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Allen A, Hung A. Racial and ethnic disparities related to the Medicare Part D Medication Therapy Management Program. J Manag Care Spec Pharm 2024; 30:609-616. [PMID: 38824629 PMCID: PMC11144990 DOI: 10.18553/jmcp.2024.30.6.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Medicare's Part D Medication Therapy Management (MTM) programs serve approximately 4.5 million eligible beneficiaries. Prior research suggested that the thresholds to enter Part D MTM programs would disproportionately favor White beneficiaries compared with Black or Hispanic beneficiaries. This article summarizes those initial studies and compares the results with more recent analyses of racial and ethnic differences in MTM program enrollment, which, in general, show higher odds of MTM enrollment for minority beneficiaries compared with White beneficiaries. Disparities in the utilization of comprehensive medication review (CMR), a core MTM service, are also discussed. Although trends vary, disparities exist for various minority groups. For example, Black beneficiaries and Hispanic beneficiaries are less likely to be offered a CMR compared with White beneficiaries. Additionally, minority (Asian, Hispanic, and North American Native) beneficiaries are less likely to receive a CMR after being offered the service compared with White beneficiaries. Black, Hispanic, and Asian beneficiaries are more likely than White beneficiaries to have a longer duration between MTM enrollment and CMR offer. There is also a distinct difference in the type of pharmacist (ie, plan pharmacist, MTM vendor pharmacist, or community pharmacist) completing the CMR for certain racial and ethnic groups. For example, compared with White beneficiaries, Black beneficiaries were less likely to receive a CMR from a community pharmacist, whereas Asian beneficiaries were more likely.
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Affiliation(s)
- Audrey Allen
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Anna Hung
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA, NC
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC
- Duke-Margolis Center for Health Policy, Durham, NC
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Hung A, Wilson L, Smith VA, Pavon JM, Sloan CE, Hastings SN, Farley J, Maciejewski ML. Comprehensive Medication Review Completion Rates and Disparities After Medicare Star Rating Measure. JAMA HEALTH FORUM 2024; 5:e240807. [PMID: 38700854 PMCID: PMC11069085 DOI: 10.1001/jamahealthforum.2024.0807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/06/2024] [Indexed: 05/06/2024] Open
Abstract
Importance Comprehensive medication reviews (CMRs) are offered to qualifying US Medicare beneficiaries annually to optimize medication regimens and therapeutic outcomes. In 2016, Medicare adopted CMR completion as a Star Rating quality measure to encourage the use of CMRs. Objective To examine trends in CMR completion rates before and after 2016 and whether racial, ethnic, and socioeconomic disparities in CMR completion changed. Design, Setting, and Participants This observational study using interrupted time-series analysis examined 2013 to 2020 annual cohorts of community-dwelling Medicare beneficiaries aged 66 years and older eligible for a CMR as determined by Part D plans and by objective minimum eligibility criteria. Data analysis was conducted from September 2022 to February 2024. Exposure Adoption of CMR completion as a Star Rating quality measure in 2016. Main Outcome and Measures CMR completion modeled via generalized estimating equations. Results The study included a total of 561 950 eligible beneficiaries, with 253 561 in the 2013 to 2015 cohort (median [IQR] age, 75.8 [70.7-82.1] years; 90 778 male [35.8%]; 6795 Asian [2.7%]; 24 425 Black [9.6%]; 7674 Hispanic [3.0%]; 208 621 White [82.3%]) and 308 389 in the 2016 to 2020 cohort (median [IQR] age, 75.1 [70.4-80.9] years; 126 730 male [41.1%]; 8922 Asian [2.9%]; 27 915 Black [9.1%]; 7635 Hispanic [2.5%]; 252 781 White [82.0%]). The unadjusted CMR completion rate increased from 10.2% (7379 of 72 225 individuals) in 2013 to 15.6% (14 185 of 90 847 individuals) in 2015 and increased further to 35.8% (18 376 of 51 386 individuals) in 2020, in part because the population deemed by Part D plans to be MTM-eligible decreased by nearly half after 2015 (90 487 individuals in 2015 to 51 386 individuals in 2020). Among a simulated cohort based on Medicare minimum eligibility thresholds, the unadjusted CMR completion rate increased but to a lesser extent, from 4.4% in 2013 to 12.6% in 2020. Compared with White beneficiaries, Asian and Hispanic beneficiaries experienced greater increases in likelihood of CMR completion after 2016 but remained less likely to complete a CMR. Dual-Medicaid enrollees also experienced greater increases in likelihood of CMR completion as compared with those without either designation, but still remained less likely to complete CMR. Conclusion and Relevance This study found that adoption of CMR completion as a Star Rating quality measure was associated with higher CMR completion rates. The increase in CMR completion rates was achieved partly because Part D plans used stricter eligibility criteria to define eligible patients. Reductions in disparities for eligible Asian, Hispanic, and dual-Medicaid enrollees were seen, but not eliminated. These findings suggest that quality measures can inform plan behavior and could be used to help address disparities.
