Troy Trygstad

Pharmacist engagement in medical home practices: Report of the APhA–APPM Medical Home Workgroup

OBJECTIVES To identify factors that have led to successful involvement of pharmacists in patient-centered medical home (PCMH) practices, identify challenges and suggested solutions for pharmacists involved in medical home practices, and disseminate findings. DATA SOURCES In July 2011, the American Pharmacists Association Academy of Pharmacy Practice & Management convened a workgroup of pharmacists currently practicing or conducting research in National Committee for Quality Assurance-accredited PCMH practices. DATA SYNTHESIS A set of guiding questions to explore the early engagement and important process steps of pharmacist engagement with PCMH practices was used to conduct a series of conference calls during an 8-month period. CONCLUSION Based on knowledge gained from early adopters of PCMH, the workgroup identified 10 key findings that it believes are essential to pharmacist integration into PCMH practices.

A+KIDS, a Web-Based Antipsychotic Registry for North Carolina Youths: An Alternative to Prior Authorization

OBJECTIVE The rise in use of antipsychotics among U.S. children is well documented. Compliance rates with current safety-monitoring guidelines are low. In response, the North Carolina Division of Medical Assistance established the Antipsychotics-Keeping It Documented for Safety (A+KIDS) registry. The initial objectives of the project were to successfully establish a Web-based safety registry and to obtain and evaluate clinical information derived from the registry. METHODS In April 2011, A+KIDS began asking prescribers of antipsychotics for children age 12 and under to respond to a set of questions regarding dose, indication, and usage history. Antipsychotic registrations were examined by linking North Carolina Medicaid prescription claims to registry entries. Prescribers were classified into different types, and the number of patients and registrations per prescriber were examined. RESULTS In the initial six months, 730 prescribers registered 5,532 patients, 19% below age seven. By month 6 of the registry, 72% of all fills were registered with the program. Top diagnosis groups for registry patients were unspecified mood disorders, autism spectrum disorders, and disruptive behavior disorders. Top target symptoms were aggression (48%), irritability (19%), and impulsivity (11%). Psychosis accounted for 5% of the target symptoms. Twenty-eight percent of children were receiving no form of psychotherapy. Twenty-five percent of all A+KIDS prescribers were responsible for 81% of the registrations. CONCLUSIONS The A+KIDS registry initiative has been successful, as measured by rapid uptake, and is providing clinical information not available from claims data alone. Future efforts will allow for detailed examinations of antipsychotic utilization and further safety improvement.

857 – Findings from an online drug monitoring and safety registry for children prescribed antipsychotics

Introduction There is widespread concern over the perceived indiscriminant prescribing of antipsychotic medications in children, particularly for those residing in low-income households or foster care. Ongoing safety and efficacy monitoring is suggested by many professional associations. Objectives Describe reported diagnosis and symptomology for over 15,000 children prescribed antipsychotics in the 17- month period from April 2011 through August 2012. Aims Increase appropriate monitoring of children who are prescribed antipsychotics. Methods A policy was developed by the North Carolina Division of Medical Assistance, in collaboration with Community Care of North Carolina, that requires prescribers to register patients via a web portal before reimbursement is allowed to the pharmacy. Required registration elements include a patients primary diagnosis, target symptom for medication use, initiating prescriber, caregiver support of medication use, adverse drug event reporting, and metabolic monitoring deemed best practice by the literature review. Results From April of 2011 through August 2012, a total of 1,241 prescribers have written 29,691 prescriptions for 15,194 patients in the A+KIDS program. Unspecified Mood Disorder was the first most common representing 22%.of patients. Bipolar Disorder, Autism Spectrum Disorder, and ADHD, followed at 14%, 12%, and 12% respectively. “Aggression towards others,” “Irritability” and “Tantrums/temper” were the most common target symptoms (representing 63.6% of patients).

P-1122 - Transparent evidence-based, physician approved smart drug utilization review

Introduction Childhood use of antipsychotics in the U.S. has grown dramatically over the past decade. In North Carolina (NC), roughly 20 thousand children under the age of 18 covered by Medicaid have filled more than

Pharmacist Response to Alerts Generated From Medicaid Pharmacy Claims in a Long-term Care Setting: Results From the North Carolina Polypharmacy Initiative

40 million in prescriptions for antipsychotics in the last year. Traditionally the primary mechanism of controlling drug use has been through prior authorization and determination of appropriate use through medical and pharmacy claims. Objective Determine if an online safety monitoring system can be successfully deployed without significant prescriber disruption. Aims Increase monitoring and best practice management of undesirable metabolic effects of current treatment regimens. Methods North Carolina Medicaid designed an online safety monitoring system that collects prescribing intentions and monitoring activities for children under the age of 18 and is tied to the pharmacy point-of-sale system. A comprehensive educational effort that included promotion of monitoring best practices and assistance with registration in the online system was endorsed by the professional medical societies and deployed using experts from four medical schools in NC. Data regarding call center activity were collected at the time of support and combined with data from the online documentation system. Claims data were examined to determine delays in time to refill medications. Results By the end of the first three months, the online system had been used by prescribers 87% of the time for antipsychotics with little evidence of delays in filling the scripts.