The evaluation of comprehensive medication management for chronic diseases in primary care clinics, a Texas delivery system reform incentive payment program

Abstract

Background: The Institute of Medicine reported that more than 1.5 million preventable adverse drug events occur annually in the United States. Comprehensive Medication Management (CMM) is the medication review process to improve clinical outcomes, enhance patient adherence, reduce drug therapy problems and reduce health care costs. University of Texas (UT) Physicians implemented a CMM program in several community-based clinics. We evaluated the effectiveness of CMM to reduce drug therapy problems and achieve medical cost savings. Methods: This was a retrospective, observational study of CMM participants from October 2015 to September 2016. Program participants included patients aged 18 years or older who had taken more than 4 prescribed medications and were diagnosed with at least one of the following chronic diseases: hypertension, congestive heart failure, chronic obstructive pulmonary disease, asthma or diabetes. Under the CMM program, a clinical pharmacist reviewed patients' electronic health records and created action plans to resolve identified drug problems. As part of the evaluation of the clinical process, two independent physicians conducted peer review on the recommendations issued by the pharmacist in order to establish inter-rater reliability of drug therapy problems and potential consequent medical services. The drug therapy problems were identified and classified into four categories: indication, effectiveness, safety and/or compliance. The average cost of avoided medical services was obtained based on cost extrapolations from the literature, combined with hospital discharge data. Potential medical services avoided were linked to the average cost of those services to calculate the total cost savings of the program from the payers' perspective.

Medication therapy problems identified by pharmacists conducting telephonic comprehensive medication management within a team‐based at‐home care program

“…A few limitations should be noted in our study. It is not clear why our MTP acceptance rates were lower than in other studies, which found typical acceptance rates that range from 37% to 59.6% 13–16 . For example, it is unclear whether providers saw the recommendations and disagreed with the assessment of the pharmacist or if they simply failed to notice the recommendations.…”

“…It is not clear why our MTP acceptance rates were lower than in other studies, which found typical acceptance rates that range from 37% to 59.6%. [13][14][15][16] For example, it is unclear whether providers saw the recommendations and disagreed with the assessment of the pharmacist or if they simply failed to notice the recommendations. We also did not examine whether the rate of acceptance or the types of MTPs identified chan- Due to an oversight however, an MTP for the need for monitoring for effectiveness was not included on the standardized documentation form.…”

“…12 The rates at which these MTPs are accepted varies, ranging from less than 40% to nearly 100% with higher rates of acceptance associated with more direct relationships with opportunities for feedback between the prescriber and pharmacist. [13][14][15][16] In examining these studies, the most commonly identified MTPs were nonadherence and needs additional monitoring.CMM is usually delivered face-to-face in a pharmacy or ambulatory clinic, however due to logistical challenges and the recent coronavirus disease 2019 (COVID-19) pandemic, there is increasing interest in the telephonic delivery of CMM. 17,18 Currently, it is unclear how mode of delivery affects MTP identification and acceptance.…”

Drug-Related Problems of Patients in Primary Health Care Institutions: A Systematic Review

“…After preliminary screening, 250 articles needed to be further screened. Twenty-seven articles ( Patel et al, 2005 ; Gisev et al, 2009 ; Gomez et al, 2009 ; Hooper et al, 2009 ; Zhao, 2012 ; Roth et al, 2013 ; Lenander et al, 2014 ; Nadir et al, 2014 ; Tan et al, 2014 ; Mendonca et al, 2016 ; Okumura et al, 2016 ; Rodis et al, 2017 ; Schwartz et al, 2017 ; Benson et al, 2018 ; Vande Griend et al, 2018 ; Yang et al, 2018 ; Hazen et al, 2019 ; Khera et al, 2019 ; Neves et al, 2019 ; Santos et al, 2019 ; Zhang et al, 2020a ; Zhang et al, 2020b ; Chung et al, 2020 ; Gerard et al, 2020 ; Puspitasari et al, 2020 ; Samir Abdin et al, 2020 ; Troncoso-Marino et al, 2020 ) were finally included (there were only 26 studies because one of the studies was reported in two articles) ( Zhang et al, 2020a ; Zhang et al, 2020b ). The process of study selection is shown in Figure 1 .…”

“…Among the included studies, 61.54% ( n = 16) were from developed countries, including six from America ( Patel et al, 2005 ; Roth et al, 2013 ; Rodis et al, 2017 ; Schwartz et al, 2017 ; Vande Griend et al, 2018 ; Chung et al, 2020 ), three from Canada ( Khera et al, 2019 ; Gerard et al, 2020 ; Samir Abdin et al, 2020 ), three from Australia ( Gisev et al, 2009 ; Tan et al, 2014 ; Benson et al, 2018 ), two from Spain ( Gomez et al, 2009 ; Troncoso-Marino et al, 2020 ), one from the Netherlands ( Hazen et al, 2019 ), and one from Sweden ( Lenander et al, 2014 ); 38.46% ( n = 10) were from developing countries, including four from Brazil ( Mendonca et al, 2016 ; Okumura et al, 2016 ; Neves et al, 2019 ; Santos et al, 2019 ), three from China ( Zhao, 2012 ; Yang et al, 2018 ; Zhang et al, 2020a ; Zhang et al, 2020b ), two from Qatar ( Hooper et al, 2009 ; Nadir et al, 2014 ), and one from Indonesia ( Puspitasari et al, 2020 ). According to the types of study design reported by the authors, there were six prospective studies ( Hooper et al, 2009 ; Roth et al, 2013 ; Rodis et al, 2017 ; Benson et al, 2018 ; Yang et al, 2018 ; Zhang et al, 2020a ; Zhang et al, 2020b ), five cross-sectional studies ( Zhao, 2012 ; Nadir et al, 2014 ; Okumura et al, 2016 ; Hazen et al, 2019 ; Troncoso-Marino et al, 2020 ), four retrospective studies ( Mendonca et al, 2016 ; Vande Griend et al, 2018 ; Chung et al, 2020 ; Gerard et al, 2020 ), five before-and-after controlled or longitudinal studies ( Gomez et al, 2009 ; Tan et al, 2014 ; Khera et al, 2019 ; Neves et al, 2019 ; Samir Abdin et al, 2020 ), and one rand...…”