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Affiliation(s)
- Anna Hung
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Lauren Wilson
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Valerie A. Smith
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Juliessa M. Pavon
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
- Geriatrics Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Caroline E. Sloan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Durham, North Carolina
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Susan N. Hastings
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
- Geriatrics Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Joel Farley
- Department of Pharmaceutical Care & Health Systems, University of Minnesota College of Pharmacy, Minneapolis
| | - Matthew L. Maciejewski
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke-Margolis Center for Health Policy, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Dong X, Tsang CCS, Wan JY, Chisholm-Burns MA, Finch CK, Tsao JW, Browning JA, Garuccio J, Zeng R, Wang J. Effects of Medicare Part D medication therapy management on racial/ethnic disparities in adherence to antidementia medications among patients with Alzheimer's disease and related dementias: An observational study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100420. [PMID: 38420610 PMCID: PMC10900920 DOI: 10.1016/j.rcsop.2024.100420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/18/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
Background Evidence is sparse on the effects of Medicare medication therapy management (MTM) on racial/ethnic disparities in medication adherence among patients with Alzheimer's disease and related dementias. Objectives This study examined the Medicare MTM program's effects on racial/ethnic disparities in the adherence to antidementia medications among patients with Alzheimer's disease and related dementias. Methods This is a retrospective analysis of 100% of 2010-2017 Medicare Parts A, B, and D data linked to Area Health Resources Files. The study outcome was nonadherence to antidementia medications, and intervention was defined as new MTM enrollment in 2017. Propensity score matching was conducted to create intervention and comparison groups with comparable characteristics. A difference-in-differences model was employed with logistic regression, including interaction terms of dummy variables for the intervention group and racial/ethnic minorities. Results Unadjusted comparisons revealed that Black, Hispanic, and Asian/Pacific Islander patients were more likely to be nonadherent than non-Hispanic White (White) patients in 2016. Differences in odds of nonadherence between Black and White patients among the intervention group were lower in 2017 than in 2016 by 27% (odds ratios [OR]: 0.73, 95% confidence interval [CI]: 0.65-0.82). A similar lowering was seen between Hispanic and White patients by 26% (OR: 0.74, 95% CI: 0.63-0.87). MTM enrollment was associated with reduced disparities in nonadherence for Black-White patients of 33% (OR: 0.67, 95% CI: 0.57-0.78) and Hispanic-White patients of 19% (OR: 0.81, 95% CI: 0.67-0.99). Discussion The Medicare MTM program was associated with lower disparities in adherence to antidementia medications between Black and White patients, and between Hispanic and White patients in the population with Alzheimer's disease and related dementias. Conclusions Expanding the MTM program may particularly benefit racial/ethnic minorities in Alzheimer's disease and related dementia care.
