Craig Kelly J T, Zaleski Amanda L, MacKenzie Shannon M, Butler Brenda L, Youngerman Rebecca A, McNutt Sherrie L, Baquet-Simpson Alena M
Clinical Evidence Development, Aetna® Medical Affairs, CVS Health®, Hartford, Connecticut, United States.
Aetna Medicare Strategic Programs, CVS Health, New York, New York, United States.
Appl Clin Inform. 2024 Mar;15(2):320-326. doi: 10.1055/a-2297-4334. Epub 2024 Apr 1.
Compared to White populations, multicultural older adults experience more gaps in preventive care (e.g., vaccinations, screenings, chronic condition monitoring), social determinants of health barriers (e.g., access to care, language, transportation), and disparities and inequities (e.g., comorbidities, disease burden, and health care costs).
This study aims to describe an informatics-based approach used to execute and evaluate results of a member-centric, pharmacoinformatics-informed engagement program to deliver culturally tailored microinterventions to close medication-related gaps in care utilizing multidisciplinary care coordination that leverages the expanded role of the pharmacist. The operational framework will be described, and the influence of the medication use processes will be reported in a multicultural Medicare Advantage cohort.
A pharmacoinformatics framework was leveraged to conduct a retrospective, observational cohort analysis of the program. Claims data were used to evaluate the influence of medication use process microinterventions from a large Medicare Advantage cohort of members who self-identify as Black and/or Hispanic, and have type 2 diabetes mellitus and/or hypertension, and meet eligibility criteria for multidisciplinary (e.g., nursing and pharmacy) care management (CM) and received pharmacy referral from January 1, 2022, through September 30, 2023.
A total of 3,265 Medicare Advantage members (78.3% Black and 21.7% Hispanic) received CM and pharmacy referral. Pharmacovigilance reviews conducted during this timeframe identified 258 acute events that escalated member CM. Provider outreach ( = 185) informed of safety issues (drug duplication, = 48; drug interactions, = 21; drug-disease interactions, = 5; noncompliance and/or dosing issues, = 27). Outreach to members ( = 160) and providers ( = 164) informed of open quality-related measure gaps for medication adherence.
The application of pharmacoinformatics by a payor-led multicultural clinical program demonstrated quality improvements in Medicare Advantage member identification including risk stratification, timely outreach for pharmacy-related safety issues, and improved efficiency of multidisciplinary care coordination involving medication use process workflows.
与白人人群相比，多元文化背景的老年人在预防保健（如疫苗接种、筛查、慢性病监测）、健康的社会决定因素障碍（如就医机会、语言、交通）以及差异和不平等（如合并症、疾病负担和医疗费用）方面存在更多差距。
本研究旨在描述一种基于信息学的方法，该方法用于执行和评估以会员为中心、药物信息学指导的参与计划的结果，以提供文化定制的微干预措施，利用多学科护理协调来弥合与药物相关的护理差距，其中多学科护理协调利用了药剂师扩大的作用。将描述操作框架，并报告药物使用过程在多元文化医疗保险优势队列中的影响。
利用药物信息学框架对该计划进行回顾性观察队列分析。索赔数据用于评估药物使用过程微干预措施的影响，这些微干预措施来自一个大型医疗保险优势队列的成员，这些成员自我认定为黑人或西班牙裔，患有2型糖尿病和/或高血压，并且符合多学科（如护理和药学）护理管理（CM）的资格标准，并在2022年1月1日至2023年9月30日期间接受了药学转诊。
共有3265名医疗保险优势成员（78.3%为黑人，21.7%为西班牙裔）接受了CM和药学转诊。在此期间进行的药物警戒审查确定了258起急性事件，这些事件升级了会员的CM。向提供者 outreach（=185）通报了安全问题（药物重复，=48；药物相互作用，=21；药物与疾病相互作用，=5；不依从和/或给药问题，=27）。向会员（=160）和提供者（=164）outreach通报了与药物依从性相关的开放质量指标差距。
由付款人主导的多元文化临床计划应用药物信息学，在医疗保险优势成员识别方面显示出质量改进，包括风险分层、及时就与药学相关的安全问题进行 outreach，以及提高涉及药物使用过程工作流程的多学科护理协调效率。
