ADOPTION OF THE NOVA SCOTIA (CANADA) COMMUNITY PHARMACY MEDICATION MANAGEMENT PROGRAM, 1-YEAR POST-INITIATION
Main Article Content
Keywords
medication management review, pharmacy reimbursement, medication therapy management, pharmacy services
Abstract
Background
Pharmacists conduct medication reviews to optimize drug therapy. Each jurisdiction implements and funds these programs differently.
Methods
This retrospective analysis included 294 pharmacies and 105,000 beneficiaries enrolled in the Nova Scotia Seniors’ Pharmacare Program. Prescription and service claims data from this program were analyzed to determine type and number of beneficiaries receiving a medication review, number and predictors of pharmacies completing reviews, and number of prescribed medications 6-months before and 6-months after the review.
Results
428 medication reviews were conducted and billed by 33% of Nova Scotia pharmacies (1–50 reviews per pharmacy per year). The mean number and range of medications before the review were 10.8 (4-28) and following the review 10.4 (0–24), with an average decrease of 0.4 medications (95% CI 0.1–0.6), p 5 .0043). Patients receiving a review had a mean age of 75.2 years; 64.9% were female. Most pharmacies conducted reviews when patients reached their annual copayment (93%).
Conclusions
Approximately 33% of pharmacies billed at least one medication review in the first year of the program. In spite of a $150 reimbursement per community pharmacy medication review, only 428 reviews were conducted over a 13-month period for a population of over 100,000 seniors.
Results suggest financial reimbursement alone is not sufficient to implement a medication management program; health systems need to determine patient, pharmacist, pharmacy and health system level strategies to implement medication reviews more broadly.
References
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6. Cherubini A, Corsonello A, Lattanzio F. Underprescription of beneficial medicines in older people: causes, consequences and prevention. Drugs Aging 2012;29(6):463-75.
7. Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med 2010;170(18):1648-54.
8. Gurwitz JH, Rochon P. Improving the quality of medication use in elderly patients. Arch Intern Med 2002;162:1670-3.
9. Spinewine A, Schmader KE, Barber N, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 2007 Jul 14;370(9582):173-184.
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11. Goulding MR. Inappropriate medication prescribing for elderly ambulatory care patients. Arch Intern Med 2004 Feb 9;164(3):305-312.
12. Gallagher P, Barry P, O’Mahony D D. Inappropriate prescribing in the elderly. J Clin Pharm Ther 2007;32(2):113-21.
13. Hamilton H, Gallagher P, O’Mahoney D. Inappropriate prescribing and adverse drug events in older people. BMC Geriatr 2009;9:5.
14. Canadian Institute for Health Information. Seniors and the health care system: What is the impact of multiple chronic conditions? (January 2011) https://secure. cihi.ca/free_products/air-chronic_disease_aib_en.pdf (accessed Mar 11, 2016).
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16. R. Christie. Does Continuity of Community Pharmacy Care Influence Adherence to Statins? Dalhousie University, Halifax, Nova Scotia; 2013.
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19. Sketris IS, Langille Ingram EM, Lummis HL. Strategic opportunities for effective optimal prescribing and medication management. Can J Clin Pharmacol 2009 Winter;16(1):e103-25.
20. Tannenbaum C, Tsuyuki RT. The expanding scope of pharmacists’ practice: implications for physicians. CMAJ 2013 Oct 1;185(14):1228-1232.
21. Blalock SJ, Roberts AW, Lauffenburger JC, Thompson T, O’Connor SK. The effect of community pharmacy-based interventions on patient health outcomes: a systematic review. Med Care Res Rev 2013 Jun;70(3):235-266.
22. White CM. Pharmacists need recognition as providers to enhance patient care. Ann Pharmacother 2014 Feb;48(2):268-273.
23. Amara S, Adamson RT, Lew I, Slonim A. Accountable care organizations: impact on pharmacy. Hosp Pharm 2014 Mar;49(3):253-259.
