Electronic Pharmacotherapy Risk Management - Full Text View

Purpose

The purpose of the Utah ePRM (electronic Pharmacotherapy Risk Management) project is to improve quality and safety of medication use while simultaneously controlling costs and detecting fraud and abuse.

Condition	Intervention
Asthma Mental Health Pain	Behavioral: provider feedback Behavioral: patient intervention Behavioral: Process-level

Study Type:	Observational
Study Design:	Time Perspective: Retrospective
Official Title:	Developing a Utah Pharmacotherapy Risk Management System With an Electronic Surveillance Tool (Utah ePRM)

Resource links provided by NLM:

MedlinePlus related topics: Asthma Health Fraud Mental Health

U.S. FDA Resources

Further study details as provided by University of Utah:

Enrollment:	174000
Study Start Date:	July 2007
Study Completion Date:	March 2010
Primary Completion Date:	March 2010 (Final data collection date for primary outcome measure)

Groups/Cohorts	Assigned Interventions
Pediatric Asthmatics Medicaid beneficiaries ≤21 years of age who meet the HEDIS criteria for persistent asthma	Behavioral: provider feedback The provider-level intervention includes a targeted review of trigger-flagged beneficiaries' drug utilization history and an information packet sent to providers which includes patient-specific pharmacy and medical claims history, patient specific recommendations, and provider comparative profiling. Behavioral: patient intervention The patient intervention arm includes the provider-level intervention mentioned above in addition to Medication Therapy Management Services (MTMS), a program that provides patients one-on-one therapy counseling administered by community pharmacists who have completed an MTMS certificate program. Behavioral: Process-level The process-level intervention includes the provider-level intervention plus in-clinic evidence-based quality improvement workshops with opportunity for CME credit
Antipsychotic Therapy Medicaid beneficiaries ≥18 years of age and enrolled ≥6 months of the past 12 months with enrollment in at least one of the past 3 months and ≥3 antipsychotic Rx within past 12 months	Behavioral: provider feedback The provider-level intervention includes a targeted review of trigger-flagged beneficiaries' drug utilization history and an information packet sent to providers which includes patient-specific pharmacy and medical claims history, patient specific recommendations, and provider comparative profiling. Behavioral: patient intervention The patient intervention arm includes the provider-level intervention mentioned above in addition to Medication Therapy Management Services (MTMS), a program that provides patients one-on-one therapy counseling administered by community pharmacists who have completed an MTMS certificate program. Behavioral: Process-level The process-level intervention includes the provider-level intervention plus in-clinic evidence-based quality improvement workshops with opportunity for CME credit
Bipolar Therapy Medicaid beneficiaries ≥18 years of age and enrolled ≥6 months of the past 12 months with enrollment in at least one of the past 3 months and a diagnosis of Bipolar in past 3 years, and ≥ 1 antidepressant Rx in past 6 months, and no mood stabilizer in past 6 months.	Behavioral: provider feedback The provider-level intervention includes a targeted review of trigger-flagged beneficiaries' drug utilization history and an information packet sent to providers which includes patient-specific pharmacy and medical claims history, patient specific recommendations, and provider comparative profiling. Behavioral: patient intervention The patient intervention arm includes the provider-level intervention mentioned above in addition to Medication Therapy Management Services (MTMS), a program that provides patients one-on-one therapy counseling administered by community pharmacists who have completed an MTMS certificate program. Behavioral: Process-level The process-level intervention includes the provider-level intervention plus in-clinic evidence-based quality improvement workshops with opportunity for CME credit
Opioid Therapy Medicaid beneficiaries ≥18 years and enrolled ≥6 of prior 12 months with enrollment in ≥1 of prior 3 months and ≥1 opioid fill in prior 3 months and none of the following in prior 12 months: Hospice CPT code or Primary diagnosis of cancer or Oncology CPT code	Behavioral: Process-level The process-level intervention includes the provider-level intervention plus in-clinic evidence-based quality improvement workshops with opportunity for CME credit
Fraud and Abuse Medicaid beneficiaries who filled at least 3 opioid Rx in the last 12 months
Pediatric Antipsychtotic Therapy Medicaid beneficiaries <18 years of age with at least 3 antipsychotic Rx's in the past year.

Detailed Description:

The ePRM project has two objectives:

Refine and implement a computerized surveillance and trigger tool to support medication therapy and risk management services. The ePRM tool will be used to (1) identify potential drug-therapy problems, which include quality, safety and cost-related problems; (2) select patients and providers for in-depth clinical reviews and possibly direct intervention (i.e., letter, phone call, Medication Therapy Management Services (MTMS), or Academic Detailing); (3) identify potential fraud and diversion of controlled substances; and (4) track patterns of medication use and evaluate ePRM performance, identify improvements, and direct policy change.
Conduct innovative multi-pronged interventions that are guided by the ePRM trigger tool. Clinical areas chosen for review include diabetes therapy, hypertension, asthma, antipsychotic therapy, pain management (opioid narcotics and anticonvulsants) and anticoagulation/antiplatelet drugs. Interventions in these areas will address potential under and overuse, or patient safety concerns. Clinical pharmacists and physicians will implement five types of inter-related interventions: a) provider level reviews, which includes prescribers' profiling and feedback for outlier prescribers; b) patient level reviews and letters to prescribers for high-risk patients; c) phone consultation and Academic Detailing with outlier prescribers; d) MTMS; and e) detecting and pursuing suspected fraud and abuse cases.

Eligibility

Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No
Sampling Method:	Non-Probability Sample

Study Population

all medicaid recipients in the salt lake area

Criteria

Inclusion Criteria:

All medicaid recipients and providers with in the salt lake area

Exclusion Criteria:

each participant much be a Medicaid recipient

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00828490

Locations

United States, Utah
Multi-clinic site
Salt Lake City, Utah, United States

Sponsors and Collaborators

University of Utah

Utah Department of Health

Investigators

Principal Investigator:	Jonathan R Nebeker, M.D., M.S.	VASLCHCS
Principal Investigator:	Gary Oderda, PharmD, M.P.H.	University of Utah

More Information

No publications provided

Responsible Party:	Jonathan Nebeker MD, University of Utah
ClinicalTrials.gov Identifier:	NCT00828490 History of Changes
Other Study ID Numbers:	24987, 7570516-1
Study First Received:	January 23, 2009
Last Updated:	March 21, 2010
Health Authority:	United States: Institutional Review Board

Keywords provided by University of Utah:

Fraud and Abuse
opioids

Additional relevant MeSH terms:

Asthma
Bronchial Diseases
Respiratory Tract Diseases
Lung Diseases, Obstructive
Lung Diseases
Respiratory Hypersensitivity
Hypersensitivity, Immediate
Hypersensitivity
Immune System Diseases
Antipsychotic Agents
Analgesics, Opioid

Tranquilizing Agents
Central Nervous System Depressants
Physiological Effects of Drugs
Pharmacologic Actions
Central Nervous System Agents
Therapeutic Uses
Psychotropic Drugs
Analgesics
Sensory System Agents
Peripheral Nervous System Agents

ClinicalTrials.gov processed this record on June 17, 2013

Electronic Pharmacotherapy Risk Management (ePRM)