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Affiliation(s)
- Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Jim Y. Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 North Pauline St, Memphis, TN 38163, USA
| | - Marie A. Chisholm-Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Christopher K. Finch
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Jack W. Tsao
- Department of Neurology, University of Tennessee Health Science Center College of Medicine, 855 Monroe Avenue, Memphis, TN 38163, USA
| | - Jamie A. Browning
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Joseph Garuccio
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Rose Zeng
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, USA
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Rao P, Hung A. Impact of medication therapy management programs on potentially inappropriate medication use in older adults: A systematic review. J Manag Care Spec Pharm 2024; 30:3-14. [PMID: 38153866 PMCID: PMC10775773 DOI: 10.18553/jmcp.2024.30.1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
BACKGROUND The use of potentially inappropriate medications (PIMs) is prevalent, costly, and harmful for older adults. These medications are to be avoided among older adults because they generally have (1) a high risk of adverse events in this population and/or (2) limited evidence of benefits in the presence of safer or more effective alternatives. Medication therapy management (MTM) programs can help address PIM use; however, there has not been a synthesis of studies examining the impact of MTM programs on PIM use. OBJECTIVE To review published literature evaluating the impact of MTM on PIM use in older adults. METHODS A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines using MEDLINE (PubMed) studies were included if they (1) had a Medicare population, (2) were based in the United States, (3) examined an MTM program (ie, used the term "medication therapy management"), (4) focused on the impact of MTM programs on PIM use as the primary outcome, (5) had a randomized controlled trial or an observational study design, and (6) were available in English. RESULTS Of 221 articles identified, 31 full-text articles were assessed, and 7 met all inclusion and exclusion criteria. The studies took place in various settings, ranging from single-site tertiary medical centers to multisite outpatient clinics, community pharmacies, and nationwide telehealth MTM providers. Patient populations were majority female sex (ranging from 61% to 71%) and majority White (ranging from 81% to 94%), with a mean age of 73 to 78 years. In 5 of the 7 studies, MTM reduced the use of PIMs; however, 3 did not adjust for confounding or apply a comparator group. Measurement of MTM impacts on PIM use varied across studies. Patient-level and plan-level studies mostly assessed shorter-term PIM usage reduction (4 months or less), whereas studies performed at the provider and institutional level assessed PIM usage reduction trends across consecutive measurement years. CONCLUSIONS Based on the current limited evidence, MTM programs in older adults appear to have a positive impact on reducing PIM use. However, evidence was limited by study design, the lack of consistency in outcome measures, and a short follow-up period. Future work should adjust for confounding, apply comparator groups, include longer-term outcomes, and develop a core set of measures that can be consistently applied across studies.
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Affiliation(s)
- Preeyanka Rao
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Anna Hung
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, NC
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC
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Wang J, Shen JY, Yu F, Nathan K, Caprio TV, Conwell Y, Moskow MS, Brasch JD, Simmons SF, Mixon AS, Norton SA. Challenges in Deprescribing among Older Adults in Post-Acute Care Transitions to Home. J Am Med Dir Assoc 2024; 25:138-145.e6. [PMID: 37913819 PMCID: PMC10843747 DOI: 10.1016/j.jamda.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Medications with a higher risk of harm or that are unlikely to be beneficial are used by nearly all older patients in home health care (HHC). The objective of this study was to understand stakeholders' perspectives on challenges in deprescribing these medications for post-acute HHC patients. DESIGN Qualitative individual interviews were conducted with stakeholders involved with post-acute deprescribing. SETTING AND PARTICIPANT Older HHC patients, HHC nurses, pharmacists, and primary/acute care/post-acute prescribers from 9 US states participated in individual qualitative interviews. MEASURES Interview questions were focused on the experience, processes, roles, training, workflow, and challenges of deprescribing in hospital-to-home transitions. We used the constant comparison approach to identify and compare findings among patient, prescriber, and pharmacist and HHC nurse stakeholders. RESULTS We interviewed 9 older patients, 11 HHC nurses, 5 primary care physicians (PCP), 3 pharmacists, 1 hospitalist, and 1 post-acute nurse practitioner. Four challenges were described in post-acute deprescribing for HHC patients. First, PCPs' time constraints, the timing of patient encounters after hospital discharge, and the lack of prioritization of deprescribing make it difficult for PCPs to initiate post-acute deprescribing. Second, patients are often confused about their medications, despite the care team's efforts in educating the patients. Third, communication is challenging between HHC nurses, PCPs, specialists, and hospitalists. Fourth, the roles of HHC nurses and pharmacists are limited in care team collaboration and discussion about post-acute deprescribing. CONCLUSIONS AND IMPLICATIONS Post-acute deprescribing relies on multiple parties in the care team yet it has challenges. Interventions to align the timing of deprescribing and that of post-acute care visits, prioritize deprescribing and allow clinicians more time to complete related tasks, improve medication education for patients, and ensure effective communication in the care team with synchronized electronic health record systems are needed to advance deprescribing during the transition from hospital to home.
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Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, University of Rochester, School of Nursing, Rochester, NY, USA.
