Targeted Medication Reviews Research Articles

Use of targeted medication reviews to deliver preconception care: A demonstration project

ObjectivesTo demonstrate the ability of a statewide network of community pharmacists to provide preconception care services with the use of targeted medication reviews (TMRs). Community pharmacists are well qualified and well positioned to assist in this public health priority; however, there are no documented case studies of pharmacists providing preconception care with the use of TMRs. MethodsThrough the demonstration project, pharmacists provided educational TMRs focused on 3 elements of preconception care to women aged 15 to 45 years enrolled in a nonprofit managed care plan: (1) medications that may cause fetal harm (category D/X); (2) folic acid use; and (3) immunizations. TMRs were generated and released to the individual pharmacy where that patient had prescriptions filled. Any practicing pharmacist in Ohio participating in the medication therapy management platform with a patient in the sample received a TMR notification. The pharmacists documented and billed for the service through this commercially available platform. ResultsNineteen weeks after implementation of the TMRs, 1149 individual pharmacists from 818 different pharmacies had completed at least 1 TMR. Pharmacists completed 33% of all TMR opportunities with a 65% success rate. ConclusionEstablishing new services that were focused on preconception care resulted in rapid integration into existing medication therapy management processes in hundreds of pharmacies across Ohio. These results may help to provide justification for additional payers to reimburse for similar services. Through demonstrating the impact on preconception care, the role of the community pharmacist may continue to expand to include provision of additional preventive care services following the model developed in this initiative.

Blue Cross & Blue Shield of Rhode Island pharmacist program engages patients improves star ratings

“C had a routine visit with her primary care physician at Anchor Medical Associates in Providence, RI. Though she was following the treatment plan, her glycosylated hemoglobin (A1C) wasn’t at goal. Unsure what to try next, the physician asked Kenny Correia, PharmD, to meet with Catherine for additional diabetes education. Correia is a clinical pharmacist at Anchor Medical Associates, where he sees patients who are eligible for Blue Cross & Blue Shield of Rhode Island’s (BCBSRI) Patient-Centered Pharmacist Program.

Promoting Safer Use of High-Risk Pharmacotherapy: Impact of Pharmacist-Led Targeted Medication Reviews

BackgroundAdverse drug reactions are a recognised cause of hospital admissions. A small group of medicines carry a higher risk of adverse outcomes and are more frequently involved in hospital admissions than other medicines. These ‘high-risk medicines’ have been identified in previous research. However, it is less clear how to reduce the risks associated with these known high-risk medicines, or which high-risk medicines should be prioritised when implementing risk reduction interventions. Previous research has questioned the efficacy of pharmacist-led medication reviews in reducing hospital admissions and drug-related morbidity and mortality.ObjectivesIn this study, we aimed to identify high-risk medicines through medication review to reduce iatrogenic disease; to determine a short list of high-risk medicines to target in medication reviews to achieve the greatest impact on reducing iatrogenic disease and patient harm; and to determine whether pharmacist-conducted medication reviews of high-risk medicines are safe and effective.MethodsA prospective cohort study was undertaken in 16 general practices in one Scottish health board. All patients prescribed a high-risk medicine were identified and received a medication review from a pharmacist (3643 patients from a total population of 38,399). The pharmacist decided whether it was appropriate to continue the high-risk medicine, or if the medicine should be stopped or amended. The pharmacist made recommendations to the patient’s general practitioner (GP) for medicines to be stopped or amended, which the GP could choose to accept or not. Patient outcomes for all of the pharmacist’s recommendations were identified 1 year later to determine the effectiveness of the recommendations.ResultsHigh-risk medicines were prescribed to 3643 patients from a total population of 38,399 patients. The pharmacist made 440 recommendations for GPs to stop or amend high-risk medicines. GPs accepted 214 recommendations and rejected 226, giving an acceptance rate of 49 %. The 440 recommendations were then followed up 1 year later. The risk of having an adverse outcome was significantly reduced when the pharmacist’s recommendation to stop or amend a high-risk medicine was followed compared with rejecting the pharmacist’s recommendation and continuing the high-risk medicine unchanged (p < 0.001). A total of 22 adverse outcomes occurred when the pharmacist’s advice was rejected. Of these, 21 would have been prevented if the pharmacist’s recommendation had been followed and three resulted in hospital admission.ConclusionsThis study demonstrated that medication reviews for high-risk medicines are safe and effective, with results achieved within 1 year of the initial review. It identified six high-risk medicines that could form the basis of targeted medication reviews in order to reduce iatrogenic disease. It also demonstrated that pharmacists are safe and effective at delivering medication reviews.

