Pharmacy Quality Improvement Program

Community Care has developed a comprehensive pharmacy quality improvement program to support our members' recovery. The Pharmacy quality improvement program uses a variety of strategies to improve the quality of behavioral health medication treatment for our members. There is strong focus on implementation of best practices, shared decision making processes between prescribers and members, and care coordination.

Community Care has committed significant resources to its Pharmacy Quality Improvement work. Program Staff include psychiatrists, pharmacists, and data analysts.

Key Pharmacy Quality Initiatives include activities such as:

Reducing the rate of polypharmacy among children and adolescent members

The prescribing of multiple psychotropic medications to children and adolescents during outpatient visits has increased in the last decade. As additional medications are prescribed, the risk of side effects clearly rises. Community Care evaluated the percentage of child and adolescent members on three or more psychotropic medications concurrently. In 2010, the percentage of children receiving 3 or more psychotropic medications for at least 90 days was 4.2% of all children prescribed at least one psychotropic medication.

An educational letter, along with a member profile listing the multiple medications, was mailed to all providers identified as having a pediatric member on three or more psychotropic medications. The letter encouraged physicians to review the medication profile with the member on his or her next visit to ensure that multiple medications are still clinically appropriate. Parents and/or guardians were also sent an educational letter reminding them of information they should know before administering any medication to their child. Attached to the letter was a list of their child's behavioral health medications. Parents/guardians were encouraged to share the medication list with their child's doctors.

Promotion of metabolic monitoring for members on antipsychotic medications

Atypical antipsychotics can cause significant and serious metabolic side effects and recent research suggests that the number of patients receiving recommended blood glucose or lipid testing is low. The intent of this initiative is to increase the rate of metabolic monitoring of members treated with antipsychotic medications. Community Care collaborated with several of the Pennsylvania physical health managed care plans and the Department of Public Welfare on this initiative. Results of the 2010 analysis compared to the 2008 analysis shows very significant improvement in overall metabolic monitoring rates but metabolic monitoring that fully conforms with published guidelines for members newly started on an antipsychotic medication remains low.

Community Care will be sending out provider letters to physicians discussing this low rate and the current recommended guidelines for metabolic monitoring. A member letter will also be mailed out giving our members information on antipsychotics and the importance of proper monitoring and follow-up with their physician. A worksheet will be included in the member mailing for the member to fill out and take with them to their next doctor's visit.

Education on the appropriate use of behavioral health medications in children and adolescents

Due to increased national concerns regarding the safety and off-label use of antipsychotic medications in children, Community Care was interested in the utilization rates among our pediatric and adolescent members in the Pennsylvania HealthChoices counties. Results showed that about 3% of these members received at least one prescription for an antipsychotic medication during the fourth quarter of 2009. This is a slight decrease compared to number of pediatric and adolescent members who received antipsychotic medications during the fourth quarter of 2008. Most of the children who received antipsychotic medications received them from psychiatrists and also received concurrent behavioral health services.

Surveys were sent to providers in order to gain a better understanding of the rationale for prescribing the antipsychotic medications and to check the accuracy of diagnostic claims. A provider education letter discussed recommended clinical practice guidelines, highlighted the significant medical risks associated with antipsychotic medication use in children and adolescents, and the importance of metabolic monitoring. Additional information has been provided to members.

Efforts to improve medication adherence after discharge

Community Care previously evaluated the medication adherence of Medicaid members after being discharged from an inpatient psychiatric facility. Results of the analysis found that about 25% of members did not have any psychotropic medication filled within 5 weeks after discharge. Approximately 50% of the members who were readmitted within 30 days of discharge did not have any medication filled prior to the readmission. To promote medication adherence, Care Managers now routinely ask about behavioral health medications during outreach phone calls to members recently discharged from an inpatient facility.