The role of consultant pharmacists in reducing medication problems among older adults receiving Medicaid waiver services.

OBJECTIVE: To evaluate the impact of an evidence-based, medication management intervention to reduce four targeted medication problems among older adults at risk for placement in a nursing facility.

DESIGN: A pretest-posttest design.

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, 65 years of age and older, enrolled in MSSP between June 2004 and January 2006.

INTERVENTION: In collaboration with care managers, consultant pharmacists confirmed medication problems, developed individualized treatment plans, recommended changes, and communicated recommendations to prescribing physician(s), care managers, and participants/caregivers.

MAIN OUTCOME MEASURES: Change in participant's medication at three-month follow-up.

RESULTS: Twenty-six percent (n=162) had a confirmed medication problem, and of those, 61% had at least one medication changed at three-month follow-up. Change rates for each medication problem ranged from 46% to 68%. Thirty-seven percent had two or more confirmed medication problems, and those with multiple medication problems had greater opportunity to realize at least one medication change. Pharmacists communicated with physicians, care managers, and participants/caregivers at varying levels; however, in 22 cases where all three parties were contacted, change rate was 73%.

CONCLUSION: Findings illustrate that consultant pharmacist services, in collaboration with other community-based providers, can reduce medication problems for vulnerable community-dwelling elders using well-defined criteria. There are policy implications for cost and reimbursement mechanisms that may increase identification and resolution of medication problems among older adults in Medicaid waiver services.