Impact of therapeutic switching in long-term care

To collect clinician perceptions on the impact of switching medications for nonmedical (ie, formulary) reasons in long-term care settings under Medicare Part D and to use the qualitative findings to support more robust research into the effects of Part D policies on nursing home patients and providers.

We collected individual clinician accounts of experiences with and perceptions about Part D plans when medications were switched for nonmedical reasons, including diseases that clinicians believed were most medically risky for switching with nursing home residents and the common health outcomes of switching. Publisher HCPro's long-term care readership database was used to reach survey participants. Individuals were classified by clinician type and then e-mailed an invitation to take these electronically disseminated surveys in September 2007.

A total of 569 total case histories representing 555 nursing homes were collected. About three-quarters of the case histories collected showed decreased efficacy after a nonmedical switch for Part D beneficiaries. Switching for those with hypertension, heart disease, diabetes, HIV, and bipolar disorder, among other diseases, was considered most medically risky in this population.

Nurses, physicians, and pharmacists who shared their perceptions regarding the effect of nonmedical switching in long-term care settings reported situations in which switching increased administrative time, increased side effects, and appeared to have increased downstream costs to plans.