JOURNAL ARTICLE

Characteristics associated with four potential medication problems among older adults in Medicaid waiver services

Gretchen E Alkema, Kathleen H Wilber, Dennee Frey, Susan M Enguidanos, W June Simmons
Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists 2008, 23 (5): 396-403
18540793

OBJECTIVE: To identify characteristics associated with four potential medication problems among older adults at risk for nursing home placement.

DESIGN: Cross-sectional survey.

SETTING: Three sites of California's Multipurpose Senior Services Program (MSSP), a Medi-Cal waiver care management program.

PARTICIPANTS: Six hundred fifteen dual-eligible, functionally impaired, community-dwelling adults aged 65 years and older enrolled in MSSP between June 2004 and January 2006.

INTERVENTION: Medication screening using the Home Health Criteria that include medication use and clinical risk factors.

MAIN OUTCOME MEASURES: Demographic and health characteristics associated with four problem types: 1) unnecessary therapeutic duplication, 2) psychotropic medication use with concurrent falls or confusion, 3) cardiovascular medication problems, and 4) use of nonsteroidal anti-inflammatory drugs (NSAIDs) with risk of peptic ulcer complications. Independent measures included age, gender, race/ethnicity, living arrangement, number of medications, health status, and utilization.

RESULTS: Each problem type was associated with different characteristics, as identified by logistic regression modeling. Increased number of medications was associated with therapeutic duplication (odds ratio [OR] = 1.27; confidence interval [CI] 1.20-1.35; P < 0.001) and problematic psychotropic medication use (OR = 1.15; CI 1.08-1.22; P < 0.001). Psychotropic use was also associated with emergency department, hospital, or skilled nursing admission in the previous year (OR = 1.86; CI 1.15-3.00; P = 0.012), living with someone (OR = 0.57; CI 0.34-0.95; P = 0.032), and new care management enrollment (OR = 1.99; CI 1.22-3.24; P = 0.006). New enrollment was also associated with cardiovascular medication problems (OR = 2.15; CI 1.32-3.51; P = 0.002). There were no significant characteristics associated with NSAID problems (not shown).

CONCLUSION: Unique predictors of potential medication problems highlight the need for systematic medication screening and treatment planning. These should include medication therapy management for vulnerable community-dwelling elders (upon enrollment for care management) and for those taking multiple medications. Funding mechanisms via Medicare Part D (prescription drug program) should be explored in this population to increase identification of medication problems and their resolution.

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