Pharmacoinformatics-enabled Interventions Improved Care Coordination and Identified Pharmacy-Related Safety Issues in a Multicultural Medicare Population

TL;DR

A pharmacoinformatics program improved care for multicultural Medicare patients by identifying medication issues and enhancing coordination.

Contribution

A novel pharmacoinformatics approach was applied to improve medication safety and care coordination in a multicultural Medicare population.

Findings

Pharmacovigilance identified 258 acute events requiring care escalation in 3,265 members.

Outreach to members and providers addressed medication adherence gaps and safety issues.

The program improved risk stratification and efficiency in multidisciplinary care workflows.

Abstract

Background
 Compared to White populations, multicultural older adults experience more gaps in preventive care (e.g., vaccinations, screenings, chronic condition monitoring), social determinants of health barriers (e.g., access to care, language, transportation), and disparities and inequities (e.g., comorbidities, disease burden, and health care costs).

Objectives
 This study aims to describe an informatics-based approach used to execute and evaluate results of a member-centric, pharmacoinformatics-informed engagement program to deliver culturally tailored microinterventions to close medication-related gaps in care utilizing multidisciplinary care coordination that leverages the expanded role of the pharmacist. The operational framework will be described, and the influence of the medication use processes will be reported in a multicultural Medicare Advantage cohort.

Methods
 A pharmacoinformatics framework was leveraged to conduct a retrospective, observational cohort analysis of the program. Claims data were used to evaluate the influence of medication use process microinterventions from a large Medicare Advantage cohort of members who self-identify as Black and/or Hispanic, and have type 2 diabetes mellitus and/or hypertension, and meet eligibility criteria for multidisciplinary (e.g., nursing and pharmacy) care management (CM) and received pharmacy referral from January 1, 2022, through September 30, 2023.

Results
 A total of 3,265 Medicare Advantage members (78.3% Black and 21.7% Hispanic) received CM and pharmacy referral. Pharmacovigilance reviews conducted during this timeframe identified 258 acute events that escalated member CM. Provider outreach (
n
 = 185) informed of safety issues (drug duplication,
n
 = 48; drug interactions,
n
 = 21; drug–disease interactions,
n
 = 5; noncompliance and/or dosing issues,
n
 = 27). Outreach to members (
n
 = 160) and providers (
n
 = 164) informed of open quality-related measure gaps for medication adherence.

Conclusion
 The application of pharmacoinformatics by a payor-led multicultural clinical program demonstrated quality improvements in Medicare Advantage member identification including risk stratification, timely outreach for pharmacy-related safety issues, and improved efficiency of multidisciplinary care coordination involving medication use process workflows.

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