead to disparities in cancer care. Citation Format: Claire E.P. Smith, David Hughes, Scott Gould, Anne Buck, Naomi Y. Ko. Prospective cohort study of a pharmacist-driven medication management program to improve oral cancer therapy adherence in an underserved, diverse urban setting [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A065.

Reducing Surgical Complications in Spine Patients Through a Medication Management Support Program.

A hospital-wide medication management program was implemented to ensure that high-risk patients would systematically pause antiplatelet and anticoagulant medications. We analyzed complications before and during the implementation of this program. The goal of the study was to determine if a medication management support program was effective for reducing perioperative complications, including hemorrhage, myocardial infarction, stroke, pulmonary embolism, and deep vein thrombosis. Using data from the National Surgical Quality Improvement Program database, we examined the presence of 5 complications before and during the implementation of a medication management support program. There were 9732 patients in the clinic population who underwent elective spine surgery between 2011 and 2020 and were included in this analysis. Of those 9732 patients, 7205 had surgery before the introduction of the program, whereas 2527 had surgery at some point after the program was introduced. We conducted a series of Pearson's χ 2 tests to determine the relative frequencies of the complications before and during the program. Results showed that during the implementation of the program, patients were relatively less likely to experience hemorrhage (3.16% vs. 1.11%; P <0.001). The reductions in thrombotic complications were clinically significant: myocardial infarction (0.12% vs. 0.00%), stroke (0.10% vs. 0.04%), pulmonary embolism (0.33% vs. 0.28%), and deep vein thrombosis (0.36% vs. 0.28%). These P values ranged from P =0.08 for myocardial infarction to P =0.67 for pulmonary embolism. The use of this medication management support program appears effective for reducing the need for blood transfusions and thrombotic complications. While promising, the results should be interpreted with caution as we do not know whether this type of program will be effective for other hospital systems.

Comparative analysis of potentially inappropriate medication use in long-term care facility residents and community-dwelling elders: A matched cohort study.

As the population of the elderly in long-term care facilities has grown, the number of users of potentially inappropriate medication (PIM) is also increasing. With this study, we aimed to investigate the pattern of PIM usage and related factors among the elderly receiving long-term care services. Using the South Korean National Health Insurance Service Elderly Cohort Database, we conducted a retrospective matched cohort study. Elderly residents (n = 1980) in long-term care facilities in 2013 were selected and matched 1:1 with elderly persons living in the community applying propensity score method. The matching variables were sex, age, health insurance type, long-term care grade, Charlson's Comorbidity Index score, presence of dementia, cerebrovascular disease, or Parkinson's disease, and number of drugs prescribed. PIM use was assessed according to Beers criteria 2019. The prevalence of PIM was found to be higher among the elderly in long-term care facilities (86.77%) than among community-dwelling individuals (75.35%). Logistic regression showed that long-term care facility residents were 1.84 odds more likely to use PIM than community-dwelling older adults. We also confirmed that the average number of medications taken per day and the number of outpatient visits were the major influencing factors affecting PIM prescriptions. In addition, elders living in long-term care facilities were prescribed more PIM drugs acting on the central nervous system than community-dwelling older adults. The results of this study show that among those receiving long-term care services, older people in long-term care facilities use PIM more than do the elderly living at home. Medication management programs need to be developed to reduce the use of PIM in long-term care facilities.