Do comprehensive medication review completion rates predict medication use and management quality?

Ying Wang; Joel F Farley; Stefanie P Ferreri; Chelsea P Renfro

doi:10.1016/j.sapharm.2018.06.010

Do comprehensive medication review completion rates predict medication use and management quality?

Res Social Adm Pharm. 2019 Apr;15(4):417-424. doi: 10.1016/j.sapharm.2018.06.010. Epub 2018 Jun 20.

Authors

Ying Wang¹, Joel F Farley², Stefanie P Ferreri³, Chelsea P Renfro⁴

Affiliations

¹ Independent Consultant, Ashland, MA, 01721, USA. Electronic address: flwying@gmail.com.
² College of Pharmacy, University of Minnesota, 308 Harvard St SE Minneapolis, MN, 55455, USA.
³ Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina Chapel Hill, 301 Pharmacy Ln, Chapel Hill, NC, 27599, USA.
⁴ Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, USA.

PMID: 30917893
DOI: 10.1016/j.sapharm.2018.06.010

Abstract

Objectives: Little is known about how Medicare Part D Comprehensive Medication Review (CMR) affects quality of medication use and management. In this study, changes of plan level CMR completion rates over time were examined and their associations with medication use and management related (MUMR) quality measures.

Methods: Using Medicare Part D plan Star Rating and contract information data, a longitudinal data set was developed with CMR completion rate and 17 MUMR measures. T-tests and one-way Analysis of Variance were used to examine the variation of CMR rates between contracts and over time, respectively, as well as the regression adjusted associations using fixed-effects and ordinary least squares models, verified by Generalized Estimating Equations.

Results: CMR completion rates increased substantially from contract year 2013-2016, with a larger increase among Medicare Advantage Prescription Drug Plans than stand-alone Prescription Drug Plans. Prior year's CMR completion rates had marginally positive effects on 4 of the 17 MUMR measures: medication adherence with statin drugs, continuous beta blocker treatment, and pharmacotherapy management of chronic obstructive pulmonary disease exacerbation (systemic corticosteroid or bronchodilator). Increasing CMR completion also was associated with increased chronic use of atypical antipsychotics by elderly beneficiaries in nursing homes, an unintended outcome and a reflection of poor quality of care. CMR completion rates in the same year had even more limited associations with other MUMR measures.

Conclusions: At plan level, CMR completion rates had limited and inconsistent association with other MUMR measures. Although our research used an observational study design, the associations observed have policy implications to the Center for Medicare & Medicaid (CMS) Star Ratings program and quality bonus payments, as well as implications for plans' quality improvement.

Keywords: Medication Therapy Management; Part D; Performance measurement.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Hormones / therapeutic use
Adrenergic beta-Antagonists / therapeutic use
Antipsychotic Agents / therapeutic use
Bronchodilator Agents / therapeutic use
Drug Utilization Review
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
Hypoglycemic Agents / therapeutic use
Medicare Part D*
Medication Adherence
Medication Therapy Management*
United States

Substances

Adrenal Cortex Hormones
Adrenergic beta-Antagonists
Antipsychotic Agents
Bronchodilator Agents
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hypoglycemic Agents