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GERIATRICS

Prevalence of Potential Medication Problems Among Dually Eligible Older Adults in Medicaid Waiver Services

Postdoctoral Fellow, Veterans Affairs Greater Los Angeles Healthcare System, HSR&D Center of Excellence, Sepulveda, CA; Postdoctoral Research Associate, Andrus Gerontology Center, University of Southern California, Los Angeles, CA

Kathleen H Wilber, PhD

Mary Pickford Foundation Professor of Gerontology, Andrus Gerontology Center, University of Southern California

W June Simmons, LCSW

CEO & President, Partners in Care Foundation, San Fernando, CA

Susan M Enguidanos, PhD

Director of Research, Partners in Care Foundation

Dennee Frey, PharmD

Program Director, Partners in Care Foundation

Reprints: Dr. Alkema, Andrus Gerontology Center, University of Southern California, 3715 McClintock Ave., Los Angeles, CA 90089, fax 213/740-7069, alkema{at}usc.edu

BACKGROUND: Methods for identifying potential medication problems among older adults at risk for nursing home placement have generally not included clinical risk factors in addition to medication lists.

OBJECTIVE: To assess the prevalence of potential medication problems for older adults enrolled in a Medicaid waiver service using tested Home Health Criteria that combine medication use and clinical risk factors for screening drug regimens.

METHODS: A cross-sectional survey screened 615 community-dwelling, dually eligible, functionally impaired adults aged 65 years and older enrolled in a Medi-Cal (California's Medicaid) waiver care management program, California's Multipurpose Senior Services Program (MSSP). Measures included prevalence and predictors of having 1 of 4 potential medication problems: unnecessary therapeutic duplication, use of psychotropic drugs with concurrent falls or confusion, cardiovascular medication problems, and use of nonsteroidal antiinflammatory drugs with risk of peptic ulcer complications.

RESULTS: Forty-nine percent of the sample had a potential medication problem, with unnecessary therapeutic duplication being most prevalent (24%). Nearly 20% of patients screened had 2 or more potential problems. Independent predictors of any potential medication problem were age (OR 1.029; 95% CI 1.01 to 1.05), new MSSP enrollment (OR 1.634; 95% CI 1.14 to 2.35), and number of medications (OR 1.183; 95% CI 1.13 to 1.24).

CONCLUSIONS: Prevalence of potential medication problems in MSSP was markedly higher than reported in the original home healthcare sample used to test the Home Health Criteria. The prevalence rate for older adults at risk for nursing home placement necessitates expanded screening and medication therapy management interventions, especially upon initial enrollment and for those taking multiple medications. Interventions are needed to increase medication problem identification and resolution while promoting collaboration among physicians, consultant pharmacists, and waiver service providers.

Key Words: Dually eligible, Home Health Criteria, inappropriate medication use, Medicaid waiver care management

Published Online, November 6, 2007. www.theannals.com, DOI 10.1345/aph.1K270