Drug Topics - May 19, 2008 - (Page 4) 4 DRUG TOPICS MAY 19, 2008 www.drugtopics.com Of Interest to Pharmacists Pharmacists key to medication therapy management success Fred Gebhart harmacist involvement can significantly boost the impact of medication therapy management under Medicare Part D, according to some preliminary data presented at the Academy of Managed Care Pharmacy Annual Meeting & Showcase, held recently in San Francisco. Researchers from Aetna revealed company data, which showed that pharmacist involvement in MTM improved patient outcomes and lowered the total cost of care. The Aetna study followed approximately 2,400 patients in 2007 who were identified by a drug-based algorithm as prime candidates for an adverse drug event. The control group was a similar set of patients that a prior algorithm identified as not being at higher risk for an ADE. The study will continue through 2008. Pharmacists made a ª Any pharmacist intervention in MTM real difference in made a difference in terms of the number reducing adverse of adverse events we saw,º Linda Bagget, drug events, says Linda Bagget. Aetna pharmacotherapy specialist, Medicare, told AMCP attendees. Data for the first eight months showed a 15% drop in adverse drug events associated with asthma, renal disease, myocardial infarction, bleeding, stroke, depression, and diabetes. Cost avoidance ranged from $476 to $2,506 per patient per year, added Aetna pharmacotherapy specialist Kimberly Vernachio. The lower figure is associated with a ª low-touchº intervention, a letter to alert the prescriber to a potential ADE that posed little immediate danger. The higher figure comes from ª high-touchº interventions where a pharmacist telephoned the prescriber to warn of an immediate risk, such as prescribing a quinolone to a patient currently taking warfarin. Phone calls were followed with a letter outlining the potential conflict in more detail. ª We would love to have a fleet of pharmacists to make every intervention high touch,º Vernachio said. ª But that cuts into the cost effectiveness of the program.º Aetna' s current MTM program bears little relationship to the MTM program it first offered in 2006. ª We built our program as we went along and learned,º Bagget said. ª I don' t know too many people who knew what they were doing when Part D began.º P MTM confusion One problem is a confusion between MTM programs and MTM services, noted Marissa Schlaifer, director of pharmacy affairs for the Academy of Managed Care Pharmacy. She defined MTM programs as the overall methods used by health plans to optimize therapeutic outcomes. MTM services are the components of MTM programs that are delivered by pharmacists and other healthcare professionals. AMCP joined with the American Pharmacists Association, the American Society of Consultant Pharmacists, and other groups to create a consensus document to define the elements of a sound MTM program. Program elements that emerged included a patient-centered approach, interdisciplinary teams, a combination of population and individual patient perspectives, flexibility, and evidence-based medicine. Operational aspects included full documentation and measurement, quality assurance, services tailored for different settings and cultural expectations, and coordination of care. Focusing on polypharmacy Focusing on polypharmacy produced no changes in ADE rates, Bagget said. Analysis showed that the number of unique drugs alone did not predict an opportunity for meaningful intervention. The MTM team went back to the literature and Aetna' s own claims data. It turned out that a third of hospital admissions among older members could be traced to drug-related problems with warfarin, digoxin, or insulin. In long-term care, nine of the 10 most-dangerous drug interactions involve the same three agents. Theophylline-quinolone interactions are in 10th place. Aetna found that patients under the age of 60 were just as likely to suffer drug-drug interactions as patients over the age of 80. The plan rewrote its MTM screening algorithm to focus on drug-drug interactions, Vernachio said. It was that drug-drug focus that improved patient outcomes and avoided costs. ª A pharmacist and pharmacy-based program is critical to the success of MTM,º she said. Pharmacy has the broad perspective to identify drug-drug interactions across multiple providers. And pharmacists have the training and skills to identify potential problems quickly and stratify risk factors efficiently." Photo: Fred Gebhart http://www.drugtopics.com
Table of Contents Feed for the Digital Edition of Drug Topics - May 19, 2008 Drug Topics - May 19, 2008 Contents How Drug Plans Can Survive Their Part D Audit Pharmacists Key to Medication Therapy Management Success Latest News Roundup Drug Topics - May 19, 2008 Drug Topics - May 19, 2008 - Contents (Page 1) Drug Topics - May 19, 2008 - Contents (Page 2) Drug Topics - May 19, 2008 - How Drug Plans Can Survive Their Part D Audit (Page 3) Drug Topics - May 19, 2008 - Pharmacists Key to Medication Therapy Management Success (Page 4) Drug Topics - May 19, 2008 - Latest News Roundup (Page 5) Drug Topics - May 19, 2008 - Latest News Roundup (Page 6)
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