Electronic Pharmacotherapy Risk Management (ePRM)

Utah System of Higher Education (USHE)

Status: Completed

Conditions: Asthma; Pain; Mental Health

Treatments: Behavioral: provider feedback; Behavioral: patient intervention; Behavioral: Process-level

Study type: Observational

Funder types: Other

Identifiers

NCT00828490

24987

7570516-1

Details and patient eligibility

About

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.

Full description

The ePRM project has two objectives:

1. 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.
2. 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.

Enrollment: 174,000 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• All medicaid recipients and providers with in the salt lake area

Exclusion criteria

• each participant much be a Medicaid recipient

Trial design

174,000 participants in 6 patient groups

Pediatric Asthmatics

Description:

Medicaid beneficiaries ≤21 years of age who meet the HEDIS criteria for persistent asthma

Treatment:

Behavioral: patient intervention

Behavioral: Process-level

Behavioral: provider feedback

Antipsychotic Therapy

Description:

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

Treatment:

Behavioral: patient intervention

Behavioral: Process-level

Behavioral: provider feedback

Bipolar Therapy

Description:

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.

Treatment:

Behavioral: patient intervention

Behavioral: Process-level

Behavioral: provider feedback

Opioid Therapy

Description:

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

Treatment:

Behavioral: Process-level

Fraud and Abuse

Description:

Medicaid beneficiaries who filled at least 3 opioid Rx in the last 12 months

Pediatric Antipsychtotic Therapy

Description:

Medicaid beneficiaries \<18 years of age with at least 3 antipsychotic Rx's in the past year.