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27. Chisholm-Burns MA, Kim Lee J, Spivey CA, Slack M, Herrier RN, Hall-Lipsy E. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Med Care 2010 Oct;48(10):923-933.
28. Castelino RL, Bajorek BV, Chen T. Targeting suboptimal prescribing in the elderly: a review of the impact of pharmacy services. Ann Pharmacother 2009 Jun;43(6):1096-1106.
29. Makowsky M, Koshman S, Midodzi W, Tsuyuki R. Capturing outcomes of clinical activities performed by a rounding pharmacist practicing in a team environment: the COLLABORATE study [NCT00351676]. Med Care 2009;47(6):642.
30. Ellitt GR, Brien JA, Aslani P, Chen TF. Quality patient care and pharmacists’ role in its continuity--a systematic review. Ann Pharmacother 2009 Apr;43(4):677-691.
31. Mossialos E, Naci H, Courtin E. Expanding the role of community pharmacists: policymaking in the absence of policy-relevant evidence? Health Policy 2013 Jul;111(2):135-148.
32. Holland R, Desborough J, Goodyer L, Hall S, Wright D, Loke Y. Does pharmacist-led medication review help to reduce hospital admissions and deaths in older people? A systematic review and meta-analysis. Br J Clin Pharmacol 2008;65(3):303.
33. Lewin Group. Medication therapy management services: a critical review. J Am Pharm Assoc (2003) 2005 Sep-Oct;45(5):580-587.
34. Pellegrino AN, Martin MT, Tilton JJ, Touchette DR. Medication therapy management services: definitions and outcomes. Drugs 2009;69(4):393-406.
35. Davis RG, Hepfinger CA, Sauer KA, Wilhardt MS. Retrospective evaluation of medication appropriateness and clinical pharmacist drug therapy recommendations for home-based primary care veterans. Am J Geriatr Pharmacother 2007 Mar;5(1):40-47.
36. Moczygemba LR, Barner JC, Roberson K. Texas pharmacists’ opinions about and plans for provision of medication therapy management services. J Am Pharm Assoc (2003) 2008 Jan-Feb;48(1):38-45.
37. Truong HA, Layson-Wolf C, de Bittner MR, Owen JA, Haupt S. Perceptions of patients on Medicare Part D medication therapy management services. J Am Pharm Assoc (2003) 2009 May-Jun;49(3):392-398.
38. Barnett MJ, Frank J, Wehring H, Newland B, et al. Analysis of pharmacist-provided medication therapy management (MTM) services in community pharmacies over 7 years. J Manag Care Pharm 2009 Jan-Feb;15(1):18-31.
39. Choe H, Farris K, Stevenson J, Townsend K, et al. Patient-centered medical home: developing, expanding, and sustaining a role for pharmacists. Am J Health- Sys Pharm 2012;69(12):1063-71.
40. Smith M, Cannon Breland M, Spiggle S. Consumer, physician, and payer perspectives on primary care medication management services with a shared resource pharmacists network. Res Social Adm Pharm 2014;10(3):539-53.
41. Smith S, Cell P, Anderson L, Larson T. Minnesota Department of Human Services audit of medication therapy management programs. J Am Pharm Assoc (2003) 2013;53(3):248-53.
42. de Oliveira R, Brummel AR, Miller DB. Medication therapy management: 10 years of experience in a large integrated health care system. Journal of Managed Care Pharmacy 2010;16(3):185-195.
43. General Pharmaceutical Council. Home Page. (2016) http://www.pharmacyregulation.org/ (accessed Mar 11, 2016).
44. Tinelli M, Bond C, Blenkinsopp A, et al. Patient evaluation of a community pharmacy medications management service. Ann Pharmacother 2007 Dec;41(12):1962-1970.
45. Australian Government: Department of Health. Medication Management Reviews: Information on the medication management reviews available for patients in the community or in an aged care facility, on referral from a GP. (2014) http://www. health.gov.au/internet/main/publishing.nsf/Content /medication_management_reviews.htm (accessed Mar 11, 2016).
