What types of nursing facilities are more likely to adopt a pharmacist's medication review recommendations?

BACKGROUND: Few studies in the literature have analyzed the determinants of pharmacist drug therapy recommendations in nursing facility settings, and those that have focus primarily on accepted/rejected recommendations by disease state. OBJECTIVE: To identify the set of nursing facility characteristics that are more likely to adopt a pharmacist's medication review recommendations. DESIGN: Cross-sectional, retrospective methods are used to examine 53 licensed nursing facilities receiving medication review services from a small independent consultant pharmacist practice with no ties to vendor pharmacy functions. SETTING: Nursing facilities in rural areas of central and western Minnesota in 2008. INTERVENTION: Medication review services. MAIN OUTCOME MEASURES: The number of recommendations made and accepted, which are aggregated to the level of the nursing facility. Poisson regression analysis is used to identify those nursing facility characteristics that predict total recommendations and total accepted recommendations. Data obtained from Medicare's Web site on each nursing facility's operating characteristics and quality indicators serve as covariates. RESULTS: At the 5% level, patient census (positively), greater certified nursing assistant staffing hours (positively), multisite facilities (positively), resident residency councils (negatively), and greater perceptions of registered nurse quality (negatively) predict a greater number of recommendations. Patient census (positively), greater licensed practical nurse staffing (negatively), having residency councils (negatively), and greater perceptions of registered nurse quality (negatively) significantly predict the number of accepted and implemented recommendations. CONCLUSION: Institutional specific factors, most notably, quality-of-care indicators, may affect a nursing facility's acceptance of a pharmacist's drug therapy review.

Preliminary evaluation of medication therapy management services in assisted living facilities in rural Minnesota.

OBJECTIVES: While pharmacists are providing medication therapy management (MTM) services, few programs have been assessed for outcomes, particularly those in rural areas. The objectives are to: 1) categorize the number and type of drug-therapy problems (DTPs) that were identified by consultant pharmacists in assisted living facilities, 2) assess resident and administrator satisfaction of consultant pharmacist MTM services, and 3) assess the direct costs of providing MTM services and make some preliminary inferences about the program's economic viability. DESIGN: We conducted a cross-sectional, pilot study at 14 assisted living facilities over a 12-month period. SETTING: 14 rural assisted living facilities. PATIENTS: Assisted living facility residents. INTERVENTION: MTM visits were performed by a consultant pharmacist based on the MTM model developed by the American Pharmacists Association. MAIN OUTCOME MEASURES: Patient satisfaction, clinical (DTPs), and economic costs. RESULTS: 130 residents were enrolled with a mean age of 86 years, with 77.7% female. Residents were taking an average of 13 medications (range = 1-29), including prescription and nonprescription drugs. Common medical conditions were hypertension (80.0%), hyperlipidemia (37.7%), and diabetes (20.8%). Residents had an average of 9 comorbidities (range = 2-16) and 304 DTPs (mean 2.3 per resident). Residents reported high mean satisfaction levels with the pharmacist and the services provided. Direct costs of the intervention were $20,372.96, which suggests that only modest gains in overall patient health (or a few major avoided adverse events) caused by the intervention are necessary to ensure the program's economic viability. CONCLUSION: Through the use of MTM programs to resolve medication problems, pharmacists can improve patient satisfaction with care among assisted living facility residents.