LaFleur Joanne, McBeth Carrieann, Gunning Karen, Oderda Lynda, Steinvoort Carin, Oderda Gary M
Drug Regimen Review Center, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA.
J Manag Care Pharm. 2006 Oct;12(8):677-85. doi: 10.18553/jmcp.2006.12.8.677.
Despite numerous reports of state Medicaid drug utilization review (DUR) programs, little data are available about the prevalence of drugrelated problems (DRPs) in Medicaid patients. A university-based, pharmacist-run DUR program for high utilizers was created as an alternative to imposition of a statutory limit of 7 medications per month in the Utah Medicaid program in 2002. The DUR program was designed to suggest ways that high-utilizing patients could decrease their total number of medications to 7 or fewer prior to imposition of the 7-medication limit at some time in the future.
To describe the experience in 1 Medicaid DUR program and to report the prevalence of DRPs and cost-saving opportunities (CSOs) among a population of Medicaid recipients who were high utilizers of prescription drugs.
DRPs were identified by 5 clinical pharmacists employed by the Drug Regimen Review Center (DRRC) in Salt Lake City. The purpose of the center was to provide drug therapy review services for a select number of Utah Medicaid recipients (200-300 per month) who exceeded a 7-medication limit during the calendar years 2003 and 2004.
Out of 391,890 eligible Medicaid recipients, 242,411 (62%) received at least 1 medication, and 16,958 (4.3%) exceeded the 7-medication limit during the review period. Of those exceeding the limit, the DRRC reviewed a total of 3,706 (21.9%) patients, representing the highest utilizers by volume of medication. The prevalence of DRPs considered clinically important in the review cohort was 79.7% of patients, including therapeutic duplications in 54.6% of patients, dose form optimization in 29.7%, and inappropriate uncoordinated care in 25.3%. The average pharmacy cost per month for patients with at least 1 DRP was 1,081 dollars; by contrast, the average pharmacy cost per month for all other patients receiving at least 1 prescription was 91 dollars.
Approximately 4% of Medicaid recipients exceeded the 7-medication monthly limit. Among the 22% highest utilizers in this group, 48% of nursing home residents and 87% of ambulatory recipients had at least 1 DRP, or an overall rate of 80% of high-use Medicaid recipients or as much as 3.2% of the Medicaid population.
尽管有大量关于州医疗补助计划药物利用审查（DUR）项目的报告，但关于医疗补助患者中药物相关问题（DRP）的患病率的数据却很少。2002年，犹他州医疗补助计划设立了一项基于大学、由药剂师管理的针对高用药量者的DUR项目，作为每月7种药物法定限制的替代方案。该DUR项目旨在提出一些方法，让高用药量患者在未来某个时候实施7种药物限制之前，将其用药总数减少到7种或更少。
描述一个医疗补助DUR项目的经验，并报告在高使用量处方药的医疗补助接受者群体中DRP的患病率和成本节约机会（CSO）。
盐湖城药物治疗审查中心（DRRC）雇佣的5名临床药剂师识别DRP。该中心的目的是为2003年和2004年日历年中超过7种药物限制的部分犹他州医疗补助接受者（每月200 - 300人）提供药物治疗审查服务。
在391,890名符合条件的医疗补助接受者中，242,411人（62%）至少服用了1种药物，16,958人（4.3%）在审查期间超过了7种药物的限制。在那些超过限制的人中，DRRC共审查了3,706名患者（21.9%），这些患者代表了用药量最高的人群。在审查队列中，被认为具有临床重要性的DRP患病率为79.7%的患者，其中包括54.6%的患者存在治疗重复、29.7%的患者存在剂型优化问题以及25.3%的患者存在不适当的不协调护理问题。至少有1个DRP的患者每月平均药房费用为1,081美元；相比之下，所有其他至少接受1种处方的患者每月平均药房费用为91美元。
约4%的医疗补助接受者超过了每月7种药物的限制。在该群体中用药量最高的22%的人中，48%的养老院居民和87%的非卧床接受者至少有1个DRP，即高用药量医疗补助接受者的总体发生率为80%，或占医疗补助人群的3.2%。
