1. Characteristics of Patients who Choose to Participate in a Comprehensive Medication Review (CMR) Program: Implication for Program Structure and Processes
Chung-Hsuen Wu, M.H.P.A. a, Caroline A. Gaither, Ph.D. a, Nancy JW Lewis, Pharm.D., M.P.H. a, Carol Bugdalski-Stutrud, R.Ph. b, and Marie A. Abate, Pharm.D. c,
a The University of Michigan, College of Pharmacy, b Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, c West Virginia University Center for Drug and Health Information
Background
Tables
Graphs
Table 1. Number of chronic medications taken by patients.
Medication errors and inappropriate medication use and prescribing contribute to drug-related morbidity and mortality. Drug therapy reviews, medication counseling and education on disease self-management improve medication-related outcomes.
A community-based comprehensive medication review (CMR) program designed to enhance medication adherence, improve drug therapy cost-effectiveness, and patient self-management skills was offered by a university-affiliated network of pharmacists.
The program was developed to provide comprehensive medication assessments and health education for individuals taking four or more medications.
Medication category
Mean (+SD)
Range
Prescription
8.4 (+4.0)
2 - 20
Non-prescription medications or herbal products
4.1 (+2.4)
0 - 12
Total medications
12.5 (+4.5)
2 - 25
Table 2. Common diagnoses reported by patients.
Purpose
Diagnosis
# of patients reporting condition (n=67)
% of patients reporting condition
Hypertension 50
74.6 (27.8)*
High cholesterol 41
61.2 (38.9)*
Coronary heart disease 31
46.3 (4.6)*
Diabetes 29
43.3 (8.1)*
Gastrointestinal esophageal reflux disease (GERD) 21
31.3
Osteoarthritis 19
28.4
Chronic pain
Osteoporosis 17
25.4
Asthma 14
20.9 (9.1)*
Heart failure
20.9
Anxiety 13
19.4
Depression 12
17.9
Rheumatoid arthritis 10
14.9
Hypothyroidism
To describe a community-based comprehensive medication review (CMR) program.
To identify consumer characteristics associated with the use of a CMR program.
To discuss program development and design features that could best meet the needs of consumers interested in a CMR program.
Methods
Program Population
Individuals, 18 years of age or older, who took 4 or more medications, or have been recently hospitalized and take any number of medications.
Employees, retirees, and adult dependents associated with three Michigan employers.
Measurement
Descriptive statistics were reported as mean and standard deviation (SD) for continuous variables, and as proportions for categorical variables. T-test, and paired t-test were used to analyze the data.
Data analysis
Data were analyzed by using the Statistical Analysis System (SAS 9.1).
* Resource is from Behavioral Risk Factor Surveillance System (CDC), State Prevalence Data 2005.
Table 3. Self reporting health status.
Self-rate health status
% of patient reporting health status
% of patient reporting health status (Michigan 2005)*
% of patient reporting health status (NHIS 2005)**
Poor
17.5
3.8
2.3
Excellent
4.8
18.7
35.5
Results
* Resource is from Behavioral Risk Factor Surveillance System (CDC), State Prevalence Data 2005.
** Resource is from National Health Interview Survey 2005.
Gender
Female: 59.7%.
Age
Mean age 68.7 years (± 13.9).
Sixty percent of patients were 65 years of age or older.
One third of patients were 80 years old.
Race/Ethnicity
Caucasian: 91%.
African American: 4.5%.
Native American: 4.5%.
Employment status
Active employees: 28.3%.
Retirees: 35.9%.
Dependents: 28.3%.
Table 4. Patients characteristics between age groups.
Conclusions
Characteristics
< 65
≥ 65
Significance
# of prescriptions
6.9
9.5
p<0.05
# of diagnoses
5.1
6.4
Requests for CMRs tended to be influenced by gender, age and medication use.
Individuals requesting CMRs tended to have a high incidence of disease and report low health status compared to others their age.
More than 70% of patients were not very informed regarding their perceived knowledge of medication effects, and 60% of patients were not very informed regarding ways to keep healthy.
CMR programs should be designed and delivered to meet the needs of older adults, those are are ill and/or disabled.
CMRs need to address medication problems related to both physical and mental health problems.
Table 5. Number of ED visit and hospital admission in the past 3 months.
Type of visits
Percentage of people reporting having ED visits or hospitalizations (n=67) 1 2 3 4 4+
ED visit
91.5
6.8
1.7
Hospitalizations
83.9
12.9
1.6