142nd APHA Annual Meeting and Exposition

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Healthcare provider utilization and patient outcomes: The call for enhanced coordinated care for Medicare beneficiaries

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Yvonne Mai, PharmD, MS Candidate 2015 , Thomas J Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
Rajul A. Patel, PharmD, PhD , Department of Pharmacy Practice, School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
Suzanne M. Galal, PharmD , Department of Pharmacy Practice, School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
Sian M. Carr-Lopez, PharmD , Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
Joseph A. Woelfel, PhD, RPh , Department of Pharmacy Practice, School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
  
Background: The use of complementary and alternative medicine (CAM) and other non-physician health care providers (dentists, optometrists, etc.) has steadily increased in the United States; however, the associated outcomes reported in the Medicare population is limited.

Objective: To evaluate the utilization of different healthcare providers by Medicare beneficiaries and assess resultant patient outcomes.

Methods: Fourteen outreach events targeting Medicare beneficiaries were conducted throughout Northern/Central California during the 2014 open enrollment period. Trained student pharmacists (working under licensed pharmacist supervision) provided beneficiaries with comprehensive medication therapy management (MTM) services. During each intervention, demographic, quality-of-life, health behavior, and health provider/service utilization data were collected. 

Results: Of 620 respondents, 525 (84%) and 84 (14%) reported using at least one non-physician healthcare professional or CAM provider, respectively. Beneficiaries who reported using non-physician healthcare providers were significantly (p<0.05) more likely to indicate being  ‘very confident’ in managing their chronic health conditions. The number of providers seen with prescriptive authority was correlated with the number of prescription medications taken (rs=0.342, p<0.001). The total number of providers seen was correlated with the number of drug related issues identified (rs= 0.179, p<0.001). Beneficiaries using acupuncturists were significantly (p<0.05) less likely to report having chronic pain.

Conclusion: Many beneficiaries have multiple chronic conditions and increasingly utilize a variety of healthcare professionals. As such,  bridging the communication chasm between these professionals can improve humanistic outcomes and minimize medication related issues of Medicare beneficiaries. Coordinated care, a key strategy for improving healthcare delivery under the Affordable Care Act, is a step in the right direction.

Learning Areas:

Provision of health care to the public
Public health or related research

Learning Objectives:
Describe the humanistic and clinical outcomes associated with the use of various healthcare providers. Discuss the role of care coordination in improving outcomes.

Keyword(s): Outcomes Research, Medicare

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been involved in previous research endeavors focusing on healthcare outcomes in the Medicare population during the course of my pharmacy education. Currently, I am pursuing a Fellowship/MS program in pharmacoeconomics, healthcare outcomes, and clinical services.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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