Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug;72(8):2347-2358.
doi: 10.1111/jgs.19013. Epub 2024 Jun 3.

Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries

Anna Hung  1   2   3 , Lauren E Wilson  1 , Valerie A Smith  1   3   4 , Juliessa M Pavon  4   5   6 , Caroline E Sloan  1   2   7 , Susan N Hastings  1   3   4   5   6 , Matthew L Maciejewski  1   2   3   7
Affiliations

Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries

Anna Hung et al. J Am Geriatr Soc. 2024 Aug.

Abstract

Background: The use of potentially inappropriate medications (PIMs) is associated with increased risk of hospitalizations and emergency room visits and varies by racial and ethnic subgroups. Medicare's nationwide medication therapy management (MTM) program requires that Part D plans offer an annual comprehensive medication review (CMR) to all beneficiaries who qualify, and provides a platform to reduce PIM use. The objective of this study was to assess the impact of CMR on PIM discontinuation in Medicare beneficiaries and whether this differed by race or ethnicity.

Methods: Retrospective cohort study of community-dwelling Medicare Part D beneficiaries ≥66 years of age who were eligible for MTM from 2013 to 2019 based on 5% Medicare fee-for-service claims data linked to the 100% MTM data file. Among those using a PIM, MTM-eligible CMR recipients were matched to non-recipients via sequential stratification. The probability of PIM discontinuation was estimated using regression models that pooled yearly subcohorts accounting for within-beneficiary correlations. The most common PIMs that were discontinued after CMR were reported.

Results: We matched 24,368 CMR recipients to 24,368 CMR non-recipients during the observation period. Median age was 74-75, 35% were males, most were White beneficiaries (86%-87%), and the median number of PIMs was 1. In adjusted analyses, CMR receipt was positively associated with PIM discontinuation (adjusted relative risk [aRR]: 1.26, 95% CI: 1.20-1.32). There was no evidence of differential impact of CMR by race or ethnicity. The PIMs most commonly discontinued after CMR were glimepiride, zolpidem, digoxin, amitriptyline, and nitrofurantoin.

Conclusions: Among Medicare beneficiaries who are using a PIM, CMR receipt was associated with PIM discontinuation, suggesting that greater CMR use could facilitate PIM reduction for all racial and ethnic groups.

Keywords: Medicare; comprehensive medication review; medication therapy management; potentially inappropriate medications.

PubMed Disclaimer

Conflict of interest statement

AH reports honoraria and conference support from Academy of Managed Care Pharmacy, honoraria from Journal of Managed Care and Specialty Pharmacy, conference registration from Pharmacy Quality Alliance, and research grants from Abbott and AstraZeneca. MLM reports ownership of Amgen stock due to his spouse’s employment. No other authors report conflicts.

Figures

Figure 1.
Figure 1.
Flowchart
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Charlesworth CJ, Smit E, Lee DSH, Alramadhan F, Odden MC. Polypharmacy Among Adults Aged 65 Years and Older in the United States: 1988–2010. J Gerontol A Biol Sci Med Sci. 2015;70(8):989–995. doi: 10.1093/gerona/glv013 - DOI - PMC - PubMed
    1. By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052–2081. doi: 10.1111/jgs.18372 - DOI - PubMed
    1. Clark CM, Shaver AL, Aurelio LA, et al. Potentially Inappropriate Medications Are Associated with Increased Healthcare Utilization and Costs. J Am Geriatr Soc. 2020;68(11):2542–2550. doi: 10.1111/jgs.16743 - DOI - PMC - PubMed
    1. Lockery JE, Collyer TA, Woods RL, et al. Potentially inappropriate medication use is associated with increased risk of incident disability in healthy older adults. J Am Geriatr Soc. 2023;71(8):2495–2505. doi: 10.1111/jgs.18353 - DOI - PMC - PubMed
    1. Pharmacy Quality Alliance. 2022 PQA Measure Manual: Use of High-Risk Medications in the Elderly (HRM). 2022. Accessed October 1, 2022. https://www.pqaalliance.org/.

MeSH terms