Prescriber Continuity and Disease Control of Older Adults

Maciejewski, Matthew L.; Hammill, Bradley G.; Bayliss, Elizabeth A.; Ding, Laura; Voils, Corrine I.; Curtis, Lesley H.; Wang, Virginia

doi:10.1097/mlr.0000000000000658

Cited by 27 publications

(21 citation statements)

References 35 publications

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“…Given that multimorbid beneficiaries have disproportionate use of hospital care, medications, outpatient care, and Medicare expenditures and increased risk of death, 31,32 this finding suggests yet another burden and risk of multimorbidity. Medicare beneficiaries with multiple chronic conditions may also be a high‐priority group for opioid mitigation strategies, since they often have complex medication regimens and are seen by multiple providers 33 …”

Section: Discussionmentioning

confidence: 99%

“…Medicare beneficiaries with multiple chronic conditions may also be a high-priority group for opioid mitigation strategies, since they often have complex medication regimens and are seen by multiple providers. 33 Several limitations must be acknowledged. First, results may not generalize beyond Medicare FFS beneficiaries with Medicare Part D enrollment in 2016.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Opioid Prescribing in the 2016 Medicare Fee‐for‐Service Population

Maciejewski

Zepel

Hale

et al. 2020

J American Geriatrics Society

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BACKGROUND AND OBJECTIVES Opioid use and misuse are prevalent and remain a national crisis. This study identified beneficiary characteristics associated with filling opioid prescriptions, variation in opioid dosing, and opioid use with average daily doses (ADDs) equal to 120 morphine milligram equivalents (MMEs) or more in the 100% Medicare fee‐for‐service (FFS) population. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS In a cohort of FFS beneficiaries with 12 months of Medicare Part D coverage in 2016, we examined patient factors associated with filling an opioid prescription (n = 20,880,490) and variation in ADDs (n = 7,325,031) in a two‐part model. Among those filling opioids, we also examined the probability of ADD equal to 120 MMEs or more via logistic regression. RESULTS About 35% of FFS beneficiaries had one or more opioid prescription fills in 2016 and 1.5% had ADDs equal to 120 MMEs or more. Disability‐eligible beneficiaries and beneficiaries with multiple chronic conditions were more likely to fill opioids, to have higher ADDs or were more likely to have ADD equal to 120 MMEs or more. Beneficiaries with chronic obstructive pulmonary disease (COPD) were more likely to fill opioids (odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.46–1.47), have higher ADDs (rate ratio = 1.06, 95% CI = 1.06–1.06) when filled and were more likely to have ADD equal to 120 MMEs or more (OR = 1.23, 95% CI = 1.21–1.24). Finally, black and Hispanic beneficiaries were less likely to fill opioids, had lower overall doses and were less likely to have ADDs equal to 120 MMEs or more compared to white beneficiaries. CONCLUSION Several beneficiary subgroups have underappreciated risk of adverse events associated with ADD equal to 120 MMEs or more that may benefit from opioid optimization interventions that balance pain management and adverse event risk, especially beneficiaries with COPD who are at risk for respiratory depression.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Opioid Prescribing in the 2016 Medicare Fee‐for‐Service Population

Maciejewski

Zepel

Hale

et al. 2020

J American Geriatrics Society

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“…Two practice‐related factors were added which the investigators previously used to successfully target interventions: Presence of high‐risk medications—multiple studies investigating the prevalence of adverse drug reactions resulting in ED visits, hospitalizations, or other markers of morbidity have repeatedly identified specific classes of medications as being “high‐risk” (antiepileptics, anticoagulants, antidiabetics, and medications with a narrow therapeutic index) Number of prescribers—the involvement of multiple prescribers and especially the lack of continuity and/or communication between prescribers has been identified as a risk factor for drug‐related problems in the elderly population …”

Section: Methodsmentioning

confidence: 99%

Evaluation of clinical pharmacy priority scoring methods in an adult medicine residency clinic

