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Hung A, Wilson LE, Smith VA, Pavon JM, Sloan CE, Hastings SN, Maciejewski ML. Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries. J Am Geriatr Soc 2024; 72:2347-2358. [PMID: 38826070 PMCID: PMC11323205 DOI: 10.1111/jgs.19013] [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: 11/06/2023] [Revised: 03/12/2024] [Accepted: 05/04/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND The use of potentially inappropriate medications (PIMs) is associated with increased risk of hospitalizations and emergency room visits and varies by racial and ethnic subgroups. Medicare's nationwide medication therapy management (MTM) program requires that Part D plans offer an annual comprehensive medication review (CMR) to all beneficiaries who qualify, and provides a platform to reduce PIM use. The objective of this study was to assess the impact of CMR on PIM discontinuation in Medicare beneficiaries and whether this differed by race or ethnicity. METHODS Retrospective cohort study of community-dwelling Medicare Part D beneficiaries ≥66 years of age who were eligible for MTM from 2013 to 2019 based on 5% Medicare fee-for-service claims data linked to the 100% MTM data file. Among those using a PIM, MTM-eligible CMR recipients were matched to non-recipients via sequential stratification. The probability of PIM discontinuation was estimated using regression models that pooled yearly subcohorts accounting for within-beneficiary correlations. The most common PIMs that were discontinued after CMR were reported. RESULTS We matched 24,368 CMR recipients to 24,368 CMR non-recipients during the observation period. Median age was 74-75, 35% were males, most were White beneficiaries (86%-87%), and the median number of PIMs was 1. In adjusted analyses, CMR receipt was positively associated with PIM discontinuation (adjusted relative risk [aRR]: 1.26, 95% CI: 1.20-1.32). There was no evidence of differential impact of CMR by race or ethnicity. The PIMs most commonly discontinued after CMR were glimepiride, zolpidem, digoxin, amitriptyline, and nitrofurantoin. CONCLUSIONS Among Medicare beneficiaries who are using a PIM, CMR receipt was associated with PIM discontinuation, suggesting that greater CMR use could facilitate PIM reduction for all racial and ethnic groups.
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Affiliation(s)
- Anna Hung
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- Duke-Margolis Center for Health Policy, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC
| | - Lauren E. Wilson
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Valerie A. Smith
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Juliessa M. Pavon
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC
- Center for the Study of Aging and Human Development, Duke University, Durham, NC
- Geriatrics Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, NC
| | - Caroline E. Sloan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- Duke-Margolis Center for Health Policy, Durham, NC
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Susan N. Hastings
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC
- Center for the Study of Aging and Human Development, Duke University, Durham, NC
- Geriatrics Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, NC
| | - Matthew L. Maciejewski
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- Duke-Margolis Center for Health Policy, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
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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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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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Garuccio J, Tsang CCS, Wan JY, Shih YCT, Chisholm-Burns MA, Dagogo-Jack S, Cushman WC, Dong X, Browning JA, Zeng R, Wang J. Racial and ethnic disparities in the enrolment of medicare medication therapy management programs. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2023; 14:188-197. [PMID: 37337596 PMCID: PMC10276885 DOI: 10.1093/jphsr/rmad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 02/14/2023] [Indexed: 10/25/2023]
Abstract
Objectives Racial/ethnic disparities have been found in prior literature examining enrolment in Medicare medication therapy management programs. However, those studies were based on various eligibility scenarios because enrolment data were unavailable. This study tested for potential disparities in enrolment using actual MTM enrolment data. Methods Medicare Parts A&B claims, Medication Therapy Management Data Files, and the Area Health Resources File from 2013 to 2014 and 2016 to 2017 were analysed in this retrospective analysis. An adjusted logistic regression compared odds of enrolment between racial/ethnic minorities and non-Hispanic Whites (Whites) in the total sample and subpopulations with diabetes, hypertension, or hyperlipidaemia. Trends in disparities were analysed by including interaction terms in regressions between dummy variables for race/ethnic minority groups and period 2016-2017. Key Findings Disparities in MTM enrolment were detected between Blacks and Whites with diabetes in 2013-2014 (Odds Ratio = 0.78, 95% Confidence Interval = 0.75-0.81). This disparity improved from 2013-2014 to 2016-2017 for Blacks (Odds Ratio=1.08, 95% Confidence Interval = 1.04-1.11) but persisted in 2016-2017 (Odds Ratio = 0.84, 95% Confidence Interval = 0.81-0.87). A disparity was identified between Blacks and Whites with hypertension in 2013-2014 (Odds Ratio = 0.92, 95% Confidence Interval = 0.89-0.95) but not in 2016-2017. Enrolment for all groups, however, declined between periods. For example, in the total sample, the odds of enrolment declined from 2013-2014 to 2016-2017 by 22% (Odds Ratio=0.78, 95% Confidence Interval=0.75-0.81). Conclusions Racial disparities in MTM enrolment were found between Blacks and Whites among Medicare beneficiaries with diabetes in both periods and among individuals with hypertension in 2013-2014. As overall enrolment fell between periods, concerns about program enrolment remain.
