1)To evaluate the impact of a comprehensive MTM on clinical outcomes. The working hypothesis for this aim is that patients enrolled in a MTM program that features monthly face-to-face interaction with a pharmacist including medication review, assessment of medication appropriateness, education, and adherence aids (MTM) will have better outcomes than patients in a control group receiving usual care (Control). The primary outcomes evaluated in this analysis will be adherence to therapy and medication appropriateness. Secondary clinical outcomes for this aim include adverse drug event rates, improvement in clinical monitoring parameters, and patient knowledge of medications. Economic outcomes for this aim are hospital, emergency department and physician office visits, cost of pharmacist counseling, and estimated total health care costs. Humanistic outcomes are patient satisfaction with medical care and patient and primary care provider satisfaction with the programs.

2)To determine which patient factors have the greatest impact on determining the success of an MTM program. The primary hypothesis for this aim is that low functional health literacy is associated with poorer outcomes. Secondary hypotheses for this aim are that greater patient age, lower baseline knowledge of illnesses and medications, higher number of medications, and greater number of illnesses will respond better to the MTM program.

Each year approximately 750,000 individuals experience a new stroke. Of these, an estimated 10% are attributable to carotid atherosclerosis (CAS). Over the past two decades there have been substantial changes in the diagnosis and treatment of carotid artery disease including the development of new and improved non-invasive and invasive diagnostic tests. However, our ability to answer clinical and policy questions related to the management of carotid artery disease has been limited. Investigating questions related to temporal trends and geographical variation can prove challenging given that choice of treatment is highly correlated with risk of events. Under such circumstances, the use of Medicare claims, one of the richest, most comprehensive sources of publicly available healthcare information, will be crucial in obtaining individual level symptom status, degree of carotid stenosis, presence of distal disease, comorbidity, and subsequent event severity.

We propose to evaluate temporal trends and geographical variation of use of diagnostic and treatments for carotid artery disease using Medicare data. The temporal trends analysis will be conducted using the 5% Medicare sample from 2000 through 2005, while the geographical variation analysis will be conducted using the 100% Medicare sample from 2004 through 2007. This descriptive work is to provide an understanding of the magnitude of the issues related to CAS diagnosis and treatment. The study shall examine the expanding use of non-invasive testing and geographical variation in the use of procedures.