Medication therapy management (MTM) may be optimized if pharmacists engaged in health information exchange (HIE) by reviewing unedited medical records. In this nonblinded, randomized, controlled pilot, pharmacists delivered a part of MTM, comprehensive medication reviews (CMRs), to adult patients in a practice-based research network (PBRN). Intervention community pharmacists solicited the last 6 months of patients’ primary care provider-held, unedited medical records. The primary and secondary outcomes were the number of medication-related problems (MRPs) and preventive care omissions identified. The intervention was analyzed via Mann-Whitney U test and multivariate linear regression models. Pharmacists were surveyed regarding the available health history’s helpfulness in CMR delivery. Thirty-seven patients received CMRs across the 2 groups. Intervention pharmacists (n = 4) identified significantly more MRPs (median = 11 vs 6; B = 6.98, 95% confidence interval [CI]: 0.005-13.96; P = .049) and omissions in preventive care (24% vs 17%; B = 2.78, 95% CI: 0.46-5.10; P = .009) than usual care pharmacists (n = 3). Intervention pharmacists were more likely to agree they were confident they identified all of the patient’s MRPs (47.1% vs 15.8%), but neither group was more likely than the other to believe they had resolved all MRPs (41.2% vs 42.1%). Finally, intervention pharmacists agreed 100% of the time that the available health history helped them complete a better CMR, compared with only 69% of usual care pharmacists. In this pilot, community pharmacists identified more MRPs and omissions in preventive care when they reviewed unedited medical records. Larger studies are warranted to determine whether HIE can improve outcomes.

Background: Preventable emergency department (ED) use may be targeted with interventions for improving the medication use process, as medication misadventures and nonadherence frequently cause preventable ED utilization. One intervention that could prevent ED visits is medication therapy management (MTM). Objective: To evaluate the effectiveness of a telephonic MTM service on reducing ED utilization within a Medicare-insured home health population. Methods: This was a secondary analysis of data from a cluster-randomized controlled trial examining hospitalizations among Medicare-insured patients within 40 randomly selected, geographically diverse, home health centers. The intervention consisted of an initial telephonic medication reconciliation with a pharmacy technician, a telephonic pharmacist-provided medication review, and follow-up pharmacist phone calls. The primary outcome of this analysis was 60-day all-cause ED utilization. Patients’ baseline risk of ED utilization was calculated, and patients were stratified into quartiles based on their baseline risk of ED utilization. Adjusted odd ratios of ED utilization were calculated. Results: Data from 656 patients (intervention n = 297, usual care n = 359) were available for this study. Overall, the MTM intervention was not associated with 60-day ED use, as 24.4% of intervention patients and 25.1% of usual care patients utilized the ED (adjusted odds ratio = 1.11; 95% confidence interval = 0.79-1.57). However, there was lower ED utilization among patients in the lowest risk-quartile (adjusted odds ratio = 2.52; 95% confidence interval = 1.15-5.49; P = .02). Conclusion: This pharmacist-delivered telephonic MTM program did not decrease ED utilization overall in a Medicare-insured home health population, but may further reduce the risk of ED utilization among patients who are at lower risk of utilization.