Individualized Medication Assessment and Planning: Optimizing Medication Use in Older Adults in the Primary Care Setting. Issue 8 (30th May 2013)

• Record Type: Journal Article
• Authors: Roth, Mary T.; Ivey, Jena L.; Esserman, Denise A.; Crisp, Ginny; Kurz, James; Weinberger, Morris
• Is Part Of: Pharmacotherapy. Volume 33:Issue 8(2013)
• Page Start: 787
• Page End: 797
• Publication Date: 2013-05-30
• Subjects: Chemotherapy -- Periodicals; Pharmacology -- Periodicals; Drug Therapy -- Periodicals; Pharmacology -- Periodicals; 615.1
• DOI: 10.1002/phar.1274
• Languages: English
• ISSNs: 0277-0008

Abstract

<abstract abstract-type="main" id="phar1274-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="phar1274-sec-0001" sec-type="section"> <title>Study Objective</title> <p>To test the feasibility and effectiveness of an <italic>individualized</italic> Medication Assessment and Planning (<italic>i</italic>MAP) program integrated within a primary care practice on the number and prevalence of medication‐related problems (MRPs) and acute health services utilization, defined as combined hospitalizations and emergency department visits.</p> </sec> <sec id="phar1274-sec-0002" sec-type="section"> <title>Design</title> <p>Six‐month, prospective, observational pilot study.</p> </sec> <sec id="phar1274-sec-0003" sec-type="section"> <title>Setting</title> <p>Community‐based primary care medical practice.</p> </sec> <sec id="phar1274-sec-0004" sec-type="section"> <title>Patients</title> <p>Convenience sample of 64 patients aged 65 years and older who were taking at least five medications.</p> </sec> <sec id="phar1274-sec-0005" sec-type="section"> <title>Intervention</title> <p>Each patient was enrolled in the <italic>i</italic>MAP program—a collaborative, multifaceted intervention facilitated by a clinical pharmacist whereby patients receive comprehensive medication therapy management at baseline and 3 and 6 months as part of routine clinical care.</p> </sec> <sec id="phar1274-sec-0006" sec-type="section"> <title>Measurements and Main Results</title> <p>MRPs were assessed and recommendations proposed using the previously published MRP classification tool; physician acceptance of recommendations served to validate the assessments. There was a significant reduction in mean number of MRPs/patient (4.2 at baseline vs 1.0 at 6 mo, p<0.0001) when adjusted for number of medications, race, and pharmacist. The prevalence of MRPs at 6 months compared with baseline was also significant (p<0.0008). Acute health services utilization was assessed by medical record abstraction. The 64 patients experienced a rate of 8.3 events/100 person‐months (64 total events) during the 12‐month prestudy period. During the 6‐month study period, the same patients experienced 5.4 events/100 person‐months (20 total events). Thus, we noted a reduction in acute health services utilization of 35%. Physicians were enthusiastically supportive of <italic>i</italic>MAP.</p> </sec> <sec id="phar1274-sec-0007" sec-type="section"> <title>Conclusion</title> <p> <italic>i</italic>MAP has the potential to address a significant and timely issue affecting older adults and primary care practices: the burden of managing and continuously monitoring multiple medications in medically complex older adults. A more rigorous evaluation of <italic>i</italic>MAP is warranted and planned to demonstrate sustained effectiveness and cost‐benefit.</p> </sec> </abstract>