Medication-Related Problems Identified by Pharmacists in an Enhanced Medication Therapy Management Model

Objectives: To describe the types of clinically actionable medication-related problems (MRPs) identified and the types of resolving recommendations issued by pharmacists using an advanced clinical decision support system (CDSS) for Medicare Part D beneficiaries. Study Design: Retrospective cross-sectional study. Methods: We examined frequencies of MRPs and recommendations for beneficiaries who received a first-ever medication safety review (MSR) during plan years 2018-2019. MRPs were considered clinically actionable if implementation of a recommendation would alter the medication regimen. Results: Pharmacists identified >= 1 clinically actionable MRP for 82.4% (18,703/22,696) beneficiaries receiving an MSR. Among these beneficiaries, 36,455 MRPs were identified (mean [SD] number of MRPs: 1.9 [1.0]). "Adverse drug reaction" (n = 14,788; 40.6%), "drug interaction" ( n = 9716; 26.7%), and "medication use without indication" (n = 6496; 17.8%) represented 85.0% of all MRPs. "Start alternative therapy" was most frequently recommended to resolve "adverse drug reactions" (6724/14,788; 45.5%), followed by "change time of administration" to resolve "drug interactions" (5189/9716; 53.4%) and "discontinue medication" to resolve "drug use without indication" (5718/6496; 88.0%). Overall, "start alternative therapy" (n = 12,219) and "discontinue medication" (n = 12,059) made up 66.6% of all recommendations. Conclusions: In Medicare Part D beneficiaries, pharmacists using an advanced CDSS identified a substantial number of MRPs pertaining to medication safety and issued recommendations to decrease the risk of adverse drug events.