title: Improved medication use in long-term care: building on the consultant pharmacist's drug regimen review.
abstract: Elderly and long-term care (LTC) patients often require complex medication regimens that increase their risk of adverse drug events or suboptimal pharmacotherapy. Currently, oversight of medication use in LTC facilities consists of a federally mandated monthly audit, the drug regimen review (DRR), performed by a consultant pharmacist, and yearly onsite government surveys. Although the DRR's purpose is to improve drug use and to avoid adverse drug events, the Centers for Medicare and Medicaid Services's (CMS) current DRR guidelines focus on a limited selection of medications and indications rather than on patient outcomes. An expanded model building on CMS's survey guidelines and the American Society of Consultant Pharmacists' Fleetwood Model is proposed to improve oversight of medication use. The proposed model includes using consultant pharmacists with demonstrated geriatric pharmacotherapy expertise, direct patient assessments by the pharmacist, increased interaction among healthcare professionals, evidence-based practices, and explicit patient outcome assessments. It is both feasible and timely: (1) the LTC prospective payment system aligns financial incentives between payers and providers; and (2) the Institute of Medicine has made quality improvement and error reduction a priority.
authors.affiliation: PRTM, Washington, DC, USA.
authors.forename: Chandresh
authors.initials: C
authors.lastname: Harjivan
authors.forename: Alan
authors.initials: A
authors.lastname: Lyles
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D014487:Centers for Medicare and Medicaid Services, U.S.; D002568:Certification; D003253:Consultants; D017723:Drug Utilization Review; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000592:standards*; D008297:Male; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D010595:Pharmacists; D014481:United States