46. Castelino RL, Hilmer SN, Bajorek BV, Nishtala P, Chen TF. Drug Burden Index and potentially inappropriate medications in community-dwelling older people: the impact of Home Medicines Review. Drugs Aging 2010 Feb 1;27(2):135-148.
47. Castelino RL, Bajorek BV, Chen TF. Retrospective evaluation of home medicines review by pharmacists in older Australian patients using the medication appropriateness index. Ann Pharmacother 2010 Dec;44(12):1922-1929.
48. Castelino RL, Bajorek BV, Chen TF. Are interventions recommended by pharmacists during Home Medicines Review evidence-based? J Eval Clin Pract 2011 Feb;17(1):104-110.
49. Roughead EE, Barratt JD, Ramsay E, et al. The effectiveness of collaborative medicine reviews in delaying time to next hospitalization for patients with heart failure in the practice setting: results of a cohort study. Circ Heart Fail 2009 Sep;2(5):424-428.
50. Canadian Pharmacist Association. Blueprint for pharmacy: Canadian pharmacy services framework. (2011) http://blueprintforpharmacy.ca/docs/pdfs/cpsf-framework -deck_cpha-cacds_oct-2011_final-for-distribution.pdf (accessed Mar 11, 2016).
51. Canadian Pharmacists Association (CPhA). Blueprint for Pharmacy: The Vision for Pharmacy. 2008.
52. Nova Scotia Department of Health. Pharmacare Pharmacists’ Bulletins 8-04. (2008) http://www.gov.ns.ca /health/Pharmacare/info_pro/pharmacists_bulletins /pharmacists_bulletins.asp (accessed 08/26, 2010).
53. Peterson JC, Rogers EM, Cunningham-Sabo L, Davis SM. A framework for research utilization applied to 7 case studies. Am J Prev Med 2007 Jul;33(1 Suppl):S21-34.
54. Groves KE, Schellinck T, Sketris I, MacKinnon NJ. Identifying early prescribers of cycloxygenase-2 inhibitors (COX-2s) in Nova Scotia, Canada: Considerations for targeted academic detailing. Research in Social Administration Pharmacy 2010;6(3):257-267.
55. Petty DR, Zermansky AG, Raynor DK, Lowe CJ, Freemantle N, Vail A. Clinical medication review by a pharmacist of elderly patients on repeat medications in general practice - pharmacist interventions and review outcomes. The International Journal of Pharmacy Practice 2002;10:39-45.
56. Niquille A, Lattmann C, Bugnon O. Medication reviews led by community pharmacists in Switzerland: a qualitative survey to evaluate barriers and facilitators. Pharmacy Practice 2010;8(1):35-42.
57. Michaels NM, Jenkins GF, Pruss DL, Heidrick JE, Ferreri SP. Retrospective analysis of community pharmacists’ recommendations in the North Carolina Medicaid medication therapy management program. J Am Pharm Assoc 2010;50:347-353.
58. Larson S, Drake S, Anderson L, Larson T. Adoption of medication therapy management programs in Minnesota: 2006-11. J Am Pharm Assoc (2003) 2013;53(3):254-60.
59. Lenaghan E, Holland R, Brooks A. Home-based medica - tion review in a high risk elderly population in primary care--the POLYMED randomized controlled trial. Age Ageing 2007 May;36(3):292-297.
60. Woelfel JA, Carr-Lopez SM, Delos Santos M, et al. Assessing Medicare beneficiaries’ willingness-to-pay for medication therapy management services. Consult Pharm 2014 Feb;29(2):104-109.
61. Kulchaitanaroaj P, Brooks JM, Ardery G, Newman D, Carter BL. Incremental costs associated with physician and pharmacist collaboration to improve blood pressure control. Pharmacotherapy 2012 Aug;32(8):772-780.
2. Wu C, Bell C, Wodchis W. Incidence and economic burden of adverse drug reactions among elderly patients in Ontario emergency departments: a retrospective study. Drug Safety 2012;35(9):769-81.