Krasniak

Szymaniak

Conn

et al. 2019

J Am Coll Clin Pharm

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Background: Patients with higher clinical pharmacy priority (CP2) scores are more likely to receive a medication recommendation from a pharmacist to resolve an identified medication related problem (MRP) in a family medicine clinic.Objective: The objective of this study was to compare a modified CP2 score to the original CP2 score in an adult medicine residency clinic and assess whether a modified CP2 score more appropriately captured patients in need of recommendations from a clinical pharmacist.Methods: A convenience sample of patients scheduled for visits in an adult medicine clinic had a comprehensive medication review (CMR) performed. All patients had the original CP2 score and modified CP2 score calculated retrospectively. Both versions of the CP2 scores were compared using Pearson correlation. The relationship between a recommendation from a pharmacist and each CP2 score was evaluated using Pearson correlation and t test.Results: In total, 148 patients who received a CMR by a clinical pharmacist were included in the retrospective chart review. Overall, there was a strong positive correlation between the CP2 score and the modified CP2 score (correlation coefficient (r) 0.968, P < 0.001); thus, as the CP2 scores increase, the modified CP2 score increases.Patients with higher CP2 and modified CP2 scores were more likely to receive a recommendation from a pharmacist (P < 0.001 and P < 0.001, respectively). There was a moderate correlation between both scores and number of recommendations made (CP2: r = 0.436 [P < 0.001], modified CP2: r = 0.456 [P < 0.001]) which did not differ significantly. Conclusions:The CP2 score and the modified CP2 score were both associated with pharmacist recommendations in an adult medicine clinic. Refinement of the CP2 score did not better capture patients in an adult medicine residency clinic with a recommendation from a clinical pharmacist. K E Y W O R D Shealth care systems, health services research, medication therapy management, pharmacists, pharmacy service, hospital

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“…We also examined if the number of prescribers from whom patients are receiving care affects adherence. Our hypothesis is that fewer prescribers might lead to greater adherence as prior research has shown greater continuity leads to improved adherence . Studying the drug use pattern of patients with diabetes related to race/ethnicity and region is important to guide development of targeted interventions to improve medication adherence and reduce health disparities, morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Examining factors associated with nonadherence and identifying providers caring for nonadherent subgroups

Taira

Seto

Davis

et al. 2017

J Pharm Health Serv Res

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Objectives To examine racial/ethnic and regional differences in medication adherence in patients with diabetes taking oral anti-diabetic, anti-hypertensive, and cholesterol lowering medications and to identify the pharmacies and prescribers who serve these communities. Methods Administrative claims data was analyzed for members enrolled in a large health plan in Hawaii (2008-2010) with diabetes mellitus who were taking three types of medications: 1) oral anti-diabetic medications; 2) anti-hypertensive medications; 3) cholesterol lowering medications (n=5136). The primary outcome was medication adherence based on medication possession ratios. Multivariable logistic regression models were estimated to examine the association between race/ethnicity and region to adherence to each drug class separately, followed by non-adherence to all three. Covariates included age, gender, education level, chronic conditions, copayment level, and number of prescribers and pharmacies from which the patients received their medications. Key Findings After adjustment for other factors, Filipinos [OR=0.58, 95%CI(0.45,0.74)], Native Hawaiians [OR=0.74, 95%CI(0.56,0.98)], and people of other race [OR=0.67, 95%CI(0.55,0.82)] were significantly less adherent to anti-diabetic and anti-hypertensive medications than Japanese. For cholesterol-lowering medications, all racial and ethnic groups were significantly less adherent than Japanese, except mixed race. We also found that different racial/ethnic groups tended to use different pharmacies and prescribers, particularly in rural areas Conclusion Adherence differed by race/ethnicity as well as age and region. Qualitative research involving subgroups (e.g. Filipinos, Native Hawaiians, people under age 50) is needed to identify how to adapt and enhance the effects of interventions shown to be efficacious in prior studies.

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Prescriber Continuity and Disease Control of Older Adults

Abstract: Multiple prescribers were associated with worse disease control, possibly because patients with more severe diabetes or dyslipidemia have multiple prescribers or because care fragmentation is associated with worse disease control.

Cited by 27 publications

References 35 publications

Opioid Prescribing in the 2016 Medicare Fee‐for‐Service Population

Opioid Prescribing in the 2016 Medicare Fee‐for‐Service Population

Evaluation of clinical pharmacy priority scoring methods in an adult medicine residency clinic

Examining factors associated with nonadherence and identifying providers caring for nonadherent subgroups

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