Safety Promoting Behaviors: An Innovative and Feasible Method to Determine the Effectiveness of a Pharmacy Benefit Management Program

Program: The UMWA Health and Retirement Funds developed the MineRx Program to support primary care physicians (PCPs) in their efforts to enhance the quality and effectiveness of drug therapy provided to frail elderly patients. The core of the Program is a Patient Medication List (PML) delivered quarterly to participating practitioners for each Funds beneficiary in their practice. The PML apprises the PCP of every medication prescription filled for the beneficiary in the preceding four months, including the identity of the prescriber. The Program developed and provided to participating PCPs a list of 26 Target Drugs and Drug Patterns (TDP List) known to pose risks for the elderly, and a TDP Handbook, describing the TDPs and offering strategies for managing associated risks. A Drug Resource Center is available to PCPs as a resource for drug-specific information, consultations or referring patients into medication-related care coordination.

Methods: Using the TDP Handbook, literature and expert consensus, we identified safety promoting behaviors (SPBs), clinical actions and strategies that could be objectively observed after a TDP is indentified. SPBs include changing the drug or dose, educating the patient/caregiver, or increasing monitoring. We compared patients of participating providers to patients from similar Funds networks in Alabama and three northern West Virginia counties, and to a random sample of 12,000 beneficiaries in the national Funds population. We used Medicare Part A, B, and pharmacy claims data from January 2001–December 2006. The intervention began in June 2003. We used GEE to examine the likelihood of a patient having an SPB performed, controlling for age, sex, comorbidities, group, time and group-time interaction (differential change over time for the intervention versus comparison groups). Models were calculated for each of the 26 TDPs and for groups of TDPs (e.g., warfarin, ACE Inhibitors, Benzodiazepenes, Digoxin).

Results: We found a significant increase in SPB implementation by study group over time for only the warfarin TDP group compared to the national comparison (OR 1.04, 95% CI 1.01-1.06) and the WV/AL comparison groups (OR 1.04, 95%CI 1.01-1.07). Within the warfarin group, the significant findings were driven by improved safety for patients co-prescribed warfarin and NSAIDs (Int. vs. National: aOR 1.04, 95%CI 1.01-1.07; Int. vs. WV/AL: aOR 1.13, 95%CI 1.07-1.18).

Conclusions: The intervention led to important increases in safe warfarin prescribing in the early stages of implementation. SPBs may represent a feasible method using administrative data to evaluate changes in provider behavior following drug safety interventions.