Hypertension-Focused Medication Therapy Management: A Collaborative Pilot Program Uniting Pharmacists, Public Health, and Health Insurers in Wisconsin.

Heart disease and stroke are leading causes of death and disability in the United States, and high blood pressure is a major risk factor for both. Community pharmacists are readily positioned to improve cardiovascular health through services such as medication therapy management and self-management education. In 2018, the Pharmacy Society of Wisconsin, the Wisconsin Division of Public Health, and NeuGen, a not-for-profit health insurer, piloted a pharmacist-led medication therapy management program for people with hypertension in partnership with 8 community pharmacies. We evaluated changes in use of blood pressure self-management tools and barriers to antihypertensive medication adherence before and after medication therapy management services. Participant satisfaction was also assessed for the 59 participants at the end of the program. We observed improvements in self-reported use of self-management tools, reductions in medication adherence barriers, and high satisfaction with pharmacist care. This collaborative pilot resulted in sustainable reimbursement for participating pharmacies delivering medication therapy management services to eligible NeuGen members.

Screening for adverse drug events in older adults: the impact of interventions.

OBJECTIVE: Primary, to evaluate the usefulness of a comprehensive medication review (CMR) process in screening for adverse drug event (ADE) risk and to measure the impact of pharmacist recommendations; secondary, to evaluate whether screening tools assist in detecting ADEs. DESIGN: Nonrandomized, prospective pre/post pilot study. SETTING: Wisconsin-based community pharmacy affiliated with a two-campus retirement facility serving independently living older adults. PARTICIPANTS: Sixty-nine older adults responded to the initial call for participation in the ADE screening (mean age 84 years, mean daily medications: 13.7). Thirty-nine older adults (mean age 86 years, mean daily medications: 13.8) participated in both pre/post pilot study phases. INTERVENTION: Each participant received a CMR, including self-identified geriatric syndromes and St. Louis University Memory Screen (SLUMS) assessment. Recommendation letters included lifestyle changes to reduce medication use. A three-month follow-up call gathered current medication lists and recommendation acceptance rates. Repeat screenings were also conducted. MAIN OUTCOME MEASURE(S): Number of ADEs identified, recommendation acceptance rates, medication-related changes. Secondary measures: self-reported geriatric syndromes, SLUMS scores associated with ADE identification, screening tools associated with ADE identification. RESULTS: Pharmacist-initiated CMRs resulted in a high rate of discontinued nonsteroidal anti-inflammatory drugs (NSAIDs) and overall reduction in the number of scheduled medications. Participants with a positive ADE history were significantly more likely to report a suspected current ADE. Pharmacists incorporated nonpharmacologic interventions for reported geriatric syndromes, with high participant acceptance rates. In isolated cases, cognition was measurably improved with discontinuation of a targeted medication. CONCLUSIONS: Pharmacist-provided CMR services should be comprehensive, including patient's self-report of ADEs and history of ADEs. Pharmacist intervention can minimize prescription medication use, reducing the risk of ADEs.

Evaluation of a web-based tool in screening for medication-related problems in community-dwelling older adults.

OBJECTIVE: The primary objective was to evaluate the effectiveness of a Web-based program, Monitor-Rx, in identifying older adults at risk for drug-related geriatric syndromes or inappropriate medicines. DESIGN: This prospective pilot study compared medication related risks generated by the Web-based program with those identified by a certified geriatric pharmacist (CGP). SETTING: Wisconsin-based community pharmacy serving primarily older adults. PARTICIPANTS: 29 community-dwelling older adults (mean age: 81.6 years, mean daily medications: 11.7). INTERVENTIONS: Each participant received a complete medication history, including self-identified geriatric syndromes. Each participant's demographic information and medications were entered into Monitor-Rx and concurrently reviewed by a CGP. MAIN OUTCOME MEASURES: Number of potentially inappropriate medications (PIMs), anticholinergic medicines, and identified geriatric syndromes. RESULTS: All participants were identified as at risk for falls by Monitor-Rx and the CGP. Significant medication-related risks identified were urinary incontinence, cognition/memory, nutrition, and dental care. Monitor-Rx identified more participants at risk for geriatric syndromes than the CGP; however, PIMs were identified more frequently by the CGP. Twenty-six participants self-identified at least one geriatric syndrome. Prevalence of anticholinergic use was more than 75%. CONCLUSIONS: In the participants screened, Monitor-Rx was successful at identifying those with a high risk of drug-related geriatric syndromes. An interview was also important to clarify use of the PIM and to identify whether at-risk participants were actually experiencing the drug related geriatric syndromes. Use of the Web-based tool does not supplant the experience of a well-trained geriatric pharmacist and the professional judgment that comes with that experience.