| | - Jenny Y Shen
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Kobi Nathan
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA; Wegmans School of Pharmacy, St. John Fisher College, Rochester, NY, USA
| | - Thomas V Caprio
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA; University of Rochester-Home Care, University of Rochester Medical Center, Rochester, NY, USA; Finger Lakes Geriatric Education Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Marian S Moskow
- Harriet Kitzman Center for Research Support, University of Rochester School of Nursing, Rochester, NY, USA
| | - Judith D Brasch
- Harriet Kitzman Center for Research Support, University of Rochester School of Nursing, Rochester, NY, USA
| | - Sandra F Simmons
- Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN, USA; Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda S Mixon
- Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN, USA; Division of General Internal Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sally A Norton
- School of Nursing, University of Rochester, Rochester, NY, USA
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Abu Hammour K, Alhamad H, Al-Ashwal FY, Halboup A, Abu Farha R, Abu Hammour A. ChatGPT in pharmacy practice: a cross-sectional exploration of Jordanian pharmacists' perception, practice, and concerns. J Pharm Policy Pract 2023; 16:115. [PMID: 37789443 PMCID: PMC10548710 DOI: 10.1186/s40545-023-00624-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVES The purpose of this study is to find out how much pharmacists know and have used ChatGPT in their practice. We investigated the advantages and disadvantages of utilizing ChatGPT in a pharmacy context, the amount of training necessary to use it proficiently, and the influence on patient care using a survey. METHODS This cross-sectional study was carried out between May and June 2023 to assess the potential and problems that pharmacists observed while integrating chatbots powered by AI (ChatGPT) in pharmacy practice. The correlation between perceived benefits and concerns was evaluated using Spearman's rho correlation due to the data's non-normal distribution.Any pharmacists licensed by the Jordanian Pharmacists Association were included in the study. A convenient sampling technique was used to choose the participants, and the study questionnaire was distributed utilizing an online medium (Facebook and WhatsApp). Anyone who expressed interest in taking part was given a link to the study's instructions so they may read them before giving their electronic consent and accessing the survey. RESULTS The potential advantages of ChatGPT in the pharmacy practice were widely acknowledged by the participants. The majority of participants (69.9%) concurred that educational material about pharmacy items or therapeutic areas can be provided using ChatGPT, with 66.9% of respondents believing that ChatGPT is a machine learning algorithm. Concerns about the accuracy of AI-generated responses were also prevalent. More than half of the participants (55.7%) raised the possibility that AI systems such as ChatGPT could pick up on and replicate prejudices and discriminatory patterns from the data they were trained on. Analysis shows a statistically significant positive link, albeit a minor one, between the perceived advantages of ChatGPT and its drawbacks (r = 0.255, p < 0.001). However, concerns were strongly correlated with knowledge of ChatGPT. In contrast to those who were either unsure or had not heard of ChatGPT (64.2%), individuals who had heard of it were more likely to have strong concerns (79.8%) (p = 0.002). Finally, the results show a statistically significant association between the frequency of ChatGPT use and positive perceptions of the tool (p < 0.001). CONCLUSIONS Although ChatGPT has shown promise in health and pharmaceutical practice, its application should be rigorously regulated by evidence-based law. According to the study's findings, pharmacists support the use of ChatGPT in pharmacy practice but have concerns about its use due to ethical reasons, legal problems, privacy concerns, worries about the accuracy of the data generated, data learning, and bias risk.
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Affiliation(s)
- Khawla Abu Hammour
- Department of Clinical Pharmacy and Biopharmaceutics, Faculty of Pharmacy, University of Jordan, Amman, Jordan
| | - Hamza Alhamad
- Department of Clinical Pharmacy, Faculty of Pharmacy, Zarqa University, Zarqa, Jordan
| | - Fahmi Y Al-Ashwal
- Department of Clinical Pharmacy, College of Pharmacy, Al-Ayen University, Thi-Qar, Iraq.
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Science and Technology, Sana'a, Yemen.
