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Development of measurable criteria to identify and prioritize patients for inclusion in comprehensive medication management programs within primary care settings

BACKGROUND: Pharmacists optimize medication use and ensure the safe and effective delivery of pharmacotherapy to patients using comprehensive medication management (CMM). Identifying and prioritizing individual patients who will most likely benefit from CMM can be challenging. Health systems have fa...

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Autores principales: Bishop, Martin A, Chang, Hsien-Yen, Kitchen, Christopher, Weiner, Jonathan P, Kharrazi, Hadi, Shermock, Kenneth M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Academy of Managed Care Pharmacy 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10391295/
https://www.ncbi.nlm.nih.gov/pubmed/34337988
http://dx.doi.org/10.18553/jmcp.2021.27.8.1009
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author Bishop, Martin A
Chang, Hsien-Yen
Kitchen, Christopher
Weiner, Jonathan P
Kharrazi, Hadi
Shermock, Kenneth M
author_facet Bishop, Martin A
Chang, Hsien-Yen
Kitchen, Christopher
Weiner, Jonathan P
Kharrazi, Hadi
Shermock, Kenneth M
author_sort Bishop, Martin A
collection PubMed
description BACKGROUND: Pharmacists optimize medication use and ensure the safe and effective delivery of pharmacotherapy to patients using comprehensive medication management (CMM). Identifying and prioritizing individual patients who will most likely benefit from CMM can be challenging. Health systems have far more candidates for CMM than there are clinical pharmacists to provide this service. Furthermore, current evidence lacks widely accepted standards or automated mechanisms for identifying patients who would likely benefit from a pharmacist consultation. Existing tools to prioritize patients for pharmacist review often require manual chart review by a pharmacist or other clinicians or data collection by patient survey. OBJECTIVES: To (1) create new medication risk markers for identifying and prioritizing patients within a population and (2) identify patients who met these new markers, assess their clinical characteristics, and compare them with criteria that are widely used for medication therapy management (MTM). METHODS: Along with published literature, a panel of subject matter experts informed the development of 3 medication risk markers. To assess the prevalence of markers developed, we used Multum, a medication database, for medication-level characteristics, and for patient-level characteristics, we used QuintilesIMS, an administrative claims database derived from health plans across the United States, with data for 1,541,873 eligible individuals from 2014-2015. We compared the health care costs, utilization, and medication gap among patients identified through MTM criteria (both broad and narrow, as these are provided as ranges) and our new medication management score markers. RESULTS: We developed 3 claims-derivable markers: (1) instances when a patient filled a medication with high complexity that could affect adherence, (2) instances where a patient filled a medication defined as costly within a therapeutic category that could affect access, and (3) instances when a patient filled a medication defined as risky that could increase incidence of adverse drug events. In the QuintilesIMS database, individuals with 2 new medication risk markers plus at least 3 conditions and more than $3,017 in medication costs when compared with individuals meeting narrow MTM eligibility criteria (≥ 8 medications, ≥ 3 conditions, and > $3,017 medication costs) had increased costs ($36,000 vs $26,100 total; $24,800 vs 21,400 medical; $11,300 vs $4,800 pharmacy); acute care utilization (0.328 vs 0.256 inpatient admissions and 0.627 vs 0.579 emergency department visits); and 1 or more gaps in medication adherence(41.5% vs 34.7%). CONCLUSIONS: We identified novel markers of medication use risk that can be determined using insurance claims and can be useful to identify patients for CMM programs and prioritize patients who would benefit from clinical pharmacist intervention. These markers were associated with higher costs, acute care utilization, and gaps in medication use compared with the overall population and within certain subgroups. Providing CMM to these patients may improve health system performance in relevant quality measures. Evaluation of CMM services delivered by a pharmacist using these markers requires further investigation.