Medication Therapy Management and Preconception Care: Opportunities for Pharmacist Intervention

As medication therapy management (MTM) continues to grow in the profession of pharmacy, careful consideration as to areas for positive patient impact is warranted. Given the current gaps in preconception care in the United States, and the accessibility and expertise of the pharmacist, MTM interventions related to preconception care may be valuable. This paper describes potential for pharmacist intervention in several different areas of preconception care. Notably, targeted medication reviews may be appropriate for interventions such as folic acid recommendations, teratogenic/category X medication management, immunizations, and disease state management. Comprehensive medication reviews may be warranted for selected disease states due to complexity of interventions, such the management of diabetes. Comprehensive medication reviews may also be warranted if several targeted interventions are necessary, or if there are a several medications or disease states requiring intervention. Pharmacists also have important roles in screening, support, and referrals needed for preconception care in the context of MTM. Patients may benefit substantially from pharmacist-directed MTM services related to preconception care. In addition, depending on clinical pharmacy service contracts and billing opportunities, pharmacists may be reimbursed for providing these services, generating sustainable revenue while fulfilling an important public health need.&#x0D; &#x0D; Type: Idea Paper

Quality and safety of medication use in primary care: consensus validation of a new set of explicit medication assessment criteria and prioritisation of topics for improvement

BackgroundAddressing the problem of preventable drug related morbidity (PDRM) in primary care is a challenge for health care systems internationally. The increasing implementation of clinical information systems in the UK and internationally provide new opportunities to systematically identify patients at risk of PDRM for targeted medication review. The objectives of this study were (1) to develop a set of explicit medication assessment criteria to identify patients with sub-optimally effective or high-risk medication use from electronic medical records and (2) to identify medication use topics that are perceived by UK primary care clinicians to be priorities for quality and safety improvement initiatives.MethodsFor objective (1), a 2-round consensus process based on the RAND/UCLA Appropriateness Method (RAM) was conducted, in which candidate criteria were identified from the literature and scored by a panel of 10 experts for 'appropriateness' and 'necessity'. A set of final criteria was generated from candidates accepted at each level. For objective (2), thematically related final criteria were clustered into 'topics', from which a panel of 26 UK primary care clinicians identified priorities for quality improvement in a 2-round Delphi exercise.Results(1) The RAM process yielded a final set of 176 medication assessment criteria organised under the domains 'quality' and 'safety', each classified as targeting 'appropriate/necessary to do' (quality) or 'inappropriate/necessary to avoid' (safety) medication use. Fifty-two final 'quality' assessment criteria target patients with unmet indications, sub-optimal selection or intensity of beneficial drug treatments. A total of 124 'safety' assessment criteria target patients with unmet needs for risk-mitigating agents, high-risk drug selection, excessive dose or duration, inconsistent monitoring or dosing instructions. (2) The UK Delphi panel identified 11 (23%) of 47 scored topics as 'high priority' for quality improvement initiatives in primary care.ConclusionsThe developed criteria set complements existing medication assessment instruments in that it is not limited to the elderly, can be implemented in electronic data sets and focuses on drug groups and conditions implicated in common and/or severe PDRM in primary care. Identified priorities for quality and safety improvement can guide the selection of targets for initiatives to address the PDRM problem in primary care.

Targeted medication review: patients in the community with chronic pain

Abstract Patients with chronic pain may be in need of improved pharmaceutical care because of lack of pain relief and lack of understanding of pain management, the potential for drug interaction and adverse effects. This study assessed the need for a pharmacist to review the medication of a population of patients with chronic pain in a domiciliary setting, using specific validated outcome measures to determine any benefits of pharmacist intervention. Ninety-six patients who had rheumatoid arthritis or were taking regular nonsteroidal anti-inflammatory drugs (NSAIDs) or combination analgesics were interviewed after reviewing their medical records. Expectations of pain relief and severity of pain were assessed using McGill pain questionnaire (MPQ), visual analogue scales (VAS) and verbal descriptor scales. Twenty-eight patients required referral to their GP as a result of meeting preset criteria for poor outcome from current therapy; these patients had higher expectations of pain relief than the remaining patients and also higher pain scores. Pain scores using the MPQ and VAS were generally well correlated with each other and both showed changes in the 14 patients who were re-interviewed after pharmacist intervention. A further 59 patients required advice to optimise current therapy and 12 required referral concerning inappropriate therapy. Many patients' medicine use deviated from that prescribed, and a high proportion used alternative medicines in addition. The prescription of drugs for prophylaxis against ulceration was inappropriate in 17 patients and evidence of monitoring in patients on NSAIDs and disease-modifying antirheumatic drugs (DMARDs) was poor.

Medication review as a route to optimising treatment

Medication accounts for approximately 15% of the total NHS budget in the UK. There is now increasing evidence for the effectiveness of medication review as a route to optimising therapy, improving health outcomes, reducing the likelihood of medicine-related problems and cutting waste. Targeted medication review can enable people to maintain their independence and avoid admission to residential care or hospital. Nurses have a potentially important contribution to make in educating patients about medications and this role is likely to become increasingly significant as the number of nurses independently prescribing grows.