CMSA Today - Issue 1, 2015 - (Page 13)

Population Health Medication Management in the Community Improving Medication Management in Acute and Community-Based Care BY H. EDWARD DAVIDSON, PHARMD, MPH, AND LISA F. HAN, MPH M edication use is common in the U.S. among older individuals. The number of medications is often related to the burden of comorbid illness, and it is common for an older person to take 10 or more medications. Unfortunately, this high volume of medication use increases the risk for poor outcomes, including adverse drug events and hospitalization.1 A 2006 study published in the New England Journal of Medicine looked at emergency department (ED) visits and hospitalization, and found that individuals over age 65 were 2.4 times more likely to be admitted to the ED and hospital than younger adults.2 As you can imagine, there are a number of factors contributing to adverse drugs events, including use of multiple medications, improper use, inadequate monitoring, and drug-drug and drug-supplement interactions. There is a growing interest in improving patient understanding of health-related information, including knowledge of their medications. Patients are usually uninformed about the medications they take. In one study, only 27 percent of patients could list their medications and only 37.2 percent could cite the reason they were taking them.3 Health care providers are often surprised to see adverse drugs events in their patients, and often realize many are avoidable. A number of recent studies have identified transitions of care as a contributing factor to adverse drug events.4-6 There is great interest in improving medication management in acute and community-based care. A recent study sought to determine the effectiveness and harms of outpatient-based medication therapy management compared with usual care.7 The investigators conducted a meta-analysis of studies looking at MTM interventions that included a comprehensive medication review, patient-directed education, care coordination, and opportunity for follow-up in an ambulatory setting. Two trained research team members reviewed each of the articles and abstracted them into structured evidence tables. The studies were rated on a number of factors like adequacy of randomization, group similarity at baseline, attrition, outcome assessment, and bias risk. The authors included six studies for quantitative synthesis of systematic review out of 419 full-text articles assessed for eligibility, though 44 studies were included in qualitative synthesis of systematic review. Articles were excluded for a variety of reasons such as ineligible intervention, outcomes, or settings. All of the studies used pharmacists to deliver MTM services, but the interventions varied considerably across the studies. Thirty-four of the studies were not focused on any particular patient population or chronic illness, while 10 were narrowly focused on specific conditions such as heart failure or hemodialysis. The interventions were provided in multiple settings: community pharmacies, centralized pharmacies, pharmacy call centers, outpatient medical clinics, and patients' homes. MTM inventions significantly improved medication appropriateness based on a validated 10-item medication appropriateness index, but sufficient evidence was lacking to draw any conclusions about anticoagulation, blood pressure, A1C, and low density lipoprotein (LDL) cholesterol outcomes, as the studies were not designed to address the effect of MTM on meeting therapy goals. Additionally, the study showed that medication adherence also improved following MTM interventions, as measured by the percentage of prescribed dose taken or the percentage of patients achieving a threshold adherence level, but was considered a low strength of evidence for this outcome. There was insufficient evidence to suggest that MTM increases health-related quality of life, effects on adverse events, gastrointestinal bleeding, mortality, and cognitive function. No studies evaluated the effect of MTM on activities of daily living, absenteeism, or participation in medical care or decision making. Continued on page 14 Issue 1 * 2015 * DIGITAL CMSA TODAY 13

Table of Contents for the Digital Edition of CMSA Today - Issue 1, 2015

Medication and Treatment Adherence: Why Is It So Complicated?
Association News
CMSA Corporate Partners
Medication Management in the Community
Remove From Foil Before Use
Index of Advertisers

CMSA Today - Issue 1, 2015