Medication therapy management delivery by community pharmacists: Insights from a national sample of Medicare Part D beneficiaries

IntroductionThe Medicare Part D medication therapy management (MTM) program positions pharmacists to optimize beneficiaries’ medications and improve care. Little is known regarding Part D MTM delivery by community pharmacists and other pharmacist provider types.ObjectivesTo (a) characterize Medicare Part D MTM delivery by community pharmacists, (b) compare MTM delivery by community pharmacists to other pharmacists, and (c) generate hypotheses for future research.MethodsA descriptive cross‐sectional study using merged data from a 20% random sample of Medicare beneficiary enrollment data with a 100% sample of recently available 2014 Part D MTM files was conducted. Andersen’s Behavioral Model was applied to describe MTM delivery across beneficiary characteristics. Descriptive and bivariate statistics were used to compare delivery of MTM between community and other pharmacist providers.ResultsAmong beneficiaries sampled, community pharmacists provided comprehensive medication reviews (CMRs) to 22% (n = 26 337) of beneficiaries receiving at least one CMR. Almost half (49.4%) were provided face‐to‐face. Across pharmacist cohorts, median days to CMR offer of post‐MTM program enrollment were within the 60‐day policy requirement. The community pharmacist cohort had fewer days from CMR offer to receipt (median 47 days). Community pharmacists provided more medication therapy problem (MTP) recommendations (mean [SD] of 1.8 [3.5]; P < .001), but resolved less MTPs (0.2 [0.7]; P < .001), and most commonly served beneficiaries that were in the south but less in the west/northeast. Additionally, community pharmacists served a smaller proportion of black beneficiaries, yet a larger proportion of Hispanic beneficiaries (P < .001).ConclusionCommunity pharmacists provided approximately one in five CMRs for MTM eligible beneficiaries in 2014, with CMRs occurring more quickly, resulting in more MTP recommendations, but resolving less MTPs than those provided by noncommunity pharmacists. Future research should explore geographic/racial‐ethnic disparities in beneficiaries served and strategies to increase negligible MTP resolution by community pharmacists.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151286/1/jac51160.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151286/2/jac51160_am.pd

Antimicrobial drug use in primary healthcare clinics: a retrospective evaluation

Objectives: To examine the appropriateness of antibiotics prescribed for acute infection based on the Malaysian national antibiotic guidelines and the defined daily dose (DDD) system of the World Health Organization (WHO). This study also aimed to describe the factors influencing the drug use pattern and to investigate the procurement patterns of antibiotics in the primary healthcare setting. Methods: A retrospective cohort follow-up study of randomly selected patients from all patients who received any antibiotic between January and December 2013 was conducted at three primary healthcare clinics in Selangor State of Malaysia. For each patient, the following information was recorded: name of the antibiotic, frequency and dose, and Anatomical Therapeutic Chemical (ATC) group. The defined daily dose per 1000 inhabitants per day was calculated for each antibiotic. The national antibiotic guidelines were used to assess the appropriateness of each antibiotic prescription. Results: A total of 735 patients were included in the study. The five most used antibiotics were amoxicillin (1.36 g, 35.2%), cloxacillin (0.68 g, 26.3%), erythromycin (0.32 g, 22.3%), bacampicillin (0.13 g, 7.2%), and cephalexin (0.11 g, 6.9%). Respiratory tract infections were the most commonly treated infections, and the doctors’ preferred antibiotic for the treatment of these infections was amoxicillin. More than 18% of all amoxicillin prescriptions were deemed inappropriate according to the national antibiotic guidelines. In terms of procurement costs, USD 88 885 was spent in 2011, USD 219 402 in 2012, and USD 233 034 in 2013 at the three primary healthcare clinics, an average of USD 180 440 per year for the three clinics. Conclusions: This study reports the antibiotic usage at three primary healthcare clinics in Klang Province. The most prescribed antibiotic was amoxicillin in capsules (250 mg), which was mainly prescribed for respiratory infections. Although the national antibiotic guidelines state that amoxicillin is a preferred drug for acute bacterial rhinosinusitis, this drug is also being prescribed for other disease conditions, such as acute pharyngitis and acute tonsillitis. This result shows that current practice is not following the current antibiotic guidelines, which state that phenoxypenicillin should be the preferred drug

Systematic review on quality control for drug management programs: Is quality reported in the literature?

<p>Abstract</p> <p>Background</p> <p>Maintaining quality of care while managing limited healthcare resources is an ongoing challenge in healthcare. The objective of this study was to evaluate how the impact of drug management programs is reported in the literature and to identify potentially existing quality standards.</p> <p>Methods</p> <p>This analysis relates to the published research on the impact of drug management on economic, clinical, or humanistic outcomes in managed care, indemnity insurance, VA, or Medicaid in the USA published between 1996 and 2007. Included articles were systematically analyzed for study objective, study endpoints, and drug management type. They were further categorized by drug management tool, primary objective, and study endpoints.</p> <p>Results</p> <p>None of the 76 included publications assessed the overall quality of drug management tools. The impact of 9 different drug management tools used alone or in combination was studied in pharmacy claims, medical claims, electronic medical records or survey data from either patient, plan or provider perspective using an average of 2.1 of 11 possible endpoints. A total of 68% of the studies reported the impact on plan focused endpoints, while the clinical, the patient or the provider perspective were studied to a much lower degree (45%, 42% and 12% of the studies). Health outcomes were only accounted for in 9.2% of the studies.</p> <p>Conclusion</p> <p>Comprehensive assessment of quality considering plan, patient and clinical outcomes is not yet applied. There is no defined quality standard. Benchmarks including health outcomes should be determined and used to improve the overall clinical and economic effectiveness of drug management programs.</p

AMCP Partnership Forum: Navigating Innovations in Diabetes Care

New developments that provide opportunities to enhance cost-effective diabetes care include advances in the pharmacologic treatment of diabetes, new drug delivery devices, innovations in patient management strategies, contracting strategies that incentivize effective interventions, and mobile health technologies. Payers must carefully consider the utility of these advances when making coverage decisions and designing benefits. To engage national stakeholders in a discussion about how to utilize innovations in diabetes care to optimize patient outcomes, the Academy of Managed Care Pharmacy organized the Partnership Forum on Navigating Innovations in Diabetes Care in Arlington, Virginia, on July 19-20, 2016. The forum explored current trends and advances in diabetes treatments and engaged in discussions about how organizations can leverage these emerging options to develop strategies that improve coordination of care and patient outcomes, while managing limited health resources. Additionally, stakeholders were tasked with identifying gaps in evidence that hinder decision making around novel therapies and other advances that are of direct relevance to managed care organizations