Evaluation of the Iowa MedicaidPharmaceutical CaseManagement Program

To test the effect of pharmaceutical case management (PCM) on medication safety and health care utilization. Prospective cohort design with 9-month follow-up period (enrollment from October 1, 2000, through July 1, 2001, with follow-up through July 1, 2002). Iowa Medicaid program. 2,211 non institutionalized, continuously eligible Iowa Medicaid patients taking four or more chronic medications including at least one agent commonly used in at least 1 of 12 specific diseases who were cared for by pharmacists in 117 pharmacies. Reimbursement for PCM services (initial patient assessment, written recommendations to physician, follow-up assessments and communication of progress and new problems to physician). Use of high-risk medications, Medication Appropriateness Index (MAI) score, health care utilization. Pharmacists in 114 pharmacies had eligible patients during at least one quarter during the study period; 28 pharmacies were classified as high intensity based on the number of PCM patients they managed. A total of 524 of the eligible patients received 1,599 PCM services; 90% of claims were filed by pharmacists, and the remainder by physicians. Nearly one half (46.1%) of medication sand 92.1% of patients had at least one medication problem before PCM. By closeout, the percentage of medications with problems decreased in8 of 10 MAI domains for those who received PCM. Compared with baseline, mean MAI score improved significantly from 9.4 to 8.3 among PCM recipients (P