title: Retrospective evaluation of medication appropriateness and clinical pharmacist drug therapy recommendations for home-based primary care veterans.
abstract: BACKGROUND
  The Medication Appropriateness Index (MAI) has demonstrated reliability in several outpatient settings. Clinical pharmacists play key roles as members of an interdisciplinary team in determining medication appropriateness.
  
  
  OBJECTIVE
  The goal of this study was to examine medication appropriateness using the MAI and the degree of recommendation acceptance associated with clinical pharmacist medication reviews for veterans enrolled in the Home-Based Primary Care (HBPC) program.
  
  
  METHODS
  A retrospective analysis of clinical pharmacist medication reviews was performed by accessing the computerized patient medical record. Patients included in the study were enrolled in the HBPC program between March 2002 and January 2004. The data were examined to determine a total MAI score associated with medication recommendations after each review. The number and types of pharmacist recommendations, their acceptance rate, and the total number of medications discontinued were also evaluated.
  
  
  RESULTS
  Seventy-nine patients (mean [SD] age, 75.3 [10.3] years) identified through the pharmacy database met the inclusion criteria and were included in the study. No patients identified were excluded from the analysis. A statistically significant decrease in the overall MAI score was observed from the initial review to the end of the study (P < 0.001). Recommendations to patients' primary care providers included medication initiation/discontinuation, laboratory monitoring, dosage adjustment, and other issues associated with appropriate prescribing that could be categorized using the MAI. Recommendations to home health nurses included monitoring for medication adherence, efficacy, and adverse events. Pharmacist recommendation acceptance rates for primary care providers and home health nurses were 69% and 56%, respectively. Overall, 121 medications were discontinued during the study period.
  
  
  CONCLUSIONS
  By using the MAI for evaluation, pharmacist recommendations significantly improved the appropriateness of medication use among veterans receiving home health care. A majority of pharmacist recommendations were accepted.
authors.affiliation: Carl T Hayden VA Medical Center, Phoenix, Arizona 85012, USA.
authors.forename: Ryan G
authors.initials: RG
authors.lastname: Davis
authors.forename: Charley A
authors.initials: CA
authors.lastname: Hepfinger
authors.forename: Karen Ann
authors.initials: KA
authors.lastname: Sauer
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Wilhardt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016903:Drug Monitoring; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006787:Hospitals, Veterans; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D010348:Patient Care Team; D010593:Pharmaceutical Services; D010595:Pharmacists; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration; D024382:Professional Role; D012189:Retrospective Studies; D014481:United States; D014728:Veterans