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Information & Quality Healthcare (IQH), as the Medicare Quality Improvement Organization for Medicare beneficiaries in Mississippi, is conducting a quality project in connection with the Medicare Part D prescription medications paid for by Medicare Part D that began in January 2006. One of the responsibilities of IQH is to analyze data and identify patterns in prescribing practices that fall outside current professional guideline recommendations.

The IQH project goal is to effect a reduction of adverse drug reactions, optimize clinical outcomes, and diminish the negative economic impact of duplicate prescribing practices. This particular IQH project was designed to identify clinicians who prescribe and pharmacies that dispense two or more atypical antipsychotic medications (AA) at a time to an individual patient.

In January 2007, IQH sent a letter to the physicians and pharmacists identified by claims submitted for AA prescriptions for patients dually eligible for Medicaid and Medicare. The letter emphasized the risk to patients taking this class of antipsychotic medication for the development of diabetes and cardiovascular disease and noted the current clinical guidelines recommending the routine monitoring of weight, lipids and serum glucose for the duration of treatment. To achieve the greatest impact, IQH suggested that the physicians take this opportunity to review their patient records to identify those on duplicate AA therapy.

A second intervention letter was sent to 66 physicians identified by their DEA number submitted with MemberHealth claims for duplicate AA therapy for individual patients with at least three months of duplicate AA therapy. As with any new project area, especially concerning the attributes of the database, a few instances have occurred where a physician was incorrectly identified as prescribing AAs. Therefore, IQH is investigating strategies for improving the accuracy of this database and broadening the survey of this physician group; identifying the dispensing pharmacies; and the treating physicians who have chosen to prescribe two or more AAs to individual patients.

IQH supports prescribing patterns for medications and indicated laboratory monitoring consistent with the recommendations of professional peer organizations found in the current literature. Consensus guidelines published by the American Diabetes Association and the American Psychiatric Association support atypical antipsychotic monotherapy for established indicated diagnoses, such as schizophrenia and bipolar disorder. Routine monitoring of the patient’s weight, serum lipids, and glucose are strongly recommended due to the increased risk for the development of diabetes and cardiovascular disease when taking any one of the medications within the atypical antipsychotic class. It is recommended that patients not take more than one atypical antipsychotic medication at a time, though this excludes that period of time during which a patient may transition from one AA to another.

This special pharmacy project will contribute to the continuing education of Mississippi physicians and pharmacists, the coordination of care, continuing of treatment, and improvement in clinical outcomes for beneficiaries taking an atypical antipsychotic medication. According to Dr. Sue Dillon, who serves as IQH’s clinical coordinator, “The intention of IQH is to support all participants in healthcare delivery and, by providing pertinent information, contribute to the ongoing efforts to improve the quality of care for eligible beneficiary patients.”’

IQH works with Mississippi healthcare providers, including hospitals, physician offices, nursing homes and home health agencies, to assist in improving the quality of care provided to Medicare beneficiaries through quality improvement projects, data collection and analysis and dissemination of information. IQH, as Mississippi’s federally designated Quality Improvement Organization, works under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U. S. Department of Health and Human Services.




October 2007

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