title: Effect of Clinical and Attitudinal Characteristics on Obtaining Comprehensive Medication Reviews.
abstract: BACKGROUND
  Comprehensive medication reviews (CMRs) consist of in-depth reviews of patients' medications to identify effectiveness or safety problems and often generate cost savings for individuals. Despite their advantages, CMRs are not widely obtained. Previous studies found that older age, female sex, and experience of side effects were associated with obtaining a medication review.
  
  
  OBJECTIVE
  To quantify the association between attitudinal and clinical factors with intention and predict future behavior to obtain a CMR among Medicare Part D beneficiaries.
  
  
  METHODS
  A sample of Medicare Part D beneficiaries from 1 health care plan (n = 660) completed a 14-item survey over the telephone assessing factors that were hypothesized to affect their intention and behavior to obtain a CMR. The survey collected medication use history and health care information with the medication user self-evaluation tool, health status, adherence, intention to obtain a CMR, and demographic characteristics. Subjects subsequently were informed that they could obtain a CMR from their pharmacies. Claims data were obtained that indicated which subjects received a CMR. Two dependent variables were predicted: intention to schedule a CMR using a multivariate linear regression model and receipt of a CMR using a logistic regression and including intention as a predictor variable.
  
  
  RESULTS
  The mean age of participants was 76.6 (SD = 7.61) years; 71% were female; and participants took an average of 5.2 (SD = 3.18) medications. The intention to have a CMR was 2.85 (SD = 1.41) on a 5-point scale, and 5.6% of the participants actually had a CMR. Worrying about medications doing more harm than good, number of pharmacies where participants obtained their medications from, number of medications, and number of medical conditions predicted intention to obtain a CMR. Patients who perceived their health status to be poorer compared with others their age were more likely to have a CMR. Intention to obtain a CMR was not associated with receipt of a CMR.
  
  
  CONCLUSIONS
  Stakeholders should target patients who perceive their health to be poor for a CMR, hence expanding the scope of CMRs and increasing the number of older adults benefiting from this service.
  
  
  BACKGROUND
  This study was funded by a grant from the Agency for Healthcare Research and Quality (1R18HS018353). Frank is an employee of Outcomes MTM. Pendergast has received grants from the NIH, NIA, and PICORI. Farris has received grants from NIH and speaker fees from Chulalongkorn University, Bangkok, Thailand, and the American College of Clinical Pharmacy. All other authors declare that they have no conflicts of interest. Study concept was developed by Farris, Pendergast, Chrischilles, and Doucette. Pendergast, Frank, Farris, and Aneese collected the data, with assistance from Chrischilles and Doucette. Data interpretation was performed by Farris, Marshall, Salgado, and Aneese, with assistance from the other authors. The manuscript was written by Farris, Salgado, and Aneese, with assistance from the other authors, and revised by Salgado and Marshall, assisted by the other authors.
authors.affiliation: 1 Charles R. Walgreen III Professor of Pharmacy Administration. University of Michigan College of Pharmacy, Ann Arbor.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Farris
authors.affiliation: 2 Postdoctoral Research Fellow, Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Salgado
authors.affiliation: 3 Ambulatory Care Pharmacy Resident, Beaumont Health System, Troy, Michigan.
authors.forename: Nadia
authors.initials: N
authors.lastname: Aneese
authors.affiliation: 4 Statistician, Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor.
authors.forename: Vincent D
authors.initials: VD
authors.lastname: Marshall
authors.affiliation: 5 Professor of Biostatistics, Department of Biostatistics, University of Iowa College of Public Health, Iowa City.
authors.forename: Jane F
authors.initials: JF
authors.lastname: Pendergast
authors.affiliation: 6 Vice President of Quality, Outcomes MTM, West Des Moines, Iowa.
authors.forename: Jessica
authors.initials: J
authors.lastname: Frank
authors.affiliation: 7 Professor and Marvin A. and Rose Lee Pomerantz Chair in Public Health, and Director, Health Effectiveness Research Center, University of Iowa College of Public Health, Iowa City.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chrischilles
authors.affiliation: 8 Professor and Head, Division of Health Services Research, Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City.
authors.forename: William R
authors.initials: WR
authors.lastname: Doucette
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D005260:Female; D006304:Health Status; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D054524:Medicare Part D; D055118:Medication Adherence; D054539:Medication Therapy Management / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010593:Pharmaceutical Services / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D014481:United States