Evaluation of the pharmaceutical case management program implemented in a private sector health plan

Abstract

Objectives: To characterize the drug-related problems (DRPs) identified by pharmacists providing pharmaceutical case management (PCM), describe the effect of PCM on medication appropriateness, and compare the findings from this evaluation of private insurance beneficiaries with a previous evaluation of PCM provided to Iowa Medicaid beneficiaries.

Methods: A pharmacy chart review was used to calculate medication appropriateness index (MAI) scores for patients before and after receiving PCM. Changes in MAI scores were calculated. DRPs identified by pharmacists during PCM services were characterized using online summaries submitted by pharmacists following each PCM encounter.

Results: A total of 91 patients received 195 PCM services from 29 pharmacies (2.14 services/patient). On average, pharmacists providing PCM were able to identify 2.6 DRPs per patient. The most frequently identified problems were the need for additional therapy, adverse drug reactions, and inappropriate adherence. Compared with baseline, mean MAI scores did not improve significantly following PCM (1.53 vs. 1.24, P = 0.34). MAI scores for this group were significantly lower than in a previous study of Medicaid beneficiaries receiving PCM.

Conclusion: The lower number of medications and lower MAI scores for the private beneficiaries compared with Medicaid beneficiaries suggested that these two groups have different characteristics that could translate into different needs from medication therapy management services.