Assessing the need for pharmacist-conducted drug regimen reviews in skilled nursing and intermediate care facilities

Federal regulations operating since 1974 require monthly patient drug reviews by pharmacists in skilled nursing facilities (SNFs), but intermediate care facility (ICF) reviews are only required quarterly and can be done by nurses. Based on a few previous reports, the hypothesis of this research was that there is no difference in the need for pharmacist monitoring in SNFs, ICFs, and ICF-mentally retarded (ICF-MR). Stratified by level of care, 353 patients were randomly selected from 24,770 Medicaid recipients in nursing homes throughout Minnesota. Full Medicaid claims profiles were generated for 3 months of service. An interdisciplinary expert panel defined need with explicit criteria for several parallel measures including need for pharmacist monitoring, likelihood of formal chart comment, frequency of monitoring, time per visit, and rationality of therapy. Two judges, experts in drug monitoring, used the criteria to separately score the profiles with significant correlation in the two sets of scores (p < 0.001). Using analysis of variance on the several measures for need, there was no difference between SNFs and ICFs, but ICF-MRs were significantly lower in need scores. It is expected that the explicit monitoring criteria developed in this study will be useful to practitioners in their drug review activities.