| | - Abdulsalam Halboup
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Science and Technology, Sana'a, Yemen
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Gelugor, Pulau Pinang, Malaysia
| | - Rana Abu Farha
- Clinical Pharmacy and Therapeutics Department, Faculty of Pharmacy, Applied Science Private University, P.O. Box 11937, Amman, Jordan
| | - Adnan Abu Hammour
- Medrise Medical Center, Dubai Healthcare City, Dubai, United Arab Emirates
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Dong X, Tsang CCS, Browning JA, Garuccio J, Wan JY, Shih YCT, Chisholm-Burns MA, Dagogo-Jack S, Cushman WC, Wang J, Wang J. Racial and ethnic disparities in Medicare Part D medication therapy management services utilization. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100222. [PMID: 36712831 PMCID: PMC9874058 DOI: 10.1016/j.rcsop.2023.100222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/05/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Background The Medicare Part D medication therapy management (MTM) program has positive effects on medication and health service utilization. However, little is known about its utilization, much less so about the use among racial and ethnic minorities. Objective To examine MTM service utilization among older Medicare beneficiaries and to identify any racial and ethnic disparity patterns. Methods A retrospective cross-sectional analysis of 2017 Medicare administrative data, linked to the Area Health Resources Files. Fourteen outcomes related to MTM service nature, initiation, quantity, and delivery were examined using logistic, negative binomial, and Cox proportional hazards regression models. Results Racial and ethnic disparities were found with varying patterns across outcomes. For example, compared with White patients, the odds of opting out of MTM were 8% higher for Black patients (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.03-1.14), 57% higher for Hispanic patients (OR = 1.57, 95% CI = 1.42-1.72), and 57% higher for Asian patients (OR = 1.57, 95% CI = 1.33-1.85). The odds of continuing MTM from the previous years were 12% lower for Black patients (OR = 0.88, 95% CI = 0.86-0.90) and 3% lower for other patients (OR = 0.97, 95% CI = 0.95-0.99). In addition, the probability of being offered a comprehensive medication review (CMR) after MTM enrollment was 9% lower for Hispanic patients (hazard ratio [HR] = 0.91, 95% CI = 0.85-0.97), 9% lower for Asian patients (HR = 0.91, 95% CI = 0.87-0.94), and 3% lower for other patients (HR = 0.97, 95% CI = 0.95-0.99). Hispanic and Asian patients were more likely to have someone other than themselves receive a CMR. Conclusions Racial and ethnic disparities in MTM service utilization were identified. Although the disparities in specific utilization outcomes vary across racial/ethnic groups, it is evident that these disparities exist and may result in vulnerable communities not fully benefiting from the MTM services. Causes of the disparities should be explored to inform future reform of the Medicare Part D MTM program.
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Affiliation(s)
- Xiaobei Dong
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, 1240 N. 10th St., Milwaukee, WI 53205, United States of America
| | - Chi Chun Steve Tsang
- Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 212, Memphis, TN 38163, United States of America
| | - Jamie A. Browning
- Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States of America
| | - Joseph Garuccio
- Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States of America
| | - Jim Y. Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 N. Pauline, Suite 633, Memphis, TN 38163, United States of America
| | - Ya Chen Tina Shih
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Section of Cancer Economics and Policy, 1515 Holcombe Blvd., Unit 1444, Houston, TX 77030, United States of America
| | - Marie A. Chisholm-Burns
- School of Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR 97236, United States of America
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes & Metabolism, Clinical Research Center, University of Tennessee Health Science Center, Memphis, TN 38163, United States of America
| | - William C. Cushman
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 North Pauline Street, Suite 651, Memphis, TN 38163, United States of America
| | - Junling Wang
- Department of Clinical Pharmacy & Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 221, Memphis, TN 38163, United States of America
| | - Junling Wang
- Department of Clinical Pharmacy & Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 221, Memphis, TN 38163, United States of America
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Coe AB, Farris KB, Solway E, Singer DC, Kirch M, Kullgren JT, Malani PN, Bynum JPW. Predictors of Receipt of Comprehensive Medication Reviews in Older Adults. J Gerontol A Biol Sci Med Sci 2023; 78:463-469. [PMID: 35446953 PMCID: PMC9977218 DOI: 10.1093/gerona/glac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Polypharmacy is highly prevalent among older adults. This study's purpose was to provide nationally representative estimates of self-reported comprehensive medication review (CMR) receipt among older adults and describe factors associated with their receipt, as CMRs are available through the Medicare Part D program. METHODS This cross-sectional study used data from the National Poll on Healthy Aging (NPHA), a nationally representative online survey of community-dwelling adults aged 50-80, administered in December 2019. Participants included older adults aged 65-80 with any health insurance (n = 960). Outcomes were self-reported CMR receipt, awareness of CMR insurance coverage, and interest in a future CMR with a pharmacist. Sociodemographic and health-related variables were included. Descriptive statistics and multivariable logistic regression with NPHA population sampling weights were used. RESULTS Among older adults on 2 or more prescription medications, only 20.8% had received a CMR while 34.3% were interested in a future CMR. Among individuals who had not received a CMR, most (83.4%) were unaware their insurance might cover a CMR. Factors associated with higher odds of receiving a CMR included taking 5 or more prescription medications (adjusted odds ratio [AOR] = 2.6, 95% CI: 1.59-4.38) and reporting food insecurity (AOR = 2.9, 95% CI: 1.07-7.93). Having fair or poor self-reported physical health was associated with lower odds of receiving a CMR (AOR = 0.49, 95% CI: 0.25-0.97). CONCLUSIONS Most older adults on 2 or more prescription medications with health insurance had not received a CMR and many were interested in one. Targeted strategies to increase older adults' awareness and receipt of CMRs are warranted.
