Medication Management
Annual Monitoring for Patients on Persistent Medications
Patient safety is highly important, especially for patients at increased risk of adverse drug events from long-term medication use. Persistent use of these drugs warrants monitoring and follow-up by the prescribing physician to assess for side-effects and adjust drug dosage/therapeutic decisions accordingly. The drugs included in this measure also have potentially more harmful effects in the elderly.
The costs of annual monitoring are offset by the reduction in health care costs associated with complications arising from lack of monitoring and follow-up of patients on long-term medications. The total costs of drug-related problems due to misuse of drugs in the ambulatory setting has been estimated to exceed $76 billion annually.
Appropriate monitoring of drug therapy remains a significant issue to guide therapeutic decision making and provides largely unmet opportunities for improvement in care for patients on persistent medications.
This measure is used to assess the percentage of health plan members 18 years of age and older who received at least a 180-days supply of ambulatory medication therapy for the following medications:
- Angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs)
- Digoxin
- Diuretics
- Anticonvulsants
The results reported include the total rate for the four medications and the rate for each medication.
Potentially Harmful Drug-Disease Interactions in the Elderly
Drug therapy is an essential component of medical treatment for older patients, but medications are also responsible for many adverse events in this group. According to AHRQ almost 90 percent of people 65 years of age or older take at least one medication, significantly more than any other age group. Many older adults take multiple medications for treatment of several conditions, which increases the chance of adverse drug reactions, drug-drug interactions and drug-disease interactions. Adverse drug events have been linked to preventable problems in elderly patients, such as depression, constipation, falls, immobility, confusion and hip fractures.
This measure reports the percentage of Medicare members 65 years of age and older who have evidence of an underlying disease, condition or health concern and who were dispensed an ambulatory prescription for contraindicated medications, concurrent with or after the diagnosis. The total rate is reported and reflects the following:
- A history of falls and a prescription for tricyclic antidepressants, antipsychotics or sleep agents
- Dementia and a prescription for tricyclic antidepressants or anticholinergic agents
- Chronic renal failure and prescription for nonaspirin NSAIDs or Cox-2 Selective NSAIDs
The rate for each measure is also reported. For this measure a lower number is better.
Use of High-Risk Medications in the Elderly
With an increasing focus on patient safety, NCQA introduced new HEDIS patient safety measures assessing the safe use of medications in the Medicare population, in 2006. Certain medications are associated with increased risk of harm from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in the elderly. Studies link prescription drug use by the elderly with adverse drug events that contribute to hospitalization, increased length of hospital stay, increased duration of illness, nursing home placement and falls and fractures that are further associated with physical, functional and social decline in the elderly.
Reducing prescriptions of high-risk drugs in the elderly represents an opportunity to reduce the costs associated with the harm from medications (i.e., hospitalizations from drug toxicity) and encourage clinicians to consider safer, alternative medications. Reducing unnecessary prescribing will also help to reduce cost, given that the elderly population represent one third of all prescription drug expenditures in the U.S. but comprises only 13 percent of the population.
Use of high-risk medications in the elderly (DAE), assesses whether patients 65 and older have filled prescriptions for drugs (such as barbiturates) that have been determined to be harmful to elderly patients. These drugs have been deemed harmful regardless of drug dose, frequency, or patient’s underlying health status and are based on widely used consensus criteria for medication use in older adults. This measure reports two rates:
- The percentage of Medicare members 65 years of age and older who received at least one high-risk medication.
- The percentage of Medicare members 65 years of age and older who received at least two different high-risk medications.
For this measure a lower number is better.
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