Medication management for complex patients in primary care: application of a remote, asynchronous clinical pharmacist model

Figures & data

Table 1. Inclusion and exclusion criteria

INCLUSION CRITERIA

UHC Medicare Advantage Members with a Pharmacy Benefit Part D (MAPD)

Taking 5 or more medications

2 or more visits to American Health Network in 2018

Continuous enrollment in United Health Care health plan for at least 1 year

2 or more chronic conditions within the past year

3 or more distinct GPI (Generic Pharmaceutical Identifier) 2 Digit drug classes OR 5 or more distinct NDC (National Drug Code) drugs within the past year

3 or more distinct prescribing NPIs (National provider Identifiers) within the past year

≥ 5,000 USD in total medical spend in the last year

Willing and able to provide verbal informed consent

EXCLUSION CRITERIA

Highest 1% of medical cost of care for population in last year

End stage renal disease

Table 2. Types of drug therapy problems

INDICATION

Unnecessary Drug Therapy

Needed Additional Therapy

EFFECTIVENESS

More Effective Drug Available

Dosage Too Low

SAFETY

Adverse Drug Reaction

Dosage Too High

COMPLIANCE

Figure 1. Member engagement metrics

Table 3. Participant characteristics

	Member Count	Percent
Age Group
40–49	6	3%
50–59	9	4%
60–69	49	24%
70–79	88	44%
80–89	45	22%
>90	5	2%
Gender
Female	118	58%
Male	84	42%
Ethnic/racial White 15,275% Nonwhite 8 4% Unavailable 42 21% Elixhauser Mortality Score
0–4	125	62%
5–9	27	13%
10–14	20	10%
15–19	10	5%
20–24	8	4%
25–29	6	3%
30–34	3	1.5%
>34	3	1.5%
A Provider Visit Count
2–5	53	26%
6–10	84	42%
11–15	41	20%
16–20	16	8%
>20	8	4%
National Provider Identifiers (NPI) Count
3–5	99	49%
6–10	92	46%
>10	11	5%
Medication Count
5–10	108	53%
11–15	79	39%
16–20	15	7%
Generic Pharmaceutical Identifier (GPI) Count
5–10	51	25%
11–15	88	44%
16–20	47	23%
21–25	15	7%
>25	1	<1%

Figure 2. Drug therapy problem waterfall: Initial engagement. Confirmation of resolution included provider communication via EMR, patient report and claims medication data

Figure 3. Drug therapy problems by type (n = 438)