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Affiliation(s)
- Antoinette B Coe
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Karen B Farris
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Dianne C Singer
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey T Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Preeti N Malani
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie P W Bynum
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Yoo A, Fennelly JE, Renauer MM, Coe AB, Choe HM, Marshall VD, Parsons D, Farris KB. Comprehensive medication review service by embedded pharmacists in primary care: Innovations and impact. J Am Pharm Assoc (2003) 2021; 62:580-587.e1. [PMID: 34696978 DOI: 10.1016/j.japh.2021.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary care may offer innovations in delivering comprehensive medication reviews (CMRs). OBJECTIVES This study aimed to (1) describe innovations to improve delivery and impact of CMR, (2) quantify CMR completion rates and patient satisfaction, and (3) characterize medication changes and impact on medication costs. PRACTICE DESCRIPTION Board-certified ambulatory care pharmacists with collaborative practice agreements embedded in primary care provided CMRs in 5 clinics for eligible university prescription plan retirees. PRACTICE INNOVATION Innovations included (1) physician review of potential CMR recipient list, (2) use of trained student pharmacists to recruit and set up CMR visits, (3) use of clinical information in a standardized CMR 2-visit approach by embedded pharmacists, and (4) enrollment into disease management programs or referrals to other providers. EVALUATION METHODS Data from a retrospective cohort were collected. The CMR completion rate and therapeutic interventions were documented. Prescription fill data were available for 6 months before and after the CMR. An anonymous survey assessed patient satisfaction. Frequencies and descriptive statistics characterized completion rate, interventions, and patient satisfaction. The median cost to the plan of deleted versus added medications and per member per month total drug costs before and after the CMR were compared. RESULTS Among 729 beneficiaries screened, 489 were eligible and 223 (46%) received a CMR. There were 388 medication interventions: the most common intervention was to delete medications (41.0%). One in 4 was enrolled into the pharmacists' disease management programs. Individuals reported 4.68 (SD 0.67) of 5 for helpfulness of the CMR. The ratio of median costs for medication deletions versus additions was $1.46 vs. $1.00. CONCLUSION Innovations to deliver CMRs capitalized on well-established physician-pharmacist relationships and nonpharmacist personnel to recruit and prepare the intake. Almost half of eligible beneficiaries received a CMR, and the CMRs were impactful for patients and payers. The most prevalent intervention was to discontinue medications for efficacy reasons.
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10
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Dong X, Tsang CCS, Zhao S, Browning JA, Wan JY, Chisholm-Burns MA, Finch CK, Tsao JW, Hines LE, Wang J. Effects of the Medicare Part D comprehensive medication review on medication adherence among patients with Alzheimer's disease. Curr Med Res Opin 2021; 37:1581-1588. [PMID: 34039232 PMCID: PMC8419788 DOI: 10.1080/03007995.2021.1935224] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Older patients with Alzheimer's disease (AD) are challenged with adhering to complex medication regimens. We examined effects of Comprehensive Medication Review (CMR), a required Medicare Part D Medication Therapy Management (MTM) program component, on medication adherence among AD patients. METHODS This retrospective study analyzed 100% of 2016-2017 Medicare claims covering the entire United States, linked to Area Health Resources Files. Medicare beneficiaries aged ≥65 years were included. Propensity score matching identified comparable intervention and comparison groups with the intervention defined as receiving a CMR in 2017. A difference-in-differences analysis included in multivariate logistic regressions an interaction term between CMR receipt and year 2017. The outcome measured was nonadherence to diabetes, hypertension and hyperlipidemia medications, with nonadherence defined as proportion of days covered <80% for study medications. RESULTS Unadjusted comparisons indicated the proportion of nonadherence for intervention group members decreased from 2016 to 2017 but increased for the comparison group. In adjusted analyses, reduction in medication nonadherence among the intervention group remained higher: odds ratios for the interaction term were 0.62 (95% confidence interval [CI] = 0.54-0.71), 0.54 (95% CI = 0.50-0.58) and 0.50 (95% CI = 0.47-0.53) respectively for diabetes, hypertension and hyperlipidemia medications. This suggests that the likelihood of nonadherence in the intervention group was respectively reduced by 38%, 46% and 50% more than the comparison group. CONCLUSIONS CMR was found to reduce nonadherence to diabetes, hypertension and hyperlipidemia medications among older Medicare beneficiaries with AD. This provides evidence that the MTM program is effective for a population with unique medication compliance challenges.
