Effectiveness of a Clinical Pharmacist Medication Therapy Management Program in Discontinuation of Drugs to Avoid in the Elderly

Abstract

Background: Despite evidence of fall risk associated with some drugs to avoid in the elderly (DAEs), many aged patients continue to receive them.

Objective: To assess the effectiveness of a clinical pharmacist medication therapy management program (MTM) on discontinuation of prescribed DAEs.

Methods: This was a retrospective cohort study conducted at an integrated health care delivery system. Kaiser Permanente Colorado beneficiaries aged ≥65 years who were MTM-eligible and targeted for a DAE dispensing between 01/01/2015 and 09/30/2015 were included in the observation group. Medicare beneficiaries who were not eligible for MTM but had a targeted DAE dispensing during the same time period were included in the control group. The percentage of patients with another DAE dispensing of the same specified medication (no matter the strength) during the 100 days following index DAE dispensing was assessed. Univariate and multivariable logistic regression analyses were conducted.

Results: A total of 9,059 Medicare beneficiaries were included, with 226 beneficiaries in the MTM group and 8,833 beneficiaries in the non-MTM group. Beneficiaries were primarily female and white and had a high burden of chronic disease. The percentages of patients with another dispensing of the specified DAE were 7.1% (95% CI = 3.7%-10.4%) for the MTM beneficiaries and 35.3% (95% CI 34.2%-36.2%) for the non-MTM beneficiaries (P < 0.001). The OR for the MTM group to have received another dispensing of the specified DAE was 0.12 (95% CI = 0.08-0.22) with adjustment for potential confounders.

Conclusions: A clinical pharmacist-provided MTM intervention was associated with decreased DAE dispensing in Medicare beneficiaries. Future studies should evaluate means to further decrease DAE use in the aged.

Disclosures: This study was funded by the Kaiser Permanente Colorado Pharmacy Department. The funder had no role in the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit the manuscript for publication. Delate has received grant funding from Janssen Pharmaceutical Companies of Johnson & Johnson outside of this study. The authors report no other disclosures. Delate supervised the study and had complete access to the data and takes responsibility for the data integrity. Study concept and design were contributed by Caffiero, Delate, Ehizuelen, and Vogel. Delate collected the data, assisted by the other authors, and analysis and interpretation of the data were provided by Ehizuelen and Vogel, along with Caffiero and Delate. The manuscript was written by Caffiero and Delate, with assistance from Ehizuelen and Vogel, and revised by all the authors. Preliminary findings from this study were presented at the Mountain States Conference for Pharmacy Residents, Fellows, and Preceptors on May 13, 2016, in Salt Lake City, Utah.