Title: Evaluating the Impact of Clinical Pharmacist Interventions on the New Anticholinergic Measure in a Private Primary Care Setting
Authors: Sarah Emily Strickland, Leah A. Surbaugh, Whitney Aultman
Background: Ambulatory care clinical pharmacists have historically been involved in interventions to improve quality metrics set forth by the Centers for Medicare and Medicaid Services Star Ratings. The Centers for Medicare and Medicaid Services recently established a new star rating which includes patient’s 65 years or older, prescribed and filling 2 or more anticholinergic medications concurrently for 30 days or more on a Medicare Part D plan. The purpose of this study is to evaluate the impact on metric improvement following clinical pharmacists' interventions on the Polypharmacy: Use of Anticholinergic Medications (POLY-ACH) quality metric.
Methods: Patients evaluated for inclusion in the study were identified from data provided by BlueCross BlueShield and Humana Medicare Advantage Plans. Selection of these Medicare Advantage plans was based on those currently monitoring or tracking the anticholinergic metric as well as insurance plans holding a gain share contract with the private care practice site. Patients were included if they were 65 years or older, followed by a primary care provider within State of Franklin Healthcare Associates, which is a physician-led and employee-owned private medical group with over 30 practices across Northeast Tennessee and Southwest Virginia with the majority being internal medicine or family medicine practices. Patients must be prescribed 1 or more anticholinergic medication and there must have been communication of medication recommendations made to the provider from the clinical pharmacist related to the anticholinergic medication prescribed. All patients included needed an appointment scheduled on or before December 31, 2025. Data collection points included patient demographics, baseline and follow up anticholinergic burden score, anticholinergic medication use and duration, prescribing physician, and intervention response. The primary outcome was a composite endpoint of the impact of interventions made by the clinical pharmacist. This included medication changed based on pharmacist recommendations, patient declined alternative therapy despite provider encouragement, or the provider contacted an outside prescriber with alternative recommendation provided by clinical pharmacist. Data analysis included a one-sample proportion test for the primary outcome and descriptive statistics for the secondary outcomes, along with a paired t-test for anticholinergic burden score comparison.
Results: A total of 459 patients were screened for inclusion, and 99 patients were included in final analysis. The average patient was 76 years of age, and a majority of patients were female. The average number of baseline anticholinergic agents for each patient was 1.1. The result for the primary outcome was 73.7%. Most patients had been prescribed the anticholinergic agent for more than a year. The most common anticholinergic class prescribed was antihistamine followed by antidepressant and skeletal muscle relaxant. The average baseline anticholinergic burden score for patients enrolled was 4.6, with the follow up anticholinergic burden score showing a decrease to 3.1.
Conclusions: The results of this study highlight that clinical pharmacist interventions on anticholinergic medications led to an improvement in the Polypharmacy: Use of Anticholinergic Medications (POLY-ACH) quality metric and potentially increased reimbursement rates from Medicare Advantage Plans. The impact from the clinical pharmacist intervention also led to a reduction in patient’s anticholinergic burden score, showing a positive impact on patient outcomes. Future directions include developing educational materials based on prescribing trends identified to influence future prescribing practices.
