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      The Effectiveness of Pharmacist-Provided Telephonic Medication Therapy Management on Emergency Department Utilization in Home Health Patients

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          Abstract

          Background: Preventable emergency department (ED) use may be targeted with interventions for improving the medication use process, as medication misadventures and nonadherence frequently cause preventable ED utilization. One intervention that could prevent ED visits is medication therapy management (MTM). Objective: To evaluate the effectiveness of a telephonic MTM service on reducing ED utilization within a Medicare-insured home health population. Methods: This was a secondary analysis of data from a cluster-randomized controlled trial examining hospitalizations among Medicare-insured patients within 40 randomly selected, geographically diverse, home health centers. The intervention consisted of an initial telephonic medication reconciliation with a pharmacy technician, a telephonic pharmacist-provided medication review, and follow-up pharmacist phone calls. The primary outcome of this analysis was 60-day all-cause ED utilization. Patients’ baseline risk of ED utilization was calculated, and patients were stratified into quartiles based on their baseline risk of ED utilization. Adjusted odd ratios of ED utilization were calculated. Results: Data from 656 patients (intervention n = 297, usual care n = 359) were available for this study. Overall, the MTM intervention was not associated with 60-day ED use, as 24.4% of intervention patients and 25.1% of usual care patients utilized the ED (adjusted odds ratio = 1.11; 95% confidence interval = 0.79-1.57). However, there was lower ED utilization among patients in the lowest risk-quartile (adjusted odds ratio = 2.52; 95% confidence interval = 1.15-5.49; P = .02). Conclusion: This pharmacist-delivered telephonic MTM program did not decrease ED utilization overall in a Medicare-insured home health population, but may further reduce the risk of ED utilization among patients who are at lower risk of utilization.

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          Author and article information

          Journal
          J Pharm Technol
          J Pharm Technol
          PMT
          sppmt
          The Journal of pharmacy technology : jPT : official publication of the Association of Pharmacy Technicians
          SAGE Publications (Sage CA: Los Angeles, CA )
          8755-1225
          1549-4810
          22 July 2016
          October 2016
          : 32
          : 5
          : 179-184
          Affiliations
          [1 ]Nova Southeastern University, Fort Lauderdale, FL, USA
          [2 ]Purdue University, Indianapolis, IN, USA
          [3 ]University of British Columbia, Vancouver, British Columbia, Canada
          Author notes
          [*]Stephanie A. Gernant, Nova Southeastern University College of Pharmacy, 3301 College Ave, Fort Lauderdale, FL 33314, USA. Email: sgernant@ 123456nova.edu
          Article
          PMC5600472 PMC5600472 5600472 10.1177_8755122516660376
          10.1177/8755122516660376
          5600472
          28924623
          bd6e9bc6-2604-4b22-97dc-732ebf0cfc35
          © The Author(s) 2016
          History
          Categories
          Research Reports

          medication therapy management,medication safety,managed care,outcomes research/analysis,home care services

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