An analysis of the North Carolina nursing home Polypharmacy Initiative.

摘要

This dissertation is an evaluation of the North Carolina Polypharmacy Initiative (Initiative). The initiative was a demonstration project that remunerated nursing home consultant pharmacists for value-added drug regimen reviews using a claims-generated patient profile that flagged targeted drugs and drug classes for review.; Shewhart's PDSA (Plan-Do-Study-Act) cycle is used as the framework to guide this evaluation. The Initiative brought about three distinct PDSA cycles throughout its history. The first was the pilot project, and the second was a statewide endeavor, while the third continues through other programs and settings in North Carolina. It is the goal of this dissertation to inform the planning stage of future PDSA cycles of pharmacist services in nursing home settings.; Three formal evaluations of the initiative were conducted. The first evaluation, a before-after without comparison group study found a per member per month (PMPM) drug cost savings of {dollar}30.33 due to initiative activities. The second, a before-after with comparison group study found a PMPM drug cost savings of {dollar}19.04. The third, a before-after with propensity matched comparison group found a PMPM drug cost savings of {dollar}21.36. Flags (alerts) were reduced for two types of alert categories across all evaluations and their sub-group evaluations. The first, alerts for drugs on the Prescription Advantage List (PAL) were substantially reduced with a percentage reduction of 19.2% for all persons having a pharmacist review. The PAL list a voluntary preferred drug list sponsored by North Carolina Medicaid. The second, alerts for drugs on the Clinical Initiatives List were also substantially reduced with a percentage reduction of 9.6% for all residents having a pharmacist review. The Clinical Initiatives List was a list of drugs submitted by consultant pharmacy organizations that were targeted for cost-effectiveness and quality concerns. Overall, Phases 1, 2 and 3 of the Initiative produced consultant pharmacist reviews for 19,144 nursing home residents. These reviews generated 17,545 recommendations that resulted in greater than 10,000 drug changes.; Findings from this dissertation support the conclusion that a targeted program using pharmacists to review patient profiles may be quickly launched and expeditiously conducted across large numbers of patients, at least in long-term-care settings.