Comparison of Medication Therapy Management Services and Their Effects on Health Care Utilization and Medication Adherence.

BACKGROUND: Medication therapy management (MTM) programs are designed to improve clinical outcomes and enhance appropriate medication use. Comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) are 2 broad interventions defined within MTM services. While MTM services have been extensively researched, there are few comparisons of CMR versus non-CMR interventions. Given the variability in MTM interventions and lack of a consistent TMR definition in the literature, this study sought to compare CMRs and TMRs that were clearly defined based on Centers for Medicare & Medicaid Services (CMS) criteria. OBJECTIVES: To (a) compare acute inpatient admissions and emergency department (ED) visits between patients participating in MTM services (CMR, TMR, or both) and eligible nonparticipating patients and (b) examine the effect of receiving TMR services on medication adherence. METHODS: This was a retrospective cohort study of patients with Medicare Part D coverage who received MTM services and a 1:1 propensity score-matched control group. Participants had to be eligible for MTM services in 2014 or 2015 based on CMS requirements. CMRs were offered to all MTM-eligible patients, while TMRs were completed based on clinical rules that helped identify medication-related problems (MRPs). The date of MTM intervention, or eligibility for the control group, was considered the index date. Participants had to be continuously enrolled in a Medicare Advantage plan that included prescription drug coverage during the study period and have at least 6 months of data before and after the index date. Medical and pharmacy claims were assessed to examine trend-adjusted inpatient admissions and ED visits from pre-index to post-index date for participants and matched controls. RESULTS: In 2014 and 2015, receipt of TMR interventions was associated with statistically significant reductions in acute inpatient admissions. In 2014, there were 55.2 fewer admits per 1,000 individuals (95% CI = 29-81) and 30.8 fewer admits per 1,000 individuals in 2015 (95% CI = 20-42). Receipt of CMR-only interventions was associated with fewer acute inpatient admissions only when coupled with preidentification of MRPs (36.8 [95% CI = 25-49] fewer admits per 1,000 individuals). In 2015, there were significant reductions in ED visits for participants receiving TMR-only interventions or TMR/CMR interventions (26.1 [95% CI = 11-41] and 12.0 [95% CI = 1-23] fewer ED visits per 1,000 individuals, respectively). In both years, a larger percentage (0.4% for oral diabetes medications; 7.7% for antihypertensives; 3.0% for statins) of MTM participants had greater improvements in medication adherence in the post-index period compared with controls. CONCLUSIONS: Receiving MTM services targeted at resolution of MRPs (TMR or CMR/TMR) resulted in positive reductions in health care utilization and increases in medication adherence. Given the importance of optimal medication utilization, this study highlights the need for additional focus on resolution of MRPs through TMRs and CMRs that can support improved clinical outcomes. DISCLOSURES: No outside funding supported this study. Researchers completed the work as part of their employment with Humana. All authors are or were employees of Humana at the time of the study. There are no other conflicts of interest to disclose. This study was previously presented at AMCP Nexus 2017 on October 16, 2017, in Dallas, TX.

Diabetes care practice patterns of recent pharmacy graduates.

PURPOSE: The objective of this project was to determine the amount and type of clinical skills and diabetes education provided by recent pharmacy school graduates. METHODS: Six hundred and one graduates were e-mailed a link to an online survey. Subjects were asked to report how frequently they either educate patients on diabetes self-care activities or perform diabetes-related patient care skills and to rate their ability to do so as poor, fair, good, or excellent. RESULTS: Data from 155 (25.8%) respondents were analyzed. The most commonly reported clinical activity was changing medication, followed by interpreting blood glucose patterns, medication management therapy, and interpreting laboratory results. Subjects reported educating patients more on the signs and symptoms of hypoglycemia, blood glucose monitoring, and diet information relative to other topics. The majority of subjects rated their skills as good or excellent. CONCLUSION: Pharmacists reported the most commonly performed diabetes-related clinical skill was changing medication and they most often educate patients about hypoglycemia and blood glucose monitoring. Subjects, who rated themselves poor/fair in these skills, preferred active learning strategies to enhance their ability.

