CONTACT: DAVE PEDERSEN
Iowa City IA 52242
(319) 335-8032; fax (319) 384-4638
Release: Jan. 21, 2003
UI researchers evaluate program to improve medication safety
team-approach used by community pharmacists and physicians taking part in
a state program designed to improve medication safety for Medicaid-eligible
patients can be effective, according to University of Iowa researchers who
evaluated the program.
Researchers from the UI Colleges of Public Health and Pharmacy evaluated
the Iowa Medicaid Pharmaceutical Case Management (PCM) program, established
with an appropriation by the Iowa Legislature in 2000 and part of the Iowa
Department of Human Services.
The program is based on the concept of pharmaceutical care, where pharmacists
take an active, even proactive, role in the drug regimens of patients
communicating with physicians and identifying potential problems with drug
interaction and drug duplication. By working together, doctors and pharmacists
find the best combination of drugs and doses for Medicaid patients, especially
those with multiple diseases.
"This model of care has proven to be very effective in hospital and
clinic settings, where pharmacists and physicians are under the same roof
and have the same access to a patient's medical record," said Elizabeth
Chrischilles, Ph.D., professor of epidemiology in the UI College of Public
Health. "The Iowa Medicaid PCM program, however, looked to deliver this
care in a community setting, without the benefit of shared locations or shared
access to patient records."
The program is available to Medicaid-eligible Iowans who are taking at least
four medications and have at least one of 12 specific diseases. Participating
pharmacists (those who are certified in pharmaceutical care or have a doctor
of pharmacy degree) perform an initial assessment for their eligible patients'
drug regimens. The pharmacist identifies any potential or existing problems
and makes a recommendation to the patient's physician, who assesses and then
accepts, rejects or modifies a recommendation. The pharmacist makes follow-up
assessments, communicating to the physician each time. Once problems are resolved,
preventive follow-up assessments occur every six months.
Both pharmacists and physicians can be reimbursed through Medicaid for the
care they provide.
UI researchers collected data on the program, analyzing pharmacist and patient
questionnaires and evaluating Medicaid claims for reimbursement. They also
studied the pharmacists' patient records to measure the medication appropriateness
and change over time.
The researchers' findings included:
Medicaid patients eligible for the PCM program are at a very high
risk for problems with medications. As many as 30 percent of the patients
self-reported an adverse drug reaction in the previous year, which was three
times the rate found in a separate group of elderly Iowans not on Medicaid.
Approximately 35 percent of the PCM-eligible patients had drug-drug interactions.
Moreover, among those patients age 60 and older, approximately 75 percent
had a drug-drug interaction.
A total of 117 pharmacies around the state participated in the program.
Of more than 3,000 patients eligible in the first year of the program, pharmacists
met with 943 and sent recommendations to doctors for 500 of these patients.
The most common recommendation made by pharmacists was to start a new medication
(52 percent of patients). Pharmacists recommended a change in medication 36
percent of the time, indicating a better therapy might be available. Pharmacists
also recommended discontinuation of medications 33 percent of the time.
The PCM program improved medication safety and did not measurably
affect Medicaid expenditures. Medicaid paid a total of $94,170 for PCM services
through May 31, 2002. Even after including the amount paid for PCM services,
there was no net increase in health care utilization or charges among patients
who received PCM services compared to those eligible who did not receive the
The UI researchers reported that the PCM program could be even more effective
with additional training to pharmacists and physicians and increased awareness
about the program.
"Pharmacists were given some training on this program before it started,
while physicians were not," Chrischilles said. "So some physicians
did not know that they could be reimbursed for these types of services. The
onus was really on the pharmacists to inform their patients' physicians about
Unlike doctors' offices, pharmacies lack support staff to gather medical
records, schedule patients and keep records. Thus, pharmacists had to do this
work themselves in addition to their other responsibilities, which meant that
the level of participation among pharmacists varied, Chrischilles noted.
"Our study showed that this program did appear to improve medication
safety, so as the program develops it has the potential to benefit a greater
number of patients, " she said. "Fostering the pharmacist-physician
team approach through additional training and dialogue was part of our recommendations
for the program."
The PCM program was implemented by the legislature as a state plan amendment,
meaning that the program is continuing and is available to all eligible Medicaid
recipients. The Iowa Pharmacy Association and the federal Centers for Medicare/Medicaid
Services funded the UI evaluation of the program.