Pharmacy Quality Measures

An FAQ Explaining the Use of Benzodiazepine Sedative Hypnotic Medications in the Elderly

by Natalie Bari

WHERE DOES THIS MEASURE sures feature medications from the the diagnoses (such as insomnia, agi- FIT INTO THE OVERALL MEDI- American Geriatrics Society’s Beers tation, delirium) that the Beers Criteria CARE PART D STAR RATINGS? Criteria for potentially inappropriate state should be avoided. This measure was endorsed by the medication use in older adults. The Pharmacy Quality Alliance (PQA) original HRM measure discussed the WHAT DOES THIS MEASURE in May 2014. But to date, it has not use of non-benzodiazepine sedative ANALYZE? been adopted by the Medicare Part D hypnotics, but it did not include This measure calculates the percent of Star Ratings program. The measure benzodiazepines as they were listed as patients 65 years of age and older who is often described as an extension “avoid only for treatment of insomnia, have received two or more prescription of the PQA measure on the use of agitation or delirium.” The additional fills for any benzodiazepine sedative high-risk medications in the elderly measure was created to address the hypnotic for a cumulative period of (HRM), which was used in the calcu- concern that an unintended conse- more than 90 days. The benzodiaze- lation of the CMS 2015 Star Ratings quence of the HRM measure would be pine sedative hypnotic medications using 2013 claims data. Both mea- increased use of benzodiazepines for are defined to include estazolam,

32 America’s PHARMACIST | January 2015 temazepam, triazolam, flurazepam, them frequently over a prolonged peri- use of the benzodiazepine agents spe- and quazepam. A PQA pilot testing of od of time. The use of these drugs has cifically labeled as sedative hypnotics. the measure utilizing populations from been associated with intellectual and Medicare Advantage Plans (MA-PD) cognitive impairment, including dimin- WHAT CAN I DO TO IMPROVE and prescription drug plans (PDP) ished short-term recall and increased PERFORMANCE? established baseline averages of 1.81 forgetfulness. These effects are often Adopting this measure will help you im- percent for the MA-PD populations and mistaken as part of the normal aging prove patient safety in your pharmacy 1.14 percent for the PDP populations. process or early onset dementia, but and prepare for its inclusion in quality for many patients on benzodiazepine measurement programs. You can WHAT IMPACT CAN THIS HAVE sedative hypnotics, cognitive func- manage it much in the same way you ON MY PHARMACY? tion improves when these agents are would manage the HRM measure, by Pharmacies have a stake in mon- discontinued. Benzodiazepines also analyzing your records to identify elder- itoring their performance against contribute to psychomotor impairment, ly patients who take these medications. endorsed quality measures. By taking which increases the risk of falls and au- Use your pharmacy software to devel- an early interest in this measure, phar- tomobile accidents in elderly patients. op reports of patients on these medica- macies have time to develop a system Several studies have also revealed an tions and analyze the frequency of their to improve intervention strategy with increased incidence of hip fracture and prescription fills. Utilize MTM services patients, caregivers, and prescribers. recurrent falls among elderly patients to evaluate patients’ use of these drugs If the time comes that the pharmacy using benzodiazepines chronically. and consult patients’ physicians when is in a network that begins tracking appropriate for therapy changes. this measure, the pharmacy will be As such, the Beers Criteria recom- in a good position to request pre- mends that for improved elderly *See additional resources for more ferred status or pay-for-performance patient safety all benzodiazepines be information. ■ incentives. Pharmacies can boost avoided for treatment of insomnia, agi- performance using medication review, tation or delirium. This quality measure Natalie Bari is a 2015 PharmD candidate recognizing cognitive impairment and seeks to further improve elderly patient at the University of Arkansas for Medical counseling on good sleep hygiene and safety by dramatically decreasing the Sciences College of Pharmacy. fall prevention.

WHAT IMPACT DOES THIS HAVE *Additional Resources: ON PATIENT SAFETY? • Pharmacy Quality Alliance Performance Measures: http://pqaalliance.org/measures/ The use of benzodiazepine sedative cms.asp hypnotic medications in the elderly is • Performance Measure: Use of Benzodiazepine Sedative Hypnotic Medications in directly related to patient safety. Re- the Elderly: http://pqaalliance.org/images/uploads/files/Approved%20Measure _ search has suggested that more than May2014.pdf 25 percent of hospital ED visits are • PQA Quality Connection bi-monthly briefing: PQA Endorses New Performance related to adverse drug events that oc- Measure… cur in elderly patients. This measure is • Use of High-Risk Medications in the Elderly: http://pqaalliance.org/images/uploads/ developed around the American Geri- files/HRM%20Measure%202013website.pdf atrics Society’s Beers Criteria in an • AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults: effort to combat this growing statistic. http://www.americangeriatrics.org/files/documents/beers/PrintableBeersPocket- The Beers Criteria was developed to Card.pdf address the age-related physiological • Bogunovic, Olivera J. and Shelly F. Greenfield. “Use of Benzodiazepines Among Elder- changes (such as decreased renal ly Patients.” Psychiatric Services. March 2004. http://ps.psychiatryonline.org/article. function, reduced muscle mass) that aspx?articleID=88327 put elderly patients at an increased for • “Optimizing Medication Use in the Elderly.” Pharmacist’s Letter. Volume 2012. http:// drug-related adverse effects. pharmacistsletter.therapeuticresearch.com/ce/cecourse.aspx?pc=12-206&AspxAuto- DetectCookieSupport=1 Retrospective studies revealed that benzodiazepine use may have caused up to 10 percent of drug-associated Editor’s Note: This is another in a continuing series of articles covering treatment of hospital admissions among the elderly, various health issues and how they relate to the Medicare Part D Star Ratings program. especially among patients who use www.americaspharmacist.net 33