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Potentially Inappropriate Medications (PIMs) Advisory Board The Potentially Inappropriate Medications (PIM) Advisory Board, convened by the New Mexico Prescription Improvement Coalition, was formed to address and reduce the use of PIMs in older adults and related drug safety issues. Its first objective is to produce PIM clinical guidelines jointly endorsed by health care providers and professional organizations statewide. These guidelines will include high-risk medications, areas of concern, and drug alternatives to PIMs. The Board has a work plan in place and is planning to release its clinical guidelines in April 2009. Measure Description: Percentage of Medicare Part D enrollees at least 65 years old with at least two potentially inappropriate medications. Applicable to health plans, health maintenance organizations (HMOs), preferred provider organizations (PPOs), and prescription drug plans. Eligible Population: Beneficiary must be continuously enrolled in the plan for at least 5 of the 6 months during a six-month measurement period, and beneficiary must be at least 65 years of age as of the start of the measurement period, determined by date of birth in enrollment data. Medications: The list of drugs for this measure encompasses the updated Beers list, Zhan’s list, the National Committee for Quality Assurance (NCQA), and those used for HEDIS® 2008 measures: - Skeletal muscle relaxants (carisopodol, methocarbamol, cyclobenzaprine, metaxalone, chlorzoxazone, orphenadrine): potential fall and bone fractures due to the “relaxant effects”
- Narcotics – meperidine, pentazocine, propoxyphene (including combinations): potential fall and bone fractures due to the sedative effects on the central nervous system (CNS)
- Chlorpropamide: potential severe hypoglycemia and/or hyponatremia in those over 65
- Thyroid hormones – dessicated thyroid: not the drug of choice due to improved alternatives
- Vasodilators–dipyridamole (short acting only) as a sole agent: not the drug of choice for stroke prevention
- Antianxiety – meprobamate: potential fall and bone fractures due to sedative effects on CNS
- Analgesic – ketorolac: potential gastrointestinal bleed, Black box warning not to exceed five days in duration of therapy
- Antipsychotics, typical – thioridazine, haloperidol, chlorpromazine, thiothixene
- CNS stimulants – amphetamines: no medical necessity for these drugs in the elderly except for narcolepsy, which is rare (1 in 1000 to 2000 in the U.S.)
- Calcium channel blockers – nifedipine (short acting only): potential profound hypotension and myocardial infarction
- Ticlopidine: Black Box warning for life-threatening hematological adverse reactions
- Belladonna alkaloids: not the drug of choice for peptic ulcer or gastric secretions; other alternatives available for gastrointestinal conditions
PIM Advisory Board Membership Chair: Amy Bachyrycz, PharmD, Walgreens Clinical Advisor: Melanie Dodd, PharmD, University of New Mexico College of Pharmacy Members: Jess Benson, PharmD, New Mexico Poison and Drug Information Center Charlotte Breeden, RPh, Total Community Care Greg D'Amour, PharmD, RPh, PhC, New Mexico State Veterans Home/New Mexico Department of Health Larry Georgopoulos, PharmD, Presbyterian Annie Jung, New Mexico Medical Society William Orr, MD, EverCare/United Galina Priloutskaya, PhD, NMMRA Richard Reynolds, MS, PharmD, Blue Cross and Blue Shield of New Mexico John Scott, RPh, Lovelace Anne Simpson, MD, University of New Mexico School of Medicine Cynthia Smith, PharmD, RPh, New Mexico Veterans HealthCare System Harris Zeyaee, PharmD, Express Scripts
Planned Activities and Timeline: Endorsement by all relevant New Mexico organizations: April 21, 2009 Press release and possible press conference on PIM clinical guidelines: April 27, 2009 Promotional activities on PIM guidelines: ongoing Distribute PIM clinical guidelines to stakeholders and providers: May 2009 Publish guidelines on the NMPIC Web site: May 2009 Evaluate effectiveness of intervention: June 2009
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