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Affiliation(s)
- Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Shirong Zhao
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Jamie A. Browning
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Jim Y. Wan
- Department of Preventive Medicine, University of Tennessee College of Medicine, 66 N. Pauline, Memphis, TN 38163, United States
| | - Marie A. Chisholm-Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Christopher K. Finch
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Jack W. Tsao
- Department of Neurology, University of Tennessee Health Science Center & Children’s Foundation Research Institute, Le Bonheur Children’s Hospital, Memphis, TN 38163, United States
| | - Lisa E. Hines
- Pharmacy Quality Alliance, 5911 Kingstowne Village Parkway, Alexandria, VA 22315, United States
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
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11
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Dong X, Tsang CCS, Wan JY, Shih YCT, Chisholm-Burns MA, Dagogo-Jack S, Cushman WC, Hines LE, Wang J. Exploring racial and ethnic disparities in medication adherence among Medicare comprehensive medication review recipients. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3. [PMID: 35434697 PMCID: PMC9009823 DOI: 10.1016/j.rcsop.2021.100041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background There has been a lack of evidence on whether there are racial and ethnic disparities in medication nonadherence among individuals receiving comprehensive medication review (CMR), a required component of the Medicare Part D medication therapy management (MTM) services. Objectives To explore racial/ethnic disparities in medication nonadherence among older MTM enrollees who received a CMR and to determine how much the identified disparities can be explained by observed characteristics. Methods The retrospective study used 100% of the 2017 Medicare claims, including MTM data. Linked Area Health Resources Files provided community characteristics. Nonadherence was defined as proportion of days covered <80%, and was measured for diabetes, hypertension, and hyperlipidemia medications. Racial/ethnic disparities were examined by logistic regressions that included racial/ethnic minority dummy variables. A nonlinear Blinder-Oaxaca decomposition method was applied to decompose the identified disparities. Results Compared with non-Hispanic Whites (Whites), Blacks were respectively 39% (odds ratio [OR] = 1.39, 95% confidence interval [CI] = 1.33–1.45), 27% (OR = 1.27, 95% CI = 1.22–1.32), and 43% (OR = 1.43, 95% CI = 1.39–1.47) more likely to be nonadherent to diabetes, hypertension, and hyperlipidemia medications; Hispanics were 20% (OR = 1.20, 95% CI = 1.14–1.27) more likely to be nonadherent to hyperlipidemia medications. The total portion of disparity explained was 13.42%, 7.66%, 14.87%, and 10.69% respectively for disparities in Black-White (B–W) diabetes, B–W hypertension, B–W hyperlipidemia, and Hispanic-White hyperlipidemia. The top three contributors were the proportion of married-couple families, census region, and male gender. Conclusions A lower level of community affluence and social support, regional variations, and a lower proportion of males in Blacks and Hispanics may contribute to the disparities in medication nonadherence. The large unexplained portion of the disparity attests that nonadherence is a complex issue. The Medicare MTM program needs to implement measures to reduce disparities in medication adherence. This retrospective study used 100% of the 2017 Medicare claims including MTM data. Racial/ethnic disparity in medication adherence was identified among CMR recipients. Blacks were more likely than Whites to be nonadherent to all medications studied. Hispanics were more likely than Whites to be hyperlipidemia medication nonadherent. Observed characteristics explained close to 15% of the identified disparity.
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Affiliation(s)
- Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 214, Memphis, TN 38163, United States of America
| | - Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 212, Memphis, TN 38163, United States of America
| | - Jim Y. Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 N. Pauline, Suite 633, Memphis, TN 38163, United States of America
| | - Ya-Chen Tina Shih
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1444, Houston, TX 77030, United States of America
| | - Marie A. Chisholm-Burns
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 264, Memphis, TN 38163, United States of America
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes & Metabolism, Clinical Research Center, University of Tennessee Health Science Center College of Medicine, 920 Madison Avenue, Suite 300A, Memphis, TN 38163, United States of America
| | - William C. Cushman
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, 66 North Pauline Street, Suite 651, Memphis, TN 38163, United States of America
| | - Lisa E. Hines
- Pharmacy Quality Alliance, 5911 Kingstowne Village Parkway, Suite 130, Alexandria, VA 22315, United States of America
| | - Junling Wang
- Department of Clinical Pharmacy & Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 221, Memphis, TN 38163, United States of America
- Corresponding author.
