Improve drug safety
for your Medicare patients in Texas

By the TMF Health Quality Institute

Drug-related problems are common in older adults. Senior patients often see several physicians, all prescribing different medications, and communication is not always what it should be. As part of a contract with the Centers for Medicare and Medicaid Services, TMF is offering to Texas physicians, at no charge, quality-improvement assistance for increasing drug safety for Texas Medicare patients. “Elderly patients are often prescribed multiple medications, increasing the possibility of adverse drug interactions. They also may have health conditions that make the use of certain drugs problematic,” says Jim Turpin, TMF Health Quality Institute pharmacy quality improvement consultant.

The Part D Drug Safety Project, sponsored by CMS, is a Texas initiative that has two components. One component targets potentially inappropriate medications, or PIMs, including specific narcotics, antihistamines and skeletal muscle relaxants that may lead to falls and fractures in the elderly. The second component targets warfarin and amiodarone as a “high-risk” adverse drug-on-drug interaction, or DDI, that is preventable.

Main objectives of the Part D Drug Safety Project are improved drug safety and a better quality of life for Texas Medicare patients, fewer emergency department visits and inpatient hospitalizations, and lower mortality and co-morbidity rates. Benefits of the Part D Drug Safety Project to physician practices are multi-faceted and include:

• Tools and guidance on quality improvement methods related to drug safety;
• Personalized data reports showing prescriptions for potentially inappropriate narcotics, antihistamines, and skeletal muscle relaxants;
• Personalized data reports listing individual patients who have been prescribed both warfarin and amiodarone;
• Use of anticoagulation clinics to improve patient outcomes and satisfaction rates; and
• The ability to network with peers, share interventions and discuss Medicare Part D data through teleconferences facilitated by TMF.

Information, tools and guidance to help prevent adverse drug events

As a Texas Medicare provider, you are entitled to access no-cost information and resources included in the Part D Drug Safety Project on the TMF Web site. For example, you can find an alternative drug list tool that itemizes drug class (generic and brand name) and possible safer drug alternatives.

Other examples of helpful information are medication discrepancy checklists and written materials that provide training on evidence-based guidelines. Guidelines for warfarin treatment are included from AAFP, the American Heart Association and the American College of Chest Physicians.

Additional assistance may also be provided in the form of on-site visits and consultation from a TMF technical advisor, Web-based instruction and conference calls.

Access to Medicare data

One of the most valuable tools that TMF provides is access to your Medicare data, allowing you to benchmark your performance. TMF will furnish those physicians participating in the Part D Drug Safety Project information on Part D prescriptions for potentially inappropriate narcotics, antihistamines and skeletal muscle relaxants to help you determine how often you prescribe PIMs and alternative medications.

Using these reports may help you avoid costly errors, not only in terms of the toll that errors may take on your patients’ health, but also the potential medical expense to both patient and provider that may result from further patient complications if PIMs and DDIs go unaddressed.

Anticoagulant clinics

Some practices that participate in the Part D Drug Safety Project will have the opportunity to use anticoagulant clinics as a means of increasing international normalized ratio (INR) testing, resulting in better outcomes for the patient.1 There are currently more than 70 anticoagulant clinics in Texas. These clinics relieve physicians of the burden of ensuring medications are within proper criteria levels (such as INR ranges). Use of anticoagulant clinics can also reduce thromboembolic events for patients taking warfarin. In addition, the use of anticoagulant clinics has the potential to prevent hospitalizations and emergency department events, thus reducing overall costs in these areas. And finally, anticoagulant clinics generally offer quick and convenient visits, leading to greater patient satisfaction.

Opportunity to network with peers

As a participant in TMF’s Part D Drug Safety Project, physicians will have the chance to share PIM and DDI quality improvement ideas, concerns and successes through TMF-sponsored teleconferences. Evidence indicates that professionals working together collaboratively with a cooperative exchange of resources and information achieve greater improvements more quickly than if they had worked alone.

Positive patient change

“Those physicians who participate in the Part D Drug Safety Project will have the advantage of being part of a leading-edge national CMS initiative and will be furnished with an evidence-based means of bringing about positive change to improve the quality of life among their elderly Medicare patients,” Turpin says. In addition, they will have the potential to greatly reduce adverse drug events that lead to emergency department and hospital inpatient admissions. For more information, visit the TMF website at http://PartDDrugSafety.tmf.org.

If you are a physician interested in working with TMF on the Part D Drug Safety Project, please contact Jim Turpin, pharmacy quality improvement consultant, at (512) 334-1644 or jturpin@txqio.sdps.org.

References

1. Chamberlain, M, Sageser, N, Ruiz, D. “Comparison of Anticoagulant Clinic Patient Outcomes with Outcomes from Traditional Care in a Family Medicine Clinic.” Journal of the American Board of Family Practice. 2001; 14 (1): 16-21.

TMF Health Quality Institute is the designated Medicare Quality Improvement Organization for Texas. Visit them online at www.tmf.org.