Abstract
Objectives(1) To develop an adaptation framework for MTM delivery for pharmacists (the MTM Adaptability Framework), (2) to examine the impact of an educational intervention informed by the MTM Adaptability Framework on MTM completion rates over a 2-year period, and (3) to explore pharmacists’ perceptions regarding knowledge and beliefs about MTM and MTM implementation self-efficacy pre- and post-intervention.MethodsThis study is a prospective, mixed-methods research study including a quasi-experimental, one-group pretest-posttest quantitative study with a sequential explanatory qualitative study arm featuring semi-structured key informant interviews. US supermarket pharmacy chain setting included 93 community pharmacy sites located in Tennessee, Kentucky, and Alabama. MTM completion rates are reported as percentage of completed comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) and pharmacist perceptions.ResultsAn 11.4% absolute increase in MTM completion rates was seen after the educational intervention targeting adaptation of MTM in the community pharmacy setting. This was found to be significant (46.92% vs. 58.3%; p < 0.001). Responses to the semi-structured interviews were mapped against CFIR and included themes: “knowledge and beliefs about MTM (pre-intervention),” “self-efficacy for MTM implementation (pre-intervention),” “knowledge and beliefs about MTM (post-intervention),” and “self-efficacy for MTM implementation (post-intervention).” Data convergence was found across these methodologies and suggested that targeting adaptability of MTM delivery increases MTM completion rates (quantitative data) and positively changes perceptions of MTM feasibility and self-efficacy (interviews).ConclusionThe use of an educational intervention about adaptation of MTM to influence adaptation of MTM to a chain community pharmacy setting part of an implementation strategy improved MTM completion rates significantly. Future research should investigate combined implementation strategies and their impact on MTM implementation success.
Highlights
Medication therapy management (MTM) involves a range of services to optimize patients’ medication regimen and at the same time, detect and prevent potentially costly medication errors [1]
Providers’ may have unrealistic expectations about the time and resources needed for implementation of evidence-based interventions, such as medication therapy management, decreasing their self-efficacy for implementation
It is possible that implementation support along with guidance about adaptation may assist pharmacists with MTM implementation. To address this gap in the research, our study has three aims: (1) to develop an adaptation framework for MTM delivery for pharmacists, (2) to examine the impact of an educational intervention informed by the MTM Adaptability Framework on MTM completion rates over a 2-year period, and (3) to explore pharmacists’ perceptions regarding knowledge and beliefs about MTM and MTM implementation selfefficacy pre- and post-intervention
Summary
Medication therapy management (MTM) involves a range of services to optimize patients’ medication regimen and at the same time, detect and prevent potentially costly medication errors [1]. MTM services can be offered by pharmacists or other qualified providers and are incentivized through programs, such as the Medicare Part D MTM program. Pharmacists are effective at leading MTM services given their doctoratelevel training and scope of practice. The Centers for Disease Control and Prevention considers pharmacist-led MTM services to have strong evidence of effectiveness [2]. MTM adoption in the US has grown; by 2015, 81% of independently owned pharmacies reported offering of MTM services [10]. A recent survey in Europe found that 44% (11 of 25 countries surveyed) provide adherence-focused MTM services, while 24% (6 of 25 countries surveyed) provide comprehensive MTM services similar to those in the USA [11]
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