Medication Therapy Management and Collaborative Health Care: Implications for Social Work Practice

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Medication therapy management (MTM) is a relatively new method of monitoring patient medication use and adherence. Medicare Part D has not only recognized its effectiveness and ability to enhance patient care, but has made MTM a required process for patient members with specific diseases (Doucette, McDonough, Klepser, & McCarthy, 2005). MTM provides a flamework for pharmacists and physicians to collaborate on medication administration and monitoring of medication use (Kuo, Bucldey, Fitzsimmons, & Steinbauer, 2004). Collaborative health-care models such as MTM offer promising possibilities for improved administration of services and enhanced quality of care for patients. These frameworks use the unique skills and knowledge of each specific health-care profession involved, and they offer opportunities for the field of social work. This article examines MTM within a framework of collaborative care. First, an overview of the collaborative model of health care is provided. Second, the use of MTM in monitoring medication adherence is examined. Third, the role of pharmacists in collaborative health care is evaluated. Finally, implications for the use of MTM in conjunction with services provided by the social work profession are addressed. COLLABORATIVE HEALTH CARE In the past several decades, health care has migrated from the historical use of the medical model toward a more integrative, collaborative approach. The medical model has been described as an individualistic, specific, and rational concept of health care (Engel, 1977; Weick, 1983). This approach treats the biological issues of the patient but does not address psychosocial needs (Bird & Rieker, 1999; Calnan & Johnson, 1985).This lack of attention to the person in environment does not allow health-care providers to address the impact of economic barriers to care (Hiatt et al., 2001), disruption of family homeostasis (Andrist, 1997), social and spiritual support systems (Doherty & McCubbin, 1985), and use of family and friends in the decision-making process (Webb & Koch, 1997). Collaborative care is emerging as an effective model of treatment (Gilbody, Bower, Fletcher, Richards, & Sutton, 2006), providing a framework in which to address the psychosocial needs of patients, improve health outcomes, reduce costs, and increase available resources and services to patients (Wagner, 2000). Collaborative care has been defined as a multidisciplinary team approach to delivering evidence-based care (Hedrick et al., 2003), one that provides an environment in which health-care professionals can teach one another and share resources (Sorrells-Jones & Weaver, 1999). The fields of medicine, pharmacy, social work, nursing, and pastoral care are key components to the success of collaborative teams (Cott, 1997). Research has supported the use of collaborative care in the treatment of mental disorders (Chang-Quan et al., 2009; Davies, McBride, & Sajatovic, 2008; Dewa, Hoch, Carmen, Guscott, & Anderson, 2009; Katon et al., 1999), heart disease (Brush et al., 2009; Coviello & Tadel, 2009), and diabetes (McElmurry et al., 2009; Phelps et al., 2009) and in the area of critical care (Carr, 2009). Collaborative care involving a working relationship between physicians and pharmacists has been shown to improve patient care and reduce medication errors (Kuo et al., 2004). A meta-analysis of 37 randomized studies of 12,355 patients diagnosed with depression reported that collaborative methods to improve medication adherence were more effective than standard care, improving both short- and long-term outcomes (Gilbody et al., 2006). The application of collaborative care in MTM is addressed in the next section. MEDICATION ADHERENCE AND MTM Medication Adherence To understand the impact of MTM, it is important to examine the issue of medication adherence. Medication behavior, the manner in which a patient adheres to prescribed medication use, strongly influences health outcomes, health-care use, improvements in medication knowledge, self-efficacy, and health-care costs (Chewning & Sleath, 1996; Delgado, 2000; Edworthy & Devins, 1999). …