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Affiliation(s)
- Joseph Garuccio
- Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, USA
| | - 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, USA
| | - Jim Y Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, USA
| | - Ya Chen Tina Shih
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, USA
- Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center, USA
| | | | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes & Metabolism, USA
- Clinical Research Center, University of Tennessee College of Medicine, USA
| | - William C Cushman
- Department of Preventive Medicine, University of Tennessee College of Medicine, USA
| | - Xiaobei Dong
- Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, USA
| | - Jamie A Browning
- Health Outcomes and Policy Research, Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, USA
| | - Rose Zeng
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, USA
| | - Junling Wang
- Department of Clinical Pharmacy & Translational Science, University of Tennessee Health Science Center College of Pharmacy, USA
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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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Waghmare PH, Huang CY, Jaynes HA, Green WM, Snyder ME, Adeoye-Olatunde OA, Coe AB, Farley JF, Zillich AJ. Disparities in Medicare beneficiaries' receiving medication synchronization. J Am Pharm Assoc (2003) 2023; 63:538-546.e2. [PMID: 36463009 DOI: 10.1016/j.japh.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/21/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Medication synchronization (med-sync) aligns patients' monthly or quarterly chronic medications to a predetermined single pickup date at a community pharmacy. The study objective was to examine med-sync enrollment disparities based on Medicare beneficiaries' predisposing, enabling, and need characteristics. METHODS This was a retrospective cohort study using a Medicare dataset of beneficiaries receiving medications from pharmacies that self-identified as providing med-sync. Medicare beneficiaries who were continuously enrolled in fee-for-service medical and pharmacy benefits during the study period (2014-2016) were included. Study cohorts (med-sync and non-med-sync patients) were defined, and bivariate and multivariable logistic regression analyses were performed. Andersen's Health Services Utilization Model guided our inclusion of predisposing, enabling, and need characteristics to examine for association with med-sync enrollment. RESULTS A total of 170,180 beneficiaries were included, of which 13,193 comprised the med-sync cohort and 156,987 comprised the non-med-sync cohort. Bivariate logistic regression analysis revealed statistically significant differences (P < 0.05) in cohorts based on age, geographic region, type of residence, number of unique chronic medications, comorbidities, outpatient visits, and inpatient hospitalizations. Beneficiaries had higher odds of being enrolled in med-sync with increasing age (adjusted odds ratio [AOR] 1.003 [95% CI 1.001-1.005]) and if they resided in the Northeast (AOR 1.094 [95% CI 1.018-1.175]), South (AOR 1.109 [95% CI 1.035-1.188]), and West (AOR 1.113 [95% CI 1.020-1.215]) than those in the Midwest. Beneficiaries residing in nonmetro areas had lower odds of enrollment (AOR 0.914 [95% CI 0.863-0.969]) than those in metro areas. Beneficiaries with previous fewer inpatient hospitalizations (AOR 0.945 [95% CI 0.914-0.977]) were more likely to be enrolled, and those with more outpatient visits (AOR 1.003 [95% CI 1.001-1.004]) were more likely to be enrolled. Those taking a higher number of oral chronic medications (AOR 1.005 [95% CI 1.002-1.008]) had greater odds of enrollment in med-sync. CONCLUSIONS Med-sync program expansion opportunities exist to address potential enrollment disparities based on age, geographic region, metropolitan area, and prior health utilization. Further studies are needed to develop and examine strategies among pharmacies to improve med-sync enrollment outreach to these subgroups of patients.
