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Evaluation of the Iowa Medicaid pharmaceutical case management program
Elizabeth A Chrischilles1, Barry L Carter, Brian C Lund
1Health Effectiveness Research Center, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52242, USA. e-chrischilles@uiowa.edu
Objective:
To test the effect of pharmaceutical case management (PCM) on medication safety and health care utilization.
Design:
Prospective cohort design with 9-month follow-up period (enrollment from October 1, 2000, through July 1, 2001, with follow-up through July 1, 2002).
Setting:
Iowa Medicaid program.
Participants:
2,211 noninstitutionalized, continuously eligible Iowa Medicaid patients taking four or more chronic medications including at least one agent commonly used in at least 1 of 12 specific diseases who were cared for by pharmacists in 117 pharmacies.
Interventions:
Reimbursement for PCM services (initial patient assessment, written recommendations to physician, follow-up assessments and communication of progress and new problems to physician).
Main Outcome Measures:
Use of high-risk medications, Medication Appropriateness Index (MAI) score, health care utilization.
Results:
Pharmacists in 114 pharmacies had eligible patients during at least one quarter during the study period; 28 pharmacies were classified as high intensity based on the number of PCM patients they managed. A total of 524 of the eligible patients received 1,599 PCM services; 90% of claims were filed by pharmacists, and the remainder by physicians. Nearly one half (46.1%) of medications and 92.1% of patients had at least one medication problem before PCM. By closeout, the percentage of medications with problems decreased in 8 of 10 MAI domains for those who received PCM. Compared with baseline, mean MAI score improved significantly from 9.4 to 8.3 among PCM recipients (P < .001). Percentage of PCM recipients using high-risk medications decreased significantly compared with PCM eligibles who did not receive the service. In the 28 pharmacies that adopted the new service most intensely, patients had a significant decrease in high-risk medication use, compared with patients of low-intensity pharmacies (P < .001). No difference was observed between PCM recipients and PCM eligibles who did not receive PCM in health care utilization or charges, even after including reimbursements for PCM.
Conclusion:
Medication safety problems were prevalent in this high-risk population. The PCM program improved medication safety during a 9-month follow-up period.