3. Tangiisuran B, Wright J, Van der Cammen T, Rajkumar C. Adverse drug reactions in elderly: challenges in identification and improving preventative strategies. Age Ageing 2009;38(4):358-9.
4. Routledge PA, O’Mahony MS, Woodhouse KW. Adverse drug reactions in elderly patients. British Journal of Clinical Pharmacology 2004;57(2):121-126.
5. Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 2011 Nov 24;365(21):2002-2012.
6. Cherubini A, Corsonello A, Lattanzio F. Underprescription of beneficial medicines in older people: causes, consequences and prevention. Drugs Aging 2012;29(6):463-75.
7. Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med 2010;170(18):1648-54.
8. Gurwitz JH, Rochon P. Improving the quality of medication use in elderly patients. Arch Intern Med 2002;162:1670-3.
9. Spinewine A, Schmader KE, Barber N, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 2007 Jul 14;370(9582):173-184.
10. Spinewine A, Dumont C, Mallet L, Swine C. Medication Appropriateness Index: reliability and recommendations for future use. J Am Geriatr Soc 2006 04;54(4):720-722.
11. Goulding MR. Inappropriate medication prescribing for elderly ambulatory care patients. Arch Intern Med 2004 Feb 9;164(3):305-312.
12. Gallagher P, Barry P, O’Mahony D D. Inappropriate prescribing in the elderly. J Clin Pharm Ther 2007;32(2):113-21.
13. Hamilton H, Gallagher P, O’Mahoney D. Inappropriate prescribing and adverse drug events in older people. BMC Geriatr 2009;9:5.
14. Canadian Institute for Health Information. Seniors and the health care system: What is the impact of multiple chronic conditions? (January 2011) https://secure. cihi.ca/free_products/air-chronic_disease_aib_en.pdf (accessed Mar 11, 2016).
15. Terner M.B., Reason B, McKeag AM, Tipper B, Webster G. Chronic conditions more than age drive health system use in Canadian seniors. Healthcare Quarterly 2011;14(3):19-22.
16. R. Christie. Does Continuity of Community Pharmacy Care Influence Adherence to Statins? Dalhousie University, Halifax, Nova Scotia; 2013.
17. Tamblyn R, Poissant L, Huang A, et al. Do too many cooks spoil the broth? Multiple physician involvement in medical management of elderly patients and potentially inappropriate drug combinations. CMAJ 1996 Apr 15;154(8):1177-1184.
18. Green J, Hawley JN, Rask KJ. Is the number of prescribing physicians an independent risk factor for adverse drug events in an elderly outpatient population? Am J Geriatr Pharmacother 2007;5(1):31-9.
19. Sketris IS, Langille Ingram EM, Lummis HL. Strategic opportunities for effective optimal prescribing and medication management. Can J Clin Pharmacol 2009 Winter;16(1):e103-25.
20. Tannenbaum C, Tsuyuki RT. The expanding scope of pharmacists’ practice: implications for physicians. CMAJ 2013 Oct 1;185(14):1228-1232.
21. Blalock SJ, Roberts AW, Lauffenburger JC, Thompson T, O’Connor SK. The effect of community pharmacy-based interventions on patient health outcomes: a systematic review. Med Care Res Rev 2013 Jun;70(3):235-266.
22. White CM. Pharmacists need recognition as providers to enhance patient care. Ann Pharmacother 2014 Feb;48(2):268-273.
23. Amara S, Adamson RT, Lew I, Slonim A. Accountable care organizations: impact on pharmacy. Hosp Pharm 2014 Mar;49(3):253-259.
24. Geurts MM, Talsma J, Brouwers JR, de Gier JJ. Medication review and reconciliation with cooperation between pharmacist and general practitioner and the benefit for the patient: a systematic review. Br J Clin Pharmacol 2012 Jul;74(1):16-33.
25. Nkansah N, Mostovetsky O, Yu C, Chheng T, Beney J, Bond CM. Effect of outpatient pharmacists’ non-dispensing roles on patient outcomes and prescribing patterns. Cochrane Database Syst Rev 2010 Jul 7;(7):CD000336. doi(7):CD000336.
