Medication-related problems encountered in the Program of All-Inclusive Care for the Elderly: An observational study

David L Bankes, Nishita S Amin, Chandni Bardolia, Michael S Awadalla, Calvin H Knowlton, Kevin T Bain

Abstract

Objective: To evaluate pharmacist-encountered medication-related problems (MRPs) among the participants of the Program of All-Inclusive Care for the Elderly (PACE).

Design: This was a retrospective analysis of proprietary pharmacy records detailing pharmacist encounters with PACE clinical staff.

Setting and participants: A national provider of pharmacy services to more than 75 PACE organizations. In total, 1057 PACE participants at 69 PACE sites across the United States with documented pharmacist encounters between March and May 2018.

Outcome measures: MRPs were classified using the Hepler-Strand taxonomy, and pharmacists’ recommendations made to prescribers to resolve these MRPs were classified using a modified Hoth taxonomy. In addition, pharmacists’ communication methods and prescribers’ responses were analyzed.

Results: Overall, 2004 MRPs were encountered. The most frequent MRPs identified were related to medication safety concerns, including drug interactions (720, 35.9%), adverse drug reactions (ADRs, 356, 17.8%), high doses (270, 13.5%), and unindicated drugs (252, 12.6%). Drug interactions frequently involved competitive inhibition, 3 or more drugs, opioids, anticoagulants, antiplatelets, and antidepressants. Deprescribe medication (561, 24.8%), start alternative therapy (553, 24.4%), change doses (457, 20.2%), and monitor (243, 10.7%) were the top 4 types of recommendations made by pharmacists. Among 1730 responses obtained from PACE prescribers, 78.1% (n = 1351) of pharmacists’ recommendations were accepted. Compared with electronic communication, telephonic communication was associated with more acceptance and less prescriber nonresponse (χ² = 78.5, P < 0.001).

Conclusion: Pharmacists identified a substantial number of MRPs in PACE, especially those related to medication safety such as drug interactions and ADRs. In this practice setting, significant collaboration occured between pharmacists and PACE prescribers, as evidenced by the rate of prescribers’ acceptance of pharmacists’ recommendations. Further research is needed to fully evaluate the economic, clinical, and humanistic outcomes associated with pharmacists’ encounters in PACE.