Qualitative analysis of telephonic comprehensive medication review content and delivery

Background: Comprehensive medication reviews (CMRs) are offered to eligible Medicare benefi-ciaries to improve patient medication knowledge, identify, and address medication concerns, and empower medication self-management. However, the specific content of real-world CMRs is unclear.Objective: To qualitatively assess CMR content and delivery among telephonic CMR providers.Methods: This qualitative thematic analysis used transcriptions of audio-recorded patient in-teractions during CMRs from 3 telephonic medication therapy management provider organiza-tions. Data were qualitatively analyzed using the inductive saturation model to code emergent themes by independent reviewers who met to agree themes through consensus. Intercoder reliability was calculated using Krippendorf alpha.Results: Overall, 32 CMR transcripts from 3 organizations were analyzed in 13 rounds of coding. Intercoder reliability was >95%. A total of 21 themes were identified across 4 stages: call opening (4 themes), medication reconciliation (5 themes), clinical assessments and guidance (8 themes), and call closing (4 themes). The call opening stage included: service explanation; insurance coverage/ cost; identity/privacy/recording; and patient's medication management. Medication reconciliation included: drug name, dose, frequency, and indication; medication deletion and addition; over-the-counter and vaccination assessment; drug efficacy assessment; and prescribing provider assess-ment. Clinical assessments and guidance included 4 core clinical assessments: allergy assessment; drug therapy problem assessment; drug-related adverse events; and medication modification; and 4 additional assessments: clinical/therapeutic guidance; cost savings guidance; diet/exercise/ lifestyle guidance; and optional clinical and behavioral assessments. Call closing included: docu-mentation; primary care provider confirmation; patient satisfaction; and call transfer. There were variations among organizations in the depth that CMR components were covered.Conclusion: These findings suggest provider organizations are including components that meet Centers for Medicare and Medicaid Services goals for CMRs. Yet, variations among or-ganizations indicate a need for standardization and patient-centered measures to ensure appropriate CMR components are covered, while maintaining fiexibility for pharmacists to provide patient-oriented CMRs that meet patients' clinical needs.(c) 2022 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.