Community pharmacists' interventions and documentation during medication therapy management encounters delivered face-to-face versus via telephone: The devil is in the details.

Abstract

To date, no studies are available comparing in-person versus telephone-administered medication therapy management (MTM) encounters in a community pharmacy setting with respect to medication-related problems, interventions and documentation. The objective of this study was to evaluate types of medication-related problems, interventions, and documentation among patients receiving MTM face-to-face versus over the telephone. A retrospective analysis was performed on all completed comprehensive medication reviews (CMR) between 2011 and 2017 in 14 community pharmacies in Western Massachusetts, USA that belong to one district of a national chain. Medication-related problems were classified as: Beers criteria medications, untreated condition, dose too high or low, medication omission, duplicate therapy, drug-drug interaction, non-adherence, complicated dosing. Pharmacist's interventions were classified as education, medication reconciliation, and vaccination. Documentation of assessment, plan, discussion notes, and recommendations were evaluated as being present or absent. In total, 297 encounters (56.5% were over the telephone) were included in the analysis. There was no significant differences between clinical and demographic characteristics and types of medication-related problems and pharmacist interventions among patients who received face-to-face versus telephone MTM service. Assessment was documented among 28% of face-to-face and 42% of telephone CMR encounters (p<0.05). Plan was documented among 27% of face-to-face and 40% of telephone CMR encounters (p<0.05). Discussion notes were documented among 97% of face-to-face and 98% of telephone CMR encounters (p>0.05). Pharmacist recommendations were documented among 92% of face-to-face and 95% of telephone CMR encounters (p>0.05). Pharmacists identify medication-related problems and provide education and medication reconciliation interventions independent of the mode of delivery. The overall low frequency of assessment and plan documentation raises concerns. It is imperative for pharmacists to document both instances of provider outreach and follow-up to ascertain resolutions of patients' medication-related problems.