Predictors of Medication-Related Problems among Medicaid Patients Participating in a Pharmacist-Provided Telephonic Medication Therapy Management Program

Abstract

Study Objective To identify predictors of medication-related problems (MRPs) among Medicaid patients participating in a telephonic medication therapy management (MTM) program. Design Retrospective analysis of data from patients enrolled in a previously published study Data Sources Two Medicaid administrative claims file databases (for healthcare utilization and prescription dispensing information) and one pharmacy organization file for MTM program information. Patients Seven hundred twelve adult Medicaid patients who participated in a statewide pharmacist-provided telephone-based MTM program and who received an initial medication therapy review. Measurements and Main Results The primary dependent variable was the number of MRPs detected during the initial medication therapy review. Secondary dependent variables were the detection of one or more MRPs related to indication, effectiveness, safety, and adherence. Predictor variables were selected a priori that, from the literature and our own practice experiences, were hypothesized as being potentially associated with MRPs: demographics, comorbidities, medication use, and healthcare utilization. Bivariate analyses were performed, and multivariable models were constructed. All predictor variables with significant associations (defined a priori as p<0.1) with the median number of MRPs detected were then entered into a three-block multiple linear regression model. The overall model was significant (p<0.001, R2= 0.064). Significant predictors of any MRPs (p<0.05) were total number of medications, obesity, dyslipidemia, and one or more emergency department visits in the past 3 months. For indication-related MRPs, the model was significant (p<0.001, R2= 0.049), and predictors included female sex, obesity, dyslipidemia, and total number of medications (p<0.05). For effectiveness-related MRPs, the model was significant (p<0.001, R2= 0.054), and predictors included bone disease and dyslipidemia (p<0.05). For safety-related MRPs, the model was significant (p<0.001, R2= 0.046), and dyslipidemia was a predictor (p<0.05). No significant predictors of adherence-related MRPs were identified. Conclusion This analysis supports the relative importance of number of medications as a predictor of MRPs in the Medicaid population and identifies other predictors. However, given the models’ low R2 values, these findings indicate that other unknown factors are clearly important and that criteria commonly used for determining MTM eligibility may be inadequate in identifying appropriate patients for MTM in a Medicaid population.

Evaluation of drug‐related problems in older polypharmacy primary care patients

“…Such findings are in accordance with several studies showing low adherence and persistence in asthma patients . In contrast, Snyder et al reported a lack of predictors in their adherence‐specific problems, possibly because of an insufficient number of asthma patients. Interestingly, although potential/actual adverse reactions were observed in more than a third of the patients involved in medication reviews, there was no particular medication or indication associated with this DRP.…”

“…The count of medications and indications were predictors of the quantity of DRPs, which was expected and in line with literature data . We identified possible risk factors for most DRPs.…”

“…These findings are in accordance with CMRs performed in community pharmacies, which included patient interviews . In contrast, non‐adherence had less impact on overall DRPs when medication reviews were conducted without interviewing the patient . A possible explanation for the discrepancy was given by Kwint et al who showed that compliance issues, toxicity, over or underdose, and education were more likely to be identified during patient interviews …”

Racial and ethnic disparities in meeting MTM eligibility criteria among patients with asthma

“…15,16 In 2012, to be eligible for MTM services, beneficiaries had to have 2–3 chronic diseases, take 2–8 Part D drugs, and exceed a drug cost threshold of inflation-adjusted $3,100.20. 16 In addition to the Medicare Part D program, non-Medicare insurance programs for populations other than Medicare beneficiaries also have offered MTM programs and used similar eligibility criteria for MTM services as Medicare Part D. 6,7,17–20 …”

Utility of a brief screening tool for medication-related problems

“…Furthermore, recent studies have found somewhat limited utility of these criteria as predictors of MRPs and opportunities for improvements in MTM eligibility criteria. 8-10 …”