Problems Remain in Reviews of Medicaid-Financed Drug Therapy in Nursing Homes

HRD-80-56: Published: Jun 25, 1980. Publicly Released: Jun 25, 1980.

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Medicaid pays for about half of all nursing home care in the United States. To help ensure the quality of that care, the Department of Health, Education, and Welfare (HEW) has set up a number of procedures, including a monthly review of each patient's drugs to determine if they are still needed, effective, and safe for the patient. Because of the major role drugs play in the treatment of elderly patients in nursing homes and the potential hazards of drug therapy, GAO evaluated the effectiveness of the medication review portion of HEW regulations and procedures. The review was limited to the examination of the records of randomly selected Medicaid nursing home patients. It adopted as a standard criteria based on standards developed by five professional standards review organizations.

Using the limited criteria available, GAO found that medication reviews could be more effective if reviewers, pharmacists, or registered nurses had ready access to: (1) a single source of authoritative information on drugs commonly used in treating elderly patients; and (2) a clear definition of the scope of those reviews. Additionally, GAO found that: (1) 81 percent of the estimated Medicaid patients residing in nursing homes were not being tested as frequently as recommended; (2) patients took combinations of tranquilizers and sedatives that a professional standards review organization characterized as inappropriate utilization; (3) some patients took drugs with labels clearly stating that they should not be used for one or more of their medical conditions; (4) some pharmacists were unsure of their qualifications to review medications; (5) pharmacists were inhibited in making drug therapy recommendations; (6) pharmacists performed less comprehensive reviews than suggested in HEW-funded training materials; (7) some registered nurses did not consider all aspects of patient medications; and (8) pharmacists making medication reviews at many of the homes were associated with the retail pharmacies which filled prescriptions for the patients, creating a potential conflict of interest.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of HEW should direct the Administrator, Health Care Financing Administration (HCFA), to: (1) gather the monitoring and usage criteria that have been developed by professional standards review organizations and others for drugs commonly taken by nursing patients and send the criteria that HCFA judges to have merit to every nursing home participating in the Medicare or Medicaid programs, revise and expand the criteria as professional standards review organizations and others gain experience in medication reviews and send these revisions to nursing homes, and share the criteria with the Food and Drug Administration for use in its efforts to improve prescription drug labeling; (2) direct the National Professional Standards Review Council to promote continued development of additional drug-monitoring criteria for drugs commonly used in nursing homes, with particular emphasis on drugs and combinations of drugs for which few or no criteria are currently available; (3) incorporate in nursing home regulations a clear definition of the scope of a medication review for both pharmacists and registered nurses; and (4) issue regulations requiring separation of pharmacist medication review and drug vendor functions whenever feasible.

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