title: Positive Medication Changes Resulting from Comprehensive and Noncomprehensive Medication Reviews in a Medicare Part D Population.
abstract: BACKGROUND
  Health care organizations face the challenge of reducing costs while improving health outcomes. Currently, more than 39 million seniors are enrolled in a Medicare Part D prescription benefit plan, many of whom also qualify for medication therapy management (MTM) services. MTM programs provide valuable services designed to prevent or resolve medication-related problems (MRPs). Two core components of all MTM programs include comprehensive medication reviews (CMRs) with followup interventions and focused non-CMR interventions. Currently, there is limited research comparing the rate of MRPs resolved by CMR and non-CMR interventions.
  
  
  OBJECTIVE
  To determine whether CMRs versus non-CMR interventions resulted in more pharmacist-initiated intervention recommendations and positive medication changes.
  
  
  METHODS
  This retrospective, cross-sectional quality improvement project evaluated outcomes for individuals who received interventions following a CMR compared with those who received non-CMR interventions as part of a comprehensive MTM program. For this project, eligible individuals qualified for an MTM program. A positive medication change was defined as the addition of an appropriate medication or the removal of an inappropriate medication within 120 days of a pharmacist recommendation. Differences between the groups were calculated using the Wilcoxon rank sum test.
  
  
  RESULTS
  During the 2-year period (2012 and 2013), 788,756 beneficiaries were enrolled in the MTM program and evaluated for potential MRPs. In both years, pharmacists recommended more medication changes per member for those receiving a CMR (0.81 in 2012 and 0.82 in 2013) compared with the non-CMR group (0.68 in 2012 and 0.61 in 2013; P value < 0.001 for both years). However, recommendations made via non-CMR interventions (representing the vast majority of all medication reviews) were more likely to result in a positive medication change (OR = 1.24, 95% CI = 1.21-1.28 for 2012; OR = 1.26, 95% CI = 1.22-1.30 for 2013).
  
  
  CONCLUSIONS
  These quality improvement project results suggest that Medicare Part D beneficiaries participating in a university-based MTM program who received non-CMR interventions had a higher likelihood of having positive medication changes than those receiving CMRs. These results are enlightening and may provide initial evidence to support inclusion of a non-CMR performance metric for the Centers for Medicare & Medicaid Service's star ratings for MTM programs.
  
  
  BACKGROUND
  No outside funding supported this study. The University of Arizona Medication Management Center (UAMMC)/SinfoniaRx provides grant funding to the University of Arizona for research. Augustine reports support from the UAMMC and ownership of Pfizer stock and was a graduate student at the University of Arizona College of Pharmacy at the time of this study. The authors report no other potential conflicts of interest. Buhl and Augustine contributed study concept and design, collected the data, and wrote the manuscript. Data interpretation was performed by all the authors. Taylor, Warholak, Augustine, and Martin revised the manuscript.
authors.affiliation: 1 University of Arizona Medication Management Center, Tucson, Arizona.
authors.forename: Allison
authors.initials: A
authors.lastname: Buhl
authors.affiliation: 2 University of Arizona College of Pharmacy, Tucson, Arizona.
authors.forename: Jill
authors.initials: J
authors.lastname: Augustine
authors.affiliation: 2 University of Arizona College of Pharmacy, Tucson, Arizona.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Taylor
authors.affiliation: 1 University of Arizona Medication Management Center, Tucson, Arizona.
authors.forename: Rose
authors.initials: R
authors.lastname: Martin
authors.affiliation: 2 University of Arizona College of Pharmacy, Tucson, Arizona.
authors.forename: Terri L
authors.initials: TL
authors.lastname: Warholak
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D054524:Medicare Part D / Q000191:economics*; D054539:Medication Therapy Management / Q000191:economics; D010593:Pharmaceutical Services / Q000191:economics; D010594:Pharmacies / Q000191:economics; D010595:Pharmacists / Q000191:economics; D012189:Retrospective Studies; D014481:United States