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spelling pubmed-103912952023-08-02 Development of measurable criteria to identify and prioritize patients for inclusion in comprehensive medication management programs within primary care settings Bishop, Martin A Chang, Hsien-Yen Kitchen, Christopher Weiner, Jonathan P Kharrazi, Hadi Shermock, Kenneth M J Manag Care Spec Pharm Research BACKGROUND: Pharmacists optimize medication use and ensure the safe and effective delivery of pharmacotherapy to patients using comprehensive medication management (CMM). Identifying and prioritizing individual patients who will most likely benefit from CMM can be challenging. Health systems have far more candidates for CMM than there are clinical pharmacists to provide this service. Furthermore, current evidence lacks widely accepted standards or automated mechanisms for identifying patients who would likely benefit from a pharmacist consultation. Existing tools to prioritize patients for pharmacist review often require manual chart review by a pharmacist or other clinicians or data collection by patient survey. OBJECTIVES: To (1) create new medication risk markers for identifying and prioritizing patients within a population and (2) identify patients who met these new markers, assess their clinical characteristics, and compare them with criteria that are widely used for medication therapy management (MTM). METHODS: Along with published literature, a panel of subject matter experts informed the development of 3 medication risk markers. To assess the prevalence of markers developed, we used Multum, a medication database, for medication-level characteristics, and for patient-level characteristics, we used QuintilesIMS, an administrative claims database derived from health plans across the United States, with data for 1,541,873 eligible individuals from 2014-2015. We compared the health care costs, utilization, and medication gap among patients identified through MTM criteria (both broad and narrow, as these are provided as ranges) and our new medication management score markers. RESULTS: We developed 3 claims-derivable markers: (1) instances when a patient filled a medication with high complexity that could affect adherence, (2) instances where a patient filled a medication defined as costly within a therapeutic category that could affect access, and (3) instances when a patient filled a medication defined as risky that could increase incidence of adverse drug events. In the QuintilesIMS database, individuals with 2 new medication risk markers plus at least 3 conditions and more than $3,017 in medication costs when compared with individuals meeting narrow MTM eligibility criteria (≥ 8 medications, ≥ 3 conditions, and > $3,017 medication costs) had increased costs ($36,000 vs $26,100 total; $24,800 vs 21,400 medical; $11,300 vs $4,800 pharmacy); acute care utilization (0.328 vs 0.256 inpatient admissions and 0.627 vs 0.579 emergency department visits); and 1 or more gaps in medication adherence(41.5% vs 34.7%). CONCLUSIONS: We identified novel markers of medication use risk that can be determined using insurance claims and can be useful to identify patients for CMM programs and prioritize patients who would benefit from clinical pharmacist intervention. These markers were associated with higher costs, acute care utilization, and gaps in medication use compared with the overall population and within certain subgroups. Providing CMM to these patients may improve health system performance in relevant quality measures. Evaluation of CMM services delivered by a pharmacist using these markers requires further investigation. Academy of Managed Care Pharmacy 2021-08 /pmc/articles/PMC10391295/ /pubmed/34337988 http://dx.doi.org/10.18553/jmcp.2021.27.8.1009 Text en Copyright © 2021, Academy of Managed Care Pharmacy. All rights reserved. https://creativecommons.org/licenses/by/4.0/This article is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use and redistribution provided that the original author and source are credited.
spellingShingle Research
Bishop, Martin A
Chang, Hsien-Yen
Kitchen, Christopher
Weiner, Jonathan P
Kharrazi, Hadi
Shermock, Kenneth M
Development of measurable criteria to identify and prioritize patients for inclusion in comprehensive medication management programs within primary care settings
title Development of measurable criteria to identify and prioritize patients for inclusion in comprehensive medication management programs within primary care settings
title_full Development of measurable criteria to identify and prioritize patients for inclusion in comprehensive medication management programs within primary care settings
title_fullStr Development of measurable criteria to identify and prioritize patients for inclusion in comprehensive medication management programs within primary care settings
title_full_unstemmed Development of measurable criteria to identify and prioritize patients for inclusion in comprehensive medication management programs within primary care settings
title_short Development of measurable criteria to identify and prioritize patients for inclusion in comprehensive medication management programs within primary care settings
title_sort development of measurable criteria to identify and prioritize patients for inclusion in comprehensive medication management programs within primary care settings
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10391295/
https://www.ncbi.nlm.nih.gov/pubmed/34337988
http://dx.doi.org/10.18553/jmcp.2021.27.8.1009
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