26. Richardson E, Pollock AM. Community pharmacy: moving from dispensing to diagnosis and treatment. BMJ 2010 May 11;340:c2298.
27. Chisholm-Burns MA, Kim Lee J, Spivey CA, Slack M, Herrier RN, Hall-Lipsy E. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Med Care 2010 Oct;48(10):923-933.
28. Castelino RL, Bajorek BV, Chen T. Targeting suboptimal prescribing in the elderly: a review of the impact of pharmacy services. Ann Pharmacother 2009 Jun;43(6):1096-1106.
29. Makowsky M, Koshman S, Midodzi W, Tsuyuki R. Capturing outcomes of clinical activities performed by a rounding pharmacist practicing in a team environment: the COLLABORATE study [NCT00351676]. Med Care 2009;47(6):642.
30. Ellitt GR, Brien JA, Aslani P, Chen TF. Quality patient care and pharmacists’ role in its continuity--a systematic review. Ann Pharmacother 2009 Apr;43(4):677-691.
31. Mossialos E, Naci H, Courtin E. Expanding the role of community pharmacists: policymaking in the absence of policy-relevant evidence? Health Policy 2013 Jul;111(2):135-148.
32. Holland R, Desborough J, Goodyer L, Hall S, Wright D, Loke Y. Does pharmacist-led medication review help to reduce hospital admissions and deaths in older people? A systematic review and meta-analysis. Br J Clin Pharmacol 2008;65(3):303.
33. Lewin Group. Medication therapy management services: a critical review. J Am Pharm Assoc (2003) 2005 Sep-Oct;45(5):580-587.
34. Pellegrino AN, Martin MT, Tilton JJ, Touchette DR. Medication therapy management services: definitions and outcomes. Drugs 2009;69(4):393-406.
35. Davis RG, Hepfinger CA, Sauer KA, Wilhardt MS. Retrospective evaluation of medication appropriateness and clinical pharmacist drug therapy recommendations for home-based primary care veterans. Am J Geriatr Pharmacother 2007 Mar;5(1):40-47.
36. Moczygemba LR, Barner JC, Roberson K. Texas pharmacists’ opinions about and plans for provision of medication therapy management services. J Am Pharm Assoc (2003) 2008 Jan-Feb;48(1):38-45.
37. Truong HA, Layson-Wolf C, de Bittner MR, Owen JA, Haupt S. Perceptions of patients on Medicare Part D medication therapy management services. J Am Pharm Assoc (2003) 2009 May-Jun;49(3):392-398.
38. Barnett MJ, Frank J, Wehring H, Newland B, et al. Analysis of pharmacist-provided medication therapy management (MTM) services in community pharmacies over 7 years. J Manag Care Pharm 2009 Jan-Feb;15(1):18-31.
39. Choe H, Farris K, Stevenson J, Townsend K, et al. Patient-centered medical home: developing, expanding, and sustaining a role for pharmacists. Am J Health- Sys Pharm 2012;69(12):1063-71.
40. Smith M, Cannon Breland M, Spiggle S. Consumer, physician, and payer perspectives on primary care medication management services with a shared resource pharmacists network. Res Social Adm Pharm 2014;10(3):539-53.
41. Smith S, Cell P, Anderson L, Larson T. Minnesota Department of Human Services audit of medication therapy management programs. J Am Pharm Assoc (2003) 2013;53(3):248-53.
42. de Oliveira R, Brummel AR, Miller DB. Medication therapy management: 10 years of experience in a large integrated health care system. Journal of Managed Care Pharmacy 2010;16(3):185-195.
43. General Pharmaceutical Council. Home Page. (2016) http://www.pharmacyregulation.org/ (accessed Mar 11, 2016).
44. Tinelli M, Bond C, Blenkinsopp A, et al. Patient evaluation of a community pharmacy medications management service. Ann Pharmacother 2007 Dec;41(12):1962-1970.
