Frequency and severity of medication related problems identified in community dwelling Medicare beneficiaries: Three year analyses of mobile clinic data

background: Medication therapy management (MTM) is a process used to identify and prevent medication related problems (MRPs); thereby optimizing drug therapy. Many Medicare beneficiaries are more vulnerable to MRPs due to their complex medication regimens. We sought to examine the frequency and severity of MRPs through the provision of MTM services from 2012 to 2014. We also recorded prescriber acceptance of recommendations made.

methods: Thirty-nine Mobile Clinics targeting Medicare beneficiaries were conducted in Northern/Central California between Fall 2012-Fall 2014. Trained student pharmacists, supervised by licensed pharmacists, provided beneficiaries with comprehensive MTM services. Demographic, medical history, medication use data, and type and frequency of MRPs were recorded. With permission, severe MRPs and suggestions for resolution were communicated to the beneficiary’s prescriber(s). Prescriber follow-up helped determine acceptance of recommendations.

results: Of 2,099 beneficiaries assisted during the three year period, 1,217 (58.0%) had at least one MRP identified. Furthermore, 242 (11.5%) had one or more severe MRP, of which 186 (86.1%) were resolved by the prescriber. The number of MRPs was significantly positively correlated with the number of chronic disease states, prescriptions, and over-the-counter medications taken. Dual-eligible beneficiaries, those with less formal education, and non-English speakers were also significantly more likely to have a severe MRP.

conclusion: Many Medicare beneficiaries may have MRPs which can be easily addressed. Moreover, certain vulnerable beneficiary subgroups are at increased risk of suffering from a severe MRP. Improved communication between the pharmacist, beneficiary, and their prescriber can potentially have a significant positive impact on health outcomes.