Current and Future Use of HEOR Data in Healthcare Decision-Making in the United States and in Emerging Markets.

BACKGROUND: Health economics and outcomes research (HEOR) is a growing field that provides important information for making healthcare coverage and access decisions. However, there is no standard process for incorporating HEOR into the decision-making process, and the current use of HEOR by healthcare payers remains unknown. OBJECTIVES: To examine how HEOR data are being used by healthcare payers, including managed care organizations today, and how the use of such data is expected to change in the future in relation to access and reimbursement decision-making. METHODS: The Managed Care Survey (MCS) and the Pharmacy & Therapeutics (P&T) Committee Survey (PTS) were distributed to decision makers in the United States. A total of 72 managed care decision makers responded to the MCS and 30 P&T Committee members responded to the PTS from US healthcare organizations that cover from tens of thousands to millions of lives. The goal of these surveys was to understand the current use of HEOR data, perceived barriers and limitations in the use of HEOR, and the expectations for future use, and how these and other factors affect formulary decisions. An international perspective was gained by modifying the MCS based on feedback received at a European conference, and a pilot version was given to individuals in emerging markets across Asia, Latin America, and the Middle East and Africa. RESULTS: The majority of US respondents to the MCS (74%; N = 53) and to the PTS (77%; N = 23) indicate that HEOR is currently being used in their decision-making process; but the majority of respondents to the MCS (66%; N = 48) also state that quality assessment is limited (quality assessment was not addressed in the PTS). In addition, the majority of respondents to the MCS (82%; N = 59) expect the use of HEOR to increase in the future. Safety and efficacy were reported in the PTS to be the most important factors in the P&T Committee decision-making process, followed by head-to-head comparisons, and cost. The current use of HEOR in Asia, Latin America, and the Middle East and Africa varied widely across respondents. CONCLUSION: This study provides an important benchmark of HEOR use in the United States before the implementation of healthcare reform. Between the years 2010 and 2011, HEOR data were used to varying extents across global regions, but their use in the future is likely to increase in relation to access and reimbursement decisions.

The impact of diabetes concentration programs on pharmacy graduates' provision of diabetes care services.

OBJECTIVE: To determine practice outcomes associated with doctor of pharmacy (PharmD) graduates from 2 universities who completed a diabetes-concentration. METHODS: An online survey instrument was sent to 93 PharmD graduates who completed a concentration in diabetes and 94 control graduates to determine their knowledge of and skills in providing diabetes care and how frequently they provided diabetes care services. RESULTS: Ninety-seven graduates (52%) responded. Significantly more graduates with a diabetes concentration rated their ability to instruct patients on insulin administration, blood glucose monitoring, foot care, and insulin dose adjustment as good or excellent compared to a control group of graduates. Graduates with a diabetes concentration also rated their ability to perform blood glucose monitoring and foot examinations higher than graduates without a diabetes concentration (P < 0.05). CONCLUSION: Completing a diabetes concentration increased graduates' knowledge of diabetes and confidence in their ability to provide care but did not appear to alter their practice patterns significantly. Further study is needed to determine whether other barriers to pharmacists providing diabetes care exist in practice settings.

Measuring Depression in African American Cancer Survivors: The Reliability and Validity of the Center for Epidemiologic Study--Depression (CES-D) Scale.

The Center for Epidemiologic Study-Depression (CES-D) Scale has been used to assess levels of depressive symptomatology in cancer survivors but has not been validated in African American cancer survivors. The current study assessed the reliability and validity of the CES-D in 216 African American cancer survivors. A Cronbach alpha was calculated to determine internal consistency reliability, and correlations were computed between the CES-D and other measure of mood states (Profile of Mood States-Short Form and Bradburn Positive and Negative Affect Scales) to assess concurrent validity. The CES-D demonstrated acceptable internal consistency (= .90), and the concurrent validity was supported by significant correlations with other measures of mood states. These analyses indicate that the CES-D is a reliable and valid measure for use with African American cancer survivors. The mean CES-D score (M = 15.7, SD = 11.89) further suggests that this sample of African American cancer survivors exhibit significant levels of depressive symptomatology.