Pharmacist impact on high risk medication use and adherence in a senior health center

Introduction: Medicare Advantage plans are now reimbursing physicians based on quality metrics including avoidance of high risk medications (HRMs) and non-adherence. Currently, there are no studies showing pharmacist impact on HRM prescribing and patient adherence rates and their resulting effect on star ratings.

Objectives: The objective of this study is to reduce the number of senior health center patients 65 years and older flagged by Medicare Advantage plans contracted with a not-for-profit health care system as having HRMs or non-adherence to prescribed medications for diabetes (excluding insulins), cholesterol, and blood pressure.

Study Design: This prospective study has been approved by the Western Institutional Review Board. The study will seek to review approximately 100 patients. Patients must be 65 years or older and have a primary care physician within the senior health center.

Methods: The patients will be identified and reported by contracted Medicare Advantage plans as having medication issues related to high risk of side effects or adherence. Recommendations for alternative medications will be made via the electronic medical record and face-to-face communication with providers. Adherence issues will be addressed by face-to-face interaction with the patient or via phone call to the patient and/or patient’s pharmacy. Information involving medications continued, discontinued, switched to alternative therapy, or documented inaccurately after pharmacist intervention will be collected.  Additionally, physician HRM prescribing rates and star ratings for payer’s reporting will be collected.

Results: Preliminary results show 36 patients on high risk medications in the senior health center and approximately 225 patients with adherence issues. With recent IRB approval, interventions and recommendations have commenced.

Conclusions: Estimated completion date of the study protocol will be April 2016.