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Individualized medication assessment and planning: optimizing medication use in older adults in the primary care setting.

Roth MT, Ivey JL, Esserman DA, Crisp G, Kurz J, Weinberger M. Individualized medication assessment and planning: optimizing medication use in older adults in the primary care setting. Pharmacotherapy. 2013 Aug 1; 33(8):787-97.

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Abstract:

STUDY OBJECTIVE: To test the feasibility and effectiveness of an individualized Medication Assessment and Planning (iMAP) program integrated within a primary care practice on the number and prevalence of medication-related problems (MRPs) and acute health services utilization, defined as combined hospitalizations and emergency department visits. DESIGN: Six-month, prospective, observational pilot study. SETTING: Community-based primary care medical practice. PATIENTS: Convenience sample of 64 patients aged 65 years and older who were taking at least five medications. INTERVENTION: Each patient was enrolled in the iMAP program-a collaborative, multifaceted intervention facilitated by a clinical pharmacist whereby patients receive comprehensive medication therapy management at baseline and 3 and 6 months as part of routine clinical care. MEASUREMENTS AND MAIN RESULTS: MRPs were assessed and recommendations proposed using the previously published MRP classification tool; physician acceptance of recommendations served to validate the assessments. There was a significant reduction in mean number of MRPs/patient (4.2 at baseline vs 1.0 at 6 mo, p < 0.0001) when adjusted for number of medications, race, and pharmacist. The prevalence of MRPs at 6 months compared with baseline was also significant (p < 0.0008). Acute health services utilization was assessed by medical record abstraction. The 64 patients experienced a rate of 8.3 events/100 person-months (64 total events) during the 12-month prestudy period. During the 6-month study period, the same patients experienced 5.4 events/100 person-months (20 total events). Thus, we noted a reduction in acute health services utilization of 35%. Physicians were enthusiastically supportive of iMAP. CONCLUSION: iMAP has the potential to address a significant and timely issue affecting older adults and primary care practices: the burden of managing and continuously monitoring multiple medications in medically complex older adults. A more rigorous evaluation of iMAP is warranted and planned to demonstrate sustained effectiveness and cost-benefit.





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