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

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.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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