Center for Healthcare Organization & Implementation Research
Medication Optimization Program (MOP)
Providing optimal medication treatment to Veteran patients is a critical goal for CHOIR, and encompasses many VA priorities regarding safer, more effective, more patient centered, and more cost-efficient prescriptive practices. Existing tools allow our operational partner, VA Pharmacy Benefits Management (PBM), some ability to ensure medication optimization for patients. However, important gaps remain. MOP, in collaboration with PBM, will address these gaps by:
- Examining how and why medication therapy is prescribed.
- Estimating beneficial and harmful outcomes of medication therapy, and how these outcomes might change with better prescribing.
- Developing and evaluating implementation strategies to promote higher-quality use of medication therapies.
1. Examining how and why medication therapy is prescribed: Numerous studies have demonstrated wide variation among VA sites regarding the prescribing of drugs, particularly high-cost drugs and drugs with safety implications. However, these observations regarding variation will not lead to improvements in care until we better understand their underpinnings. MOP is undertaking a group of projects to better understand how prescribing patterns develop in the context of teams of providers, in inpatient and outpatient settings. Relevant topics include the role of clinical pharmacists in provider teams, how social networks influence prescribing practices, and how local and national policies influence prescribing practices. MOP is also interested in examining patient-provider communication about medications (e.g., how and why particular medications are prescribed) and factors influencing patient adherence to prescribed medication.
2. Estimating beneficial and harmful outcomes of medication therapy, and how these outcomes might change with better prescribing: VA PBM releases guidance for the use of specific medications in the form of criteria for use (CFU) documents. To what extent do CFUs impact prescribing patterns after they are released? What could be done to maximize the impact of CFU documents? What are the costs and outcomes associated with prescribing that is concordant or discordant with CFU guidance? What are the factors that influence prescribing of low value medications. Answering these questions could help PBM to optimize the dissemination strategy to maximize the impact of CFUs or other official guidance.
3. Developing and evaluating implementation strategies to promote higher-quality use of medication therapies: Studies have shown that several approaches can help to improve prescribing practices, notably academic detailing. However, academic detailing is resource-intensive and therefore may not be practical or sustainable. Using our newfound understanding of the local predictors of prescribing practices (i.e., from Aims 1 and 2), we aim to craft new, efficient, and scalable strategies to promote optimal medication use, which we term “e-detailing”. We will implement and evaluate these strategies, in the process rewriting the “playbook” that is used to change prescribing practice.
In addition, MOP is generally the focal point for numerous other projects relating to medication use, prescribing patterns, and related outcomes. Any investigator with a potential project related to studying medications in any way is encouraged to contact Renda Wiener or Sarah Cutrona, co-directors of the MOP, who will involve other members of the MOP in providing guidance and support as needed. Our goal is to provide helpful advice that can help investigators succeed in their aims, with the ultimate purpose of producing more and better medication-related research at our center. This includes the related goal of maintaining close contact with our contacts at PBM to ensure that our research projects meet their operational priorities.