Roane Teresa E, Patel Vinita, Hardin Heather, Knoblich Martha
University of Florida College of Pharmacy, Dept. of Pharmacotherapy and Translational Research, MTM Communication and Care Center, 2046 N.E. Waldo Rd., Eastside Campus Office Bldg., Ste. 2250, Gainesville, FL 32609, USA.
J Manag Care Pharm. 2014 Feb;20(2):165-73. doi: 10.18553/jmcp.2014.20.2.165.
The University of Florida College of Pharmacy's Medication Therapy Management Communication and Care Center (UF MTMCCC) provides medication therapy management (MTM) services to patients enrolled in a State of Florida Medicaid Waiver Program: Medicaid for the Aged and Disabled. To provide these services, UF MTMCCC was given access to patients' prescription claims data and diagnostic billing data in the form of ICD-9 codes. Prior to calling a patient, a precomprehensive medication review (CMR) work-up was performed to identify potential medication-related problems (MRPs) and/or health-related problems (HRPs). Based on information provided by the patient in relation to comorbidities, medications, and medical history during the interactive telephone conversation, problems were either confirmed or eliminated. All of the reported information was also assessed to identify any new MRPs or HRPs. Accordingly, telephonic MTM services have the potential to bridge the gap between pharmacy claims data and patient self-reported information, since the MTM services provided rely on the accuracy of both informational resources.
To determine the degree of discrepancy in patient-reported information regarding chronic comorbidities and medications versus diagnostic billing data (ICD-9 codes for chronic comorbidities) and pharmacy claims data (medications) when providing MTM services during an interactive telephonic comprehensive medication review.
A retrospective chart review (n = 147 patients) was performed for patients who received a telephonic CMR. Pharmacy claims data and diagnostic billing data, in conjunction with the pre-CMR work-up data, were used to identify discrepancies in information obtained from the patient during the CMR. During the chart review, identified MRPs or HRPs were categorized as "confirmed" (patient reported the problem exists and/or it was deduced from the presence/absence of a medication that the problem does exist); "eliminated" (patient reported the problem does not exist and/or it was deduced from the presence/absence of a medication that the problem does not exist); or "new" (a problem that was not identified during precall identification of problems, but following the CMR interaction, it was determined that a problem now exists). The study evaluated the discrepancies before and after a CMR telephonic interaction in the following categories: medications, chronic comorbidities, level 1 drug-drug interactions, level 2 drug-drug interactions, gaps in therapy, therapeutic duplications, lack of therapy, preferred drug list alternatives, combination products, and tobacco use. Percent discrepancy was calculated as the sum of new and eliminated data elements divided by the total number of data elements for each MRP or HRP.
The percent discrepancy observed was 42% for medications, 41% for chronic comorbidities, 77% for level 1 drug-drug interactions, 93% for level 2 drug-drug interactions, 35% for gaps in therapy, 87% for therapeutic duplications, 26% for lack of therapy, 36% for preferred drug list alternatives, 42% for combination products, and 54% discrepancy for report of tobacco use. Overall, 4,441 data elements were identified as confirmed, eliminated, or new across the 147 CMRs. Among those data elements, 56% of the data was confirmed; 23% was eliminated; and 21% was discovered as new.
The study met its objective in determining the degree of discrepancies that existed when prescription claims data and ICD-9 billing data were used to identify MRPs and/or HRPs versus using patient-reported data. Data revealed that the presence of discrepancy is relatively large depending on the category, indicating a difficulty in accurately making recommendations with incomplete data or solely based on prescription claims and billing data. MTM services with patient interaction are vital in identifying information that allows for more appropriate decision making.
佛罗里达大学药学院药物治疗管理沟通与护理中心（UF MTMCCC）为参加佛罗里达州医疗补助豁免计划（老年及残疾医疗补助）的患者提供药物治疗管理（MTM）服务。为提供这些服务，UF MTMCCC有权获取患者的处方索赔数据以及以ICD - 9编码形式存在的诊断计费数据。在致电患者之前，会进行预全面药物审查（CMR）分析，以识别潜在的药物相关问题（MRP）和/或健康相关问题（HRP）。根据患者在互动电话交谈中提供的有关合并症、药物和病史的信息，对问题进行确认或排除。所有报告的信息也会进行评估，以识别任何新的MRP或HRP。因此，电话MTM服务有潜力弥合药房索赔数据与患者自我报告信息之间的差距，因为所提供的MTM服务依赖于这两种信息资源的准确性。
确定在互动电话全面药物审查期间提供MTM服务时，患者报告的关于慢性合并症和药物的信息与诊断计费数据（慢性合并症的ICD - 9编码）和药房索赔数据（药物）之间的差异程度。
对接受电话CMR的患者进行回顾性病历审查（n = 147例患者）。药房索赔数据、诊断计费数据以及CMR前分析数据用于识别在CMR期间从患者处获得的信息中的差异。在病历审查期间，识别出的MRP或HRP被分类为“确认”（患者报告问题存在和/或从药物的存在/不存在推断出问题确实存在）；“排除”（患者报告问题不存在和/或从药物的存在/不存在推断出问题不存在）；或“新发现”（在电话前问题识别期间未识别出的问题，但在CMR互动之后，确定现在存在问题）。该研究评估了CMR电话互动前后在以下类别中的差异：药物、慢性合并症、1级药物相互作用、2级药物相互作用、治疗缺口、治疗重复、治疗不足、首选药物清单替代药物、复方产品和烟草使用情况。差异百分比计算为新发现和排除的数据元素之和除以每个MRP或HRP的数据元素总数。
观察到药物方面的差异百分比为42%，慢性合并症为41%，1级药物相互作用为77%，2级药物相互作用为93%，治疗缺口为35%，治疗重复为87%，治疗不足为26%，首选药物清单替代药物为36%，复方产品为42%，烟草使用报告差异为54%。总体而言，在147次CMR中，共识别出4441个数据元素为确认、排除或新发现。在这些数据元素中，56%的数据被确认；23%被排除；21%为新发现。
该研究实现了其目标，即确定使用处方索赔数据和ICD - 9计费数据识别MRP和/或HRP与使用患者报告数据时存在的差异程度。数据显示，差异的存在因类别而异，相对较大，这表明仅根据不完整的数据或仅基于处方索赔和计费数据准确提出建议存在困难。与患者互动的MTM服务对于识别有助于做出更合适决策的信息至关重要。