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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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Browning JA, Tsang CCS, Zeng R, Dong X, Garuccio J, Wan JY, Chisholm-Burns MA, Finch CK, Tsao JW, Wang J. Racial/ethnic disparities in the enrollment of Medication Therapy Management programs among Medicare beneficiaries with Alzheimer's disease and related dementias. Curr Med Res Opin 2022; 38:1715-1725. [PMID: 35852087 PMCID: PMC9529863 DOI: 10.1080/03007995.2022.2103962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Previous analysis of policy scenarios reported potential disparities in eligibility in the Medicare Medication Therapy Management (MTM) program. With recently released MTM data, this study aimed to determine if racial/ethnic disparities exist in MTM enrollment among Medicare beneficiaries with Alzheimer's disease and related dementias (ADRD). METHODS Medicare claims/records (from 2013-2014 and 2016-2017) linked to the Area Health Resources File were examined. Included individuals were patients with ADRD and diabetes, hypertension or hyperlipidemia. The proportions of MTM enrollment were compared between non-Hispanic White (White) patients and racial/ethnic minority groups in descriptive analysis. Racial/ethnic disparities were then examined using a logistic regression adjusting for patient and community characteristics. Disparities across study periods were compared by estimating a logistic regression model with interaction terms between dummy variables for each racial/ethnic minority group and 2016-2017. RESULTS In unadjusted analyses, minorities had higher enrollment proportions than Whites. In 2016-2017, for example, enrollment percentages for Whites, Blacks, Hispanics, Asian/Pacific Islanders (Asians) and Others were respectively 14.44%, 16.71%, 19.83%, 16.66%, and 17.78%. In adjusted analyses, Blacks had lower enrollment odds than Whites within all cohorts. In the entire study sample in 2016-2017, for example, Blacks with ADRD had 9% lower odds of MTM enrollment (odds ratio 0.91, 95% confidence interval [CI] = 0.86-0.97) than Whites. These disparities decreased over time among the ADRD sample and all sub-groups. The interaction term between Blacks and 2016-2017, for instance, indicated that disparities were lowered by 11% (odds ratio 1.11, 95% CI = 1.05-1.16) across study periods among those with ADRD. CONCLUSIONS Blacks with ADRD, and diabetes, hypertension or hyperlipidemia have lower likelihood of MTM enrollment than Whites. Racial disparities were reduced over time but not eliminated.
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Affiliation(s)
- 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, United States
| | - 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, United States
| | - Rose Zeng
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Xiaobei Dong
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Joseph Garuccio
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - Jim Y. Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center 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 Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
| | - 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, 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
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163, United States
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Lee M, Zarowitz BJ, Pellegrin K, Cooke CE, Fleming SP, Brandt N. Social determinants predict whether medicare beneficiaries are offered a Comprehensive Medication review. Res Social Adm Pharm 2022; 19:184-188. [DOI: 10.1016/j.sapharm.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022]
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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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Dong X, Tsang CCS, Zhao S, Wan JY, Shih YCT, Chisholm-Burns MA, Dagogo-Jack S, Cushman WC, Hines LE, Wang J. Effects of the Medicare Part D Comprehensive Medication Review on Racial and Ethnic Disparities in Medication Adherence. AMERICAN HEALTH & DRUG BENEFITS 2021; 14:101-109. [PMID: 35261713 PMCID: PMC8845523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/30/2021] [Indexed: 06/14/2023]
Abstract
