Medication-Related Problems Identified by Pharmacists in an Enhanced Medication Therapy Management Model

David Bankes, PharmD, BCGP, Katie Pizzolato, PharmD, Stephanie Finnel, PhD, Michael S. Awadalla, PharmD, BCGP, Alan Stein, MD, PhD, Joshua Johnson, PharmD, BCGP, Jacques Turgeon, BPharm, PhD

Objectives: To describe the types of clinically actionable medication-related problems (MRPs) identified and the types of resolving recommendations issued by pharmacists using an advanced clinical decision support system (CDSS) for Medicare Part D beneficiaries.

Study Design: Retrospective cross-sectional study.

Methods: We examined frequencies of MRPs and recommendations for beneficiaries who received a first-ever medication safety review (MSR) during plan years 2018-2019. MRPs were considered clinically actionable if implementation of a recommendation would alter the medication regimen.

Results: Pharmacists identified ≥ 1 clinically actionable MRP for 82.4% (18,703/22,696) beneficiaries receiving an MSR. Among these beneficiaries, 36,455 MRPs were identified (mean [SD] number of MRPs: 1.9 [1.0]). “Adverse drug reaction” (n = 14,788; 40.6%), “drug interaction” (n = 9716; 26.7%), and “medication use without indication” (n = 6496; 17.8%) represented 85.0% of all MRPs. “Start alternative therapy” was most frequently recommended to resolve “adverse drug reactions” (6724/14,788; 45.5%), followed by “change time of administration” to resolve “drug interactions” (5189/9716; 53.4%) and “discontinue medication” to resolve “drug use without indication” (5718/6496; 88.0%). Overall, “start alternative therapy” (n = 12,219) and “discontinue medication” (n = 12,059) made up 66.6% of all recommendations.

Conclusions: In Medicare Part D beneficiaries, pharmacists using an advanced CDSS identified a substantial number of MRPs pertaining to medication safety and issued recommendations to decrease the risk of adverse drug events.