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12
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Coe AB, Bynum JP, Farris KB. Comprehensive Medication Review: New Poll Indicates Interest but Low Receipt Among Older Adults. JAMA HEALTH FORUM 2020; 1:e201243. [DOI: 10.1001/jamahealthforum.2020.1243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Antoinette B. Coe
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor
| | - Julie P.W. Bynum
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Karen B. Farris
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor
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13
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Salgado TM, Rosenthal MM, Coe AB, Kaefer TN, Dixon DL, Farris KB. Primary healthcare policy and vision for community pharmacy and pharmacists in the United States. Pharm Pract (Granada) 2020; 18:2160. [PMID: 33029264 PMCID: PMC7523559 DOI: 10.18549/pharmpract.2020.3.2160] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The United States (US) has a complex healthcare system with a mix of public, private, nonprofit, and for-profit insurers, healthcare institutions and organizations, and providers. Unlike other developed countries, there is not a single payer healthcare system or a national pharmaceutical benefits scheme/plan. Despite spending over USD 10,000 per capita in healthcare, the US is among the worst performers compared to other developed countries in outcomes including life expectancy at birth, infant mortality, safety during childbirth, and unmanaged chronic conditions (e.g., asthma, diabetes). Primary care is delivered by physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) in a variety of settings including large health systems, federally qualified health centers or free clinics that provide care to the underserved, or specific facilities for veterans or American Indian and Alaska native peoples. Since 2010, primary care delivery has shifted toward providing patient-centered, coordinated, comprehensive care focused on providing proactive, rather than reactive, population health management, and on the quality, versus volume, of care. Community pharmacy comprises a mix of independently owned, chain, supermarket and mass merchant pharmacies. Community pharmacies provide services such as immunizations, medication therapy management, medication packaging, medication synchronization, point-of-care testing and, in specific states where legislation has been passed, hormonal contraception, opioid reversal agents, and smoking cessation services. There has been criticism regarding the lack of standard terminology for services such as medication synchronization and medication therapy management, their components and how they should be provided, which hampers comparability across studies. One of the main challenges for pharmacists in the US is the lack of provider status at the federal level. This means that pharmacists are not allowed to use existing fee-for-service health insurance billing codes to receive reimbursement for non-dispensing services. In addition, despite there being regulatory infrastructure in multiple states, the extent of service implementation is either low or unknown. Research found that pharmacists face numerous barriers when providing some of these services. State fragmentation and the lack of a single pharmacy organization and vision for the profession are additional challenges.
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Affiliation(s)
- Teresa M Salgado
- MPharm, PhD. Center for Pharmacy Practice Innovation, School of Pharmacy, Virginia Commonwealth University. Richmond, VA (United States).
| | - Meagen M Rosenthal
- PhD. Department of Pharmacy Administration, School of Pharmacy, University of Mississippi. Oxford, MS (United States).
| | - Antoinette B Coe
- PharmD, PhD. Department of Clinical Pharmacy, College of Pharmacy, University of Michigan. Ann Arbor, MI (United States).
| | - Tana N Kaefer
- PharmD. Director of Clinical Services, Bremo Pharmacy. Richmond, VA (United States).
| | - Dave L Dixon
- PharmD. Center for Pharmacy Practice Innovation, School of Pharmacy, Virginia Commonwealth University. Richmond, VA (United States).
| | - Karen B Farris
- PhD. Department of Clinical Pharmacy, College of Pharmacy, University of Michigan. Ann Arbor, MI (United States).
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14
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Ferreri SP, Hughes TD, Snyder ME. Medication Therapy Management: Current Challenges. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2020; 9:71-81. [PMID: 32309200 PMCID: PMC7136570 DOI: 10.2147/iprp.s179628] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/10/2020] [Indexed: 11/23/2022] Open
Abstract
Medication therapy management (MTM) services have evolved as a means for pharmacists and other providers to assist patients and caregivers in improving therapeutic outcomes and reducing health care expenditures. More than a decade has passed since the Medicare Modernization Act of 2003 provided pharmacists with the opportunity to deliver MTM services to Medicare beneficiaries. MTM continues to offer pharmacists the opportunity to use their knowledge; yet, pharmacists have reported challenges with service delivery. Identifying the challenges that affect MTM services in pharmacy practice is necessary in order to seek improvement to MTM delivery. This narrative review explores the current challenges pharmacists face with MTM delivery, summarizes potential solutions for addressing challenges, and seeks to incite further debate, service reconfiguration, and ultimately service improvement of pharmacist-provided MTM services.
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Affiliation(s)
- Stefanie P Ferreri
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7574, USA
| | - Tamera D Hughes
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7574, USA
| | - Margie E Snyder
- College of Pharmacy, Purdue University, Indianapolis, IN 46202, USA
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