title: Improving the Care of Dual Eligible Patients in Rural Federally Qualified Health Centers: The Impact of Care Coordinators and Clinical Pharmacists.
abstract: BACKGROUND
  Dual eligible persons are those covered by both Medicare and Medicaid. There were 9.6 million dual eligible persons in the United States and 82 000 in West Virginia in 2010. Dual eligibles are poorer, sicker, and more burdened with serious mental health conditions than Medicare or Medicaid patients as a whole. Their health care costs are significantly higher and they are more likely to receive fragmented ineffective care.
  
  
  OBJECTIVE
  To improve the care experience and health care outcomes of dual eligible patients by the expanded use of care coordinators and clinical pharmacists.
  
  
  METHODS
  During 2012, 3 rural federally qualified community health centers in West Virginia identified 200 dual eligible patients each. Those with hospitalizations received more frequent care coordinator contacts. Those on more than 15 chronic medications had drug utilization reviews with recommendations to primary care providers. Baseline measures included demographics, chronic diseases, total medications and Beers list medications, hospitalization, and emergency room (ER) use in the previous year. Postintervention measures included hospitalization, ER use, total medications, and Beers list medications.
  
  
  RESULTS
  Out of 556 identified patients, 502 were contacted and enrolled. Sixty-five percent were female. The median age was 69 years, with a range of 29 to 93 years. Nineteen percent (19%) of patients were on 15 or more medications, 56% on psychotropic medication, and 33% on chronic opiates. One site showed reductions of 34% in hospitalizations and 25% in ER visits during the intervention year. For all sites combined, there was a 5.5% reduction in total medications and a 14.8% reduction in Beers list medications.
  
  
  CONCLUSIONS
  A modest investment in care coordination and clinical pharmacy review can produce significant reductions in hospitalization and harmful polypharmacy for community dwelling dual eligible patients.
authors.affiliation: Cabin Creek Health System, Dawes, WV, USA New River Health Association, Scarbro, WV, USA ddoyle@cchcwv.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.affiliation: Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Emmett
authors.affiliation: Cabin Creek Health System, Dawes, WV, USA.
authors.forename: Amber
authors.initials: A
authors.lastname: Crist
authors.affiliation: Cabin Creek Health System, Dawes, WV, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Robinson
authors.affiliation: Southern West Virginia Health System, Hamlin, WV, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Grome
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D010607:Pharmacy Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D019338:Polypharmacy; D055553:Prescription Drugs / Q000592:standards / Q000627:therapeutic use*; D019035:Rural Health Services / Q000458:organization & administration*; D014481:United States; D014903:West Virginia
chemical_list: D055553:Prescription Drugs
keywords: Beers list; Medicaid; Medicare; care coordinator; clinical pharmacist; community health center; dual eligible; polypharmacy; primary care; quality improvement; rural