Clinical outcomes of medication therapy management services in primary health care

Simone De Araújo Medina Mendonça,Danielle Maria De Souza Serio Dos Santos Santos,Angelita Cristine Melo,Gabriela Cristina Coelho Pereira,Adriana Cristina Soares,Maria Do Carmo Vilas Boas Sousa,Djenane Ramalho De Oliveira,Elisa Brandão Grossi

doi:10.1590/s1984-82502016000300002

Abstract

This study evaluates whether the integration of pharmacists into health-care teams through the delivery of pharmaceutical care-based medication therapy management (MTM) services can improve the clinical outcomes of patients with chronic health conditions in the primary health-care setting. A retrospective descriptive study of 92 outpatients assisted by MTM pharmacists in primary health-care units was carried out over 28 months (median follow-up: 05 months). Patients were followed up by MTM pharmacists, with a total of 359 encounters and a ratio of 3.9 encounters per patient. The prevalence of hypertension, diabetes mellitus and dyslipidaemia was 29.5%, 22.0% and 19.4%, respectively. There was a high prevalence of drug-related problems with a ratio of 3.4 per patient. Pharmacists performed a total of 307 interventions to prevent or resolve drug-related problems. With regard to control of the most prevalent chronic medical conditions, a high percentage of patients reached their therapy goals by the last encounter with the pharmacist: 90.0% for hypertension, 72.3% for diabetes mellitus and 90.3% for dyslipidaemia. MTM services provided by pharmacists resolved drug therapy problems and improved patients' clinical outcomes. This study provides evidence for health-care managers of the need to expand the clinical role of pharmacists within the Brazilian public health-care system.

Highlights

In pharmaceutical care practice the pharmacist takes responsibility for meeting patients’ drug-related needs by detecting and resolving drug-related problems (DRPs)
The aim of this study was to evaluate whether the integration of pharmacists into health-care teams through the delivery of pharmaceutical care-based medication therapy management services can improve the clinical outcomes of patients with chronic health conditions in the primary care setting
The high prevalence of polypharmacy in this study can be explained by the fact that it was one of the criteria for referral to medication therapy management (MTM) services

Summary

Introduction

In pharmaceutical care practice the pharmacist takes responsibility for meeting patients’ drug-related needs by detecting and resolving drug-related problems (DRPs). In this study, this professional practice is materialized into the clinical service known as medication therapy management (MTM). MTM services follow the philosophy and patient care process of pharmaceutical care practice as proposed by Cipolle, Strand and Morley (2012) and, for this reason, they are called “pharmaceutical care-based MTM” (Ramalho de Oliveira, 2009; Obreli Neto et al, 2011; de Souza et al, 2007; Lee, Grace, Taylor, 2006; Cipolle, Strand, Morley, 2012). Pharmacists in developing countries work mainly in activities related to acquisition and inventory control of drugs, with little involvement in direct patient care (Obreli Neto et al, 2011). There are a few published studies on the clinical outcomes of this practice in Brazil, mainly in the primary care setting (Mourão et al, 2013; Obreli Neto et al, 2011; Obreli Neto, Cuman, 2010; Lyra Júnior, Marcellini, Pelá, 2008; de Souza et al, 2007; Lyra Júnior et al, 2007)

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