TABLE 2.

Reasons for Exceptions Derived from Clinical Software System and Pharmacist Review to Recommend Adding ACEI or ARB Therapy for Patients with DM in Participating 96 Health Plans During the 2013 Calendar Year

Exception Reasons (N = 101,183)	n (%)
Clinical software exception reasons (n = 98,206)a
Past presence of ACEI/ARB	87,746 (89)
Inappropriate age (≥ 90 years)	3,349 (3)
Drug/condition interaction with ACEI/ARB	3,144 (3)
Potential liver condition	1,932 (2)
Potential history of high potassium levels	1,808 (2)
Pregnancy	227 (0.2)
Pharmacist exception reasons (n =2,977)a
Patient does not meet call script requirementsb	767 (26)
Previous failure or adverse drug reactionc	698 (23)
Patient states he/she does not have DM	307 (10)
Drug-disease interactionsd	188 (6)
Overlapping alerts	20 (0.7)
Patient cannot afford medication	1 (0.03)
Other	878 (29)

^aException reasons exceed the number of patients (n = 94,359); individual patients could have multiple reasons for exceptions to ACEI/ARB therapy.

^bExamples of not meeting call script requirements included patients without high blood pressure, kidney problems, or heart problems or a history of heart attack, stroke, or heart surgeries.

^cExamples of previous failure or adverse drug reaction included patients who previously took ACEI/ARB and had angioedema or low blood pressure.

^dAn example of a drug-disease interaction included patient-reported hyperkalemia.

ACEI = angiotensin-converting enzyme inhibitor; ARB = angiontensin II receptor blocker; DM = diabetes mellitus.