Background Substantial research has documented inequalities between US minorities and whites in meeting the eligibility criteria for the Medicare Part D medication therapy management (MTM) program. Even though the Centers for Medicare & Medicaid Services attempted to relax the eligibility criteria, a critical barrier to effective MTM reform is a lack of stronger evidence about the effects of MTM on minorities' health outcomes. Objective To examine the effects of comprehensive medication review (CMR), an MTM core component, on racial and ethnic disparities in adherence to diabetes, hypertension, and hyperlipidemia medications among Medicare beneficiaries aged ≥65 years. Methods This study used full-year 2017 Medicare Parts A, B, and D claims data, including MTM data, linked to the Area Health Resources Files. Racial and ethnic disparities in nonadherence to diabetes, hypertension, and hyperlipidemia medications were compared between CMR recipients and nonrecipients matched by their propensity scores. To determine the changes in racial and ethnic disparities after receiving CMR, a difference-in-differences framework was applied, by including in logistic regression analyses interaction terms between dummy variables for CMR receipt and each racial or ethnic minority group. Results Compared with CMR nonrecipients, CMR recipients had significantly lower racial and ethnic disparities across the 3 outcome measures, with the exception of the difference between whites and blacks in nonadherence to diabetes medications. For example, compared with CMR nonrecipients, among CMR recipients the differences in the odds of nonadherence to hypertension medications were reduced, respectively, by 8% (95% confidence interval [CI], 0.88-0.96) between whites and blacks; by 18% (95% CI, 0.78-0.86) between whites and Hispanics; by 16% (95% CI, 0.77-0.91) between whites and Asians; and by 9% (95% CI, 0.85-0.98) between whites and other racial and ethnic groups. Conclusion Receiving a CMR reduced the racial and ethnic disparities in adherence to diabetes, hypertension, and hyperlipidemia medications among Medicare beneficiaries aged ≥65 years. These findings provide critical empirical evidence that may inform the future design of the Medicare Part D MTM program, which is valuable for improving pharmacotherapy outcomes and could further realize its potential when additional people from racial and ethnic minorities are enrolled.
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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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14
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Adeoye-Olatunde OA, Lake LM, Strohmier CA, Gourley AK, Ray AR, Zillich AJ, Snyder ME. Positive deviants for medication therapy management: A mixed-methods comparative case study of community pharmacy practices. Res Social Adm Pharm 2021; 17:1407-1419. [PMID: 33214124 PMCID: PMC8079557 DOI: 10.1016/j.sapharm.2020.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND To optimize medication use in older adults, the Centers for Medicare & Medicaid Services (CMS) launched Medication Therapy Management (MTM) services as part of Medicare Part D policy; however, strategies for achieving high quality MTM outcomes are not well understood. OBJECTIVE The objective of this study was to generate hypotheses for strategies contributing to community pharmacies' high performance on policy-relevant MTM quality measures. METHODS This mixed-methods comparative case study was guided by the Positive Deviance approach and Chronic Care Model. The study population consisted of pharmacy staff employed by a Midwestern division of a national supermarket-community pharmacy chain. Data consisted of demographics and qualitative data from semi-structured interviews. Qualitative and quantitative data were analyzed deductively and inductively or using descriptive statistics, respectively. MTM quality measures used to evaluate participant pharmacies' MTM performance mirrored select 2017 Medicare Part D Plans' Star Rating measures. RESULTS Thirteen of 18 selected case pharmacies (72.2%) participated in this study, of which 5 were categorized as high performers, 4 moderate performers, and 4 low performers. Eleven pharmacists, 11 technicians, and 3 student interns participated in interviews. Eight strategies were hypothesized as contributing to MTM performance: Strong pharmacy staff-provider relationships and trust, Inability to address patients' social determinants of health (negatively contributing), Technician involvement in MTM, Providing comprehensive medication reviews in person vs. phone alone, Placing high priority on MTM, Using available clinical information systems to identify eligible patients, Technicians using clinical information systems to collect/document information for pharmacists, Faxing prescribers adherence medication therapy problems (MTPs) and calling on indication MTPs. CONCLUSIONS Eight strategies were hypothesized as contributing to community pharmacies' performance on MTM quality measures. Findings from this work can inform MTM practice and Medicare Part D MTM policy changes to positively influence patient outcomes. Future research should test hypotheses in a larger representative sample of pharmacies.