45. Australian Government: Department of Health. Medication Management Reviews: Information on the medication management reviews available for patients in the community or in an aged care facility, on referral from a GP. (2014) http://www. health.gov.au/internet/main/publishing.nsf/Content /medication_management_reviews.htm (accessed Mar 11, 2016).
46. Castelino RL, Hilmer SN, Bajorek BV, Nishtala P, Chen TF. Drug Burden Index and potentially inappropriate medications in community-dwelling older people: the impact of Home Medicines Review. Drugs Aging 2010 Feb 1;27(2):135-148.
47. Castelino RL, Bajorek BV, Chen TF. Retrospective evaluation of home medicines review by pharmacists in older Australian patients using the medication appropriateness index. Ann Pharmacother 2010 Dec;44(12):1922-1929.
48. Castelino RL, Bajorek BV, Chen TF. Are interventions recommended by pharmacists during Home Medicines Review evidence-based? J Eval Clin Pract 2011 Feb;17(1):104-110.
49. Roughead EE, Barratt JD, Ramsay E, et al. The effectiveness of collaborative medicine reviews in delaying time to next hospitalization for patients with heart failure in the practice setting: results of a cohort study. Circ Heart Fail 2009 Sep;2(5):424-428.
50. Canadian Pharmacist Association. Blueprint for pharmacy: Canadian pharmacy services framework. (2011) http://blueprintforpharmacy.ca/docs/pdfs/cpsf-framework -deck_cpha-cacds_oct-2011_final-for-distribution.pdf (accessed Mar 11, 2016).
51. Canadian Pharmacists Association (CPhA). Blueprint for Pharmacy: The Vision for Pharmacy. 2008.
52. Nova Scotia Department of Health. Pharmacare Pharmacists’ Bulletins 8-04. (2008) http://www.gov.ns.ca /health/Pharmacare/info_pro/pharmacists_bulletins /pharmacists_bulletins.asp (accessed 08/26, 2010).
53. Peterson JC, Rogers EM, Cunningham-Sabo L, Davis SM. A framework for research utilization applied to 7 case studies. Am J Prev Med 2007 Jul;33(1 Suppl):S21-34.
54. Groves KE, Schellinck T, Sketris I, MacKinnon NJ. Identifying early prescribers of cycloxygenase-2 inhibitors (COX-2s) in Nova Scotia, Canada: Considerations for targeted academic detailing. Research in Social Administration Pharmacy 2010;6(3):257-267.
55. Petty DR, Zermansky AG, Raynor DK, Lowe CJ, Freemantle N, Vail A. Clinical medication review by a pharmacist of elderly patients on repeat medications in general practice - pharmacist interventions and review outcomes. The International Journal of Pharmacy Practice 2002;10:39-45.
56. Niquille A, Lattmann C, Bugnon O. Medication reviews led by community pharmacists in Switzerland: a qualitative survey to evaluate barriers and facilitators. Pharmacy Practice 2010;8(1):35-42.
57. Michaels NM, Jenkins GF, Pruss DL, Heidrick JE, Ferreri SP. Retrospective analysis of community pharmacists’ recommendations in the North Carolina Medicaid medication therapy management program. J Am Pharm Assoc 2010;50:347-353.
58. Larson S, Drake S, Anderson L, Larson T. Adoption of medication therapy management programs in Minnesota: 2006-11. J Am Pharm Assoc (2003) 2013;53(3):254-60.
59. Lenaghan E, Holland R, Brooks A. Home-based medica - tion review in a high risk elderly population in primary care--the POLYMED randomized controlled trial. Age Ageing 2007 May;36(3):292-297.
60. Woelfel JA, Carr-Lopez SM, Delos Santos M, et al. Assessing Medicare beneficiaries’ willingness-to-pay for medication therapy management services. Consult Pharm 2014 Feb;29(2):104-109.
61. Kulchaitanaroaj P, Brooks JM, Ardery G, Newman D, Carter BL. Incremental costs associated with physician and pharmacist collaboration to improve blood pressure control. Pharmacotherapy 2012 Aug;32(8):772-780.