title: Medication assessment tool to detect care issues from routine data: a pilot study in primary care.
abstract: BACKGROUND
  Medication assessment tools (MATs) may be implemented in routine electronic data sources in order to identify patients with opportunities for optimisation of medication therapy management (MTM) and follow-up by a multi-disciplinary team.
  
  
  OBJECTIVE
  (1) To demonstrate the use of a MAT for cardiovascular conditions (MAT CVC) as a means of profiling potential opportunities for MTM optimisation in primary care and (2) to assess the performance of MAT CVC in identifying actual opportunities for better care.
  
  
  METHODS
  Members of a pharmacotherapy discussion group, i.e. two single-handed general practitioners (GPs), three GP partners, and community pharmacists (CPs) from each of two community pharmacies, in a rural part of the Netherlands.
  
  
  METHODS
  MAT CVC comprises 21 medication assessment criteria, each of which is designed to detect a specific care issue and to check whether it is 'addressed' by provision of guideline recommended care or 'open' in the presence ('open explained') or absence ('open unexplained') of pre-specified explanations for guideline deviations. (1) Relevant data was extracted from linked GP and CP electronic records and MAT CVC assessment was conducted to profile the population of CVC patients registered with both, participating CPs and GPs, in terms of 'open unexplained' care issues. (2) A purposive sample of patients with 'open unexplained' care issues was reviewed by each patient's GP.
  
  
  METHODS
  Number and proportion of 'open unexplained' care issues per MAT CVC criterion and per patient. The number of patients with MAT CVC detected 'open unexplained' care issues to be reviewed (NNR) in order to identify one that requires changes in MTM.
  
  
  RESULTS
  In 1,876 target group patients, MAT CVC identified 6,915 care issues, of which 2,770 (40.1 %) were 'open unexplained'. At population level, ten MAT CVC criteria had particularly high potential for quality improvement. At patient level, 1,277 (68.1 %) target group patients had at least one 'open unexplained' care issue. For patients with four or more 'open unexplained' care issues, the NNR was 2 (95 % CI 2-2).
  
  
  CONCLUSIONS
  The study demonstrates potential ways of using MA TCVC as a key component of a collaborative MTM system. Strategies that promote documentation and sharing of explanations for deviating from guideline recommendations may enhance the utility of the approach.
authors: Tobias
authors: T
authors: Dreischulte
authors: Julienne
authors: J
authors: Johnson
authors: John
authors: J
authors: McAnaw
authors: Marlies
authors: M
authors: Geurts
authors: Han
authors: H
authors: de Gier
authors: Steve
authors: S
authors: Hudson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003157:Community Pharmacy Services / Q000458:organization & administration; D003299:Cooperative Behavior; D004282:Documentation; D058005:General Practitioners / Q000458:organization & administration; D006801:Humans; D054539:Medication Therapy Management / Q000458:organization & administration*; D008875:Middle Aged; D009426:Netherlands; D010348:Patient Care Team / Q000458:organization & administration*; D010595:Pharmacists / Q000458:organization & administration; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D012424:Rural Population
references: Eur J Epidemiol. 2009;24(5):237-47
references: 19337843
references: Qual Saf Health Care. 2004 Aug;13(4):299-305
references: 15289634
references: Ann Pharmacother. 2007 Nov;41(11):1770-81
references: 17925496
references: Eur Heart J. 2006 Jun;27(11):1341-81
references: 16735367
references: Health Care Anal. 1997 Dec;5(4):292-8
references: 10177942
references: Ann Pharmacother. 2007 Oct;41(10):1569-82
references: 17712043
references: Eur J Cardiovasc Prev Rehabil. 2007 Sep;14 Suppl 2:S1-113
references: 17726407
references: Br J Clin Pharmacol. 2008 Mar;65(3):303-16
references: 18093253
references: Implement Sci. 2006 Apr 28;1:9
references: 16722539
references: Pharmacoepidemiol Drug Saf. 2011 Mar;20(3):249-57
references: 21351306
references: Ann Pharmacother. 2005 Oct;39(10):1720-5
references: 16144881
references: Am J Geriatr Pharmacother. 2007 Dec;5(4):314-6
references: 18179988
references: Eur J Heart Fail. 2008 Oct;10(10):933-89
references: 18826876
references: Pharm World Sci. 2008 Jan;30(1):120-7
references: 17721698
references: BMC Clin Pharmacol. 2012 Feb 08;12:5
references: 22316181
references: Lancet. 2012 Jul 7;380(9836):37-43
references: 22579043
references: JAMA. 2003 May 14;289(18):2363-9
references: 12746359
references: Ann Pharmacother. 2008 Sep;42(9):1195-207
references: 18682540
references: Br J Gen Pract. 2010 Jan;60(570):e20-7
references: 20040164
references: Pharm World Sci. 1997 Apr;19(2):105-13
references: 9151350
references: Eur J Clin Pharmacol. 2013 Mar;69(3):703-9
references: 22990329
references: Drugs Aging. 2010 Jan 1;27(1):63-71
references: 20030433
references: Am J Med. 2005 Dec;118 Suppl 12A:36-41
references: 16356806
references: Am J Med. 2010 Jul;123(7):638-645.e4
references: 20609686
references: BMJ. 1998 Nov 7;317(7168):1309-12
references: 9804726
references: J Pain Symptom Manage. 2009 Jun;37(6):1006-18
references: 19500723
references: Qual Saf Health Care. 2008 Apr;17(2):109-16
references: 18385404
references: Res Social Adm Pharm. 2012 Jan-Feb;8(1):36-46
references: 21454138
references: Eur Heart J. 2007 Jul;28(13):1598-660
references: 17569677
references: J Gen Intern Med. 2007 Dec;22(12):1648-55
references: 17957346
references: BMC Fam Pract. 2009 Jun 19;10:44
references: 19545376
references: Eur Heart J. 2006 Dec;27(24):3018-26
references: 16731536
references: BMJ. 1995 Apr 8;310(6984):923-5
references: 7719188
references: Eur Heart J. 2008 Dec;29(23):2909-45
references: 19004841
references: BMJ. 2000 Feb 26;320(7234):569-72
references: 10688568
references: Eur Heart J. 1999 Mar;20(6):447-55
references: 10213348
references: J Clin Epidemiol. 1992 Oct;45(10):1045-51
references: 1474400
references: Isr Med Assoc J. 2008 Mar;10(3):214-8
references: 18494235
references: Fam Pract. 2007 Apr;24(2):189-200
references: 17272285
references: Europace. 2010 Oct;12(10):1360-420
references: 20876603
references: Pharm World Sci. 2006 Dec;28(6):342-51
references: 17120130
references: Arch Intern Med. 1997 Jul 28;157(14):1531-6
references: 9236554
references: Eur J Public Health. 2005 Feb;15(1):59-65
references: 15788805