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Affiliation(s)
- Omolola A Adeoye-Olatunde
- Department of Pharmacy Practice, Purdue University College of Pharmacy, 640 Eskenazi Avenue, Indianapolis, IN, 46202, USA.
| | - Leslie M Lake
- Kroger Health Central Division, 5960 Castleway West Dr Indianapolis, IN, 46250, USA.
| | - Celena A Strohmier
- Kroger Health Central Division, 5960 Castleway West Dr Indianapolis, IN, 46250, USA; Department of Pharmacy Practice, Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN, 47907, USA.
| | - Amanda K Gourley
- Department of Pharmacy Practice, Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN, 47907, USA; CVS Target Channel District 4, 3601 N Barr St Muncie, IN 47303, USA.
| | - Ashli R Ray
- Union Hospital, 1606 N 7th St, Terre Haute, IN, 47804, USA.
| | - Alan J Zillich
- Department of Pharmacy Practice, Purdue University College of Pharmacy, 640 Eskenazi Avenue, Indianapolis, IN, 46202, USA.
| | - Margie E Snyder
- Department of Pharmacy Practice, Purdue University College of Pharmacy, 640 Eskenazi Avenue, Indianapolis, IN, 46202, USA.
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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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Chou J, Pellegrin K, Cooke CE, Zarowitz B, Hanlon A, Lozano A, Brandt NJ. Understanding the Socioeconomic and Geographical Characteristics of Beneficiaries Receiving a Comprehensive Medication Review. J Manag Care Spec Pharm 2020; 26:1276-1281. [PMID: 32996388 PMCID: PMC10391206 DOI: 10.18553/jmcp.2020.26.10.1276] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Medicare Part D sponsors are required to offer medication therapy management (MTM) programs to eligible beneficiaries. Recent studies have demonstrated that there have been racial/ethnic disparities in MTM eligibility criteria. For example, compared with non-Hispanic White beneficiaries, Hispanic and non-Hispanic Black beneficiaries are less likely to be eligible for MTM. However, there is limited evidence for socioeconomic and geographical characteristics of those who are eligible and receive MTM services. OBJECTIVE To describe the demographic, socioeconomic, and geographic characteristics of Medicare beneficiaries who received MTM services. METHODS As part of a previous study, a national survey evaluated a convenience sample of perspectives of Medicare beneficiaries on the MTM standardized format. The survey was distributed through Medicare Part D plans to beneficiaries receiving MTM services from 2017-2018. As part of the survey, respondents could provide their ZIP codes. Geographical variables, such as the National Center for Health Statistics (NCHS) urban-rural classification scheme and economic research service (ERS) county typology codes, were then applied to respondents' ZIP codes, allowing for the classification of counties or census tracts by urbanization and economic dependence measures. Descriptive statistics are reported for demographic, geographical, and socioeconomic information. RESULTS Of the 300 (of 434) respondents who provided their ZIP codes, 51.3% were aged 65-74 years; 50% were male; and 66.7% had at least a college education. There were 82.7% who self-identified as White, while only 8% self-identified as Hispanic or Black/African American. The majority of respondents (58.4%) lived in large metropolitan areas as defined by the NCHS urban-rural classification scheme. Respondents' counties were characterized by economic dependence with 14.0% of respondents living in federal/state government-dependent counties and 12.7% living in recreation-dependent counties. CONCLUSIONS The majority of respondents who provided their ZIP codes identified themselves as White and lived in large metropolitan areas. Respondents who identified themselves as Hispanic or Black/African American were not well represented. This study provides geographical and socioeconomic characteristics of Medicare beneficiaries who received MTM services and highlights racial/ethnic differences. Further work is needed to confirm geographical and socioeconomic disparities among beneficiaries who received MTM services. DISCLOSURES No outside funding supported this study. Pellegrin is a member of the AMCP MTM Advisory Group. The other authors have nothing to disclose.
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Affiliation(s)
- Joshua Chou
- University of Maryland School of Pharmacy, Baltimore
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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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