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Criteria Score Age (years) <65 1 65–75 2 >75 3 Diagnosis (code) Diabetes mellitus (250.X) 2 Chronic obstructive pulmonary disease (491.X, 492.X, 496.X) 1 Hypertension (401.X to 405.X inclusive) 2 Cardiovascular disease (410.X-414.X inclusive, 429.2, 434.0, 434.00, 434.01,435.8, 435.9, 436, 437.0, 437, 434.9x, 435, 437.1, 440.0, 441.3, 443, 440.8, 440.9, 441.4, 443.89, 443.9) 2 Heart failure (428.X) 1 Depression (311.x, 296.2x, 296.3x) 1 Estimated glomerular filtration rate <45 mL/min 1 Hemoglobin A1c >7.9% 1 >8.9% 2 BP Last BP >140/90 mmHg and last 3 averaged >140/90 mmHg 1 Last BP >160/100 mmHg and last 3 average >160/100 mmHg 2 Active items on medication list <3 0 3–5 1 6–9 2 >9 4 BP, blood pressure.
- Table 2. Clinical Pharmacy Priority (CP2) Scoring Criteria Among Those Receiving and Not Receiving a Medication Recommendation
Recommendation (n = 101) No Recommendation (n = 1006) P Value Age (years) <.0001 <65 40.6% 76.8% 65–75 38.6% 17.4% >75 20.8% 5.8% Diagnosis COPD 7.9% 3.6% .0332 Diabetes 48.5% 6.4% <.0001 Hypertension 84.2% 27.1% <.0001 Vascular disease 26.7% 5.4% <.0001 Heart failure 5% 1% .001 Depression 22.8% 14.7% .0326 eGFR <45 mL/min 9.9% 2.5% <.0001 Hemoglobin A1c >7.9% 11.9% 0.9% <.0001 Stage 1 or stage 2 hypertension* 19.8% 5.6% <.0001 Items on medication list <.0001 <3 2% 34.2% 3–5 9.9% 25.7% 6–9 25.7% 21% ≥9 61.4% 19.1% ↵* Stage 1 hypertension = blood pressure 140–159/90–99 mmHg; stage 2 hypertension = blood pressure ≥160/100 mmHg.
COPD, chronic obstructive pulmonary disease; eGFR, estimated glomerular filtration rate.
CP2 Score Patient Appointments (n) Medication Recommendation Rate (%) Level 1 0 290 0 1 178 0.6 2 120 0.8 Level 2 3 73 4.1 4 91 8.8 5 75 9.3 6 58 19 7 61 13.1 Level 3 8 56 28.6 9 45 37.8 10 18 38.9 Level 4 11 15 53.3 12 14 57.1 13 8 25 14 3 66.7 15 2 100 - Table 4. Drug Therapy Problems Identified and the Most Common Medication Recommendations (n = 223)
Drug Therapy Problem (n) Most Common Medication Recommendation (n) Needs additional therapy (118) Vaccine (62) HMG-CoA reductase inhibitor (31) Blood pressure–lowering agent (6) Antidiabetic agent (4) Unnecessary drug (31) ER niacin or ezetimibe not needed (10) Triglyceride lowering not needed (7) Wrong dose (24) Blood pressure drug dose too high/low (17) Diabetes drug dose too high/low (3) Cost (13) Brand switched to different generic (8) Potentially inappropriate drug (10) Unsafe in patient ≥65 years old (10) Duplicate therapy (7) Aspirin/clopidogrel when not indicated (2) Laboratory test needed (6) Vitamin D (2) Wrong drug (5) Five different drugs identified (5) Adverse drug reaction (4) Four different reactions identified (4) Drug interaction (4) Simvastatin interaction (4) Other (1) Nonadherence (1) ER, extended release.
