Impact Of Medication Therapy Management Research Articles

Impact of medication therapy management (MTM) service model on multi-morbidity (MMD) patients with hypertension: a pilot RCT

BackgroundThis study explored the impact of MTM service on MMD patients with hypertension.MethodsA total of 120 MMD inpatients from September to November 2019 were received and randomly divided into intervention group and control group. General services for noninfectious chronic diseases were given to the control group, while a standard MTM service was given to the intervention group. Patients’ blood pressure, EQ-5D utility value, readmission rate, drug-related problems, and average daily medication therapy cost were compared between the two groups and within the groups. This was done at the initial admission phase and in the first, third, sixth, and twelfth months after discharge.ResultsThe intervention group had significantly lower blood pressure and average daily medication therapy cost 12 months after discharge compared to the control group (systolic blood pressure: P = 0.023, diastolic blood pressure: P < 0.001, average daily medication therapy cost: P = 0.049); the number of DRPs decreased in both groups 12 months after discharge; the number of DRPs solved in the intervention group in the third, sixth and twelfth months after discharge were statistically higher compared with that in the control group (P = 0.013, P = 0.012, P = 0.001); there was no significant difference in the EQ-5D utility value and readmission rate between the two groups (P > 0.05).ConclusionsMTM implementation in MMD patients can improve health outcomes and reduce healthcare-related costs among MMD patients.Trial registrationChinese Clinical Trial Register ChiCTR2200065111, date of registration: October 28, 2022.

MO927: The Impact of Medication Therapy Management on Medication Burden Quality of Life Among Haemodialysis Patients in Egypt: An Intervention Study

Abstract BACKGROUND AND AIMS End-stage kidney disease (ESKD) is a rapidly increasing global health burden. Renal replacement therapy is essential to save the lives of ESKD patients and is done either through kidney transplantation, peritoneal dialysis or hemodialysis (HD). Patients on HD are subjected to polypharmacy, increase in drug-related problems (DRPs), adverse effects, impaired drug adherence and consequently poor medication burden quality of life (MBQoL). Medication therapy management (MTM) plays an essential role in resolving those problems. The MTM involves performing a medication review, selecting, modifying or administering medication therapy, evaluating the patient’s response to therapy, identifying and resolving any DRPs and providing patient education to enhance the patient’s understanding and adherence to the treatment plan. These pharmaceutical services have shown a positive impact on dialysis patients regarding the economic, humanistic and clinical aspects. We therefore aimed to evaluate the impact of the application of MTM on MBQoL and determine its predictors. METHOD We collected baseline data (sociodemographic, clinical, hemodialysis vintage, hospital admission, drug adverse effects and laboratory) in a pre–post one-group intervention study from all adults on regular maintenance dialysis for &amp;gt;3 months at Alexandria University Hospital. The MBQoL was assessed using the patient-reported outcomes measure of the pharmaceutical therapy (PROMPT) questionnaire after being translated and validated into Arabic. Data on drug adherence was collected by comparing prescribed doses to the actually administered by patients. A structured checklist instrument was used to identify adverse effects. The MTM intervention was applied (medication therapy review, developing a personalized medication record, participating in the medication-related action plan, and patient education sessions). All haemodialysis patients were re-assessed after 3 months. Construct validity was assessed using exploratory factor analysis and reliability was determined using Cronbach's alpha and intraclass correlation coefficient (ICC). Multiple linear regression was used to determine the predictors of the post-MBQoL and change in MBQoL from pre- to post MTM after adjusting for variables with P &amp;lt; 0.10 in bivariate analysis. RESULTS The study included 130 patients who were on average 52 year old (±13), 53.1% were males, 25.8% were smokers, 64.6% had cardiovascular diseases, 26.9% had hepatitis C virus and 14.6% were diabetics. The median (interquartile range) of the dialysis vintage was 5 (2–15) years. The validation of the PROMPT questionnaire was done on an additional 80 haemodialysis patients with similar baseline criteria as the study sample. Exploratory factor analysis revealed that items of the PROMPT were distributed on five domains. Cronbach's alpha was &amp;gt;0.70 for all domains except for ‘impact on patient's life’ (0.52). The ICC was significant (P &amp;lt; 0.01) for all items of the PROMPT questionnaire. The application of MTM had significant effects on the overall PROMPT score (50.74 ± 9.68 versus 59.3 ± 9.86; P &amp;lt; .001), the total number of DRPs (1245 versus 794; P &amp;lt; .001), and calcium level in mg/dL (9.13 ± 0.95 versus 8.77 ± 1.05; P = 0.002). There was a statistically significant reduction in the reported proportion of dry mouth, change of appetite, nausea and vomiting, stomach pain and dyspepsia, diarrhea, constipation and flatulence (P &amp;lt; 0.05). Calcium level (mg/dL) was significantly declined after the MTM application (9.13 ± 0.95 versus 8.77 ± 1.05; P = 0.002). The total number of DRPs was the only significant predictor for change in MBQoL, while university graduates and the a total number of DRPs were the predictors for the post-score of MBQoL. CONCLUSION There is a potentially relevant impact of MTM provision by a clinical pharmacist on medication burden, quality of life, drug-related problems and adverse events among haemodialysis patients.

Pharmacists’ knowledge and attitudes toward medication therapy management service and the associated challenges and barriers for its implementation

BackgroundThe literature demonstrated a positive impact of medication therapy management (MTM) services provided by the pharmacists to improve the overall health outcomes. Nevertheless, limited data is available with regard to MTM service implementation by community pharmacists and its associated factors in Jordan. ObjectiveTo evaluate community pharmacists’ knowledge, attitude and practice of MTM service and to explore the challenges and barriers for its implementation. MethodsThe present cross-sectional study utilized a validated online survey which was filled by community pharmacists in different areas across Jordan. In addition to the socio-demographic variables, the study questionnaire evaluated pharmacists’ knowledge and attitudes towards MTM service, extent of MTM implementation and its associated challenges and barriers. ResultsA total of 250 pharmacists completed the survey. The study pharmacists showed moderate knowledge level (median of the total knowledge score = 6 (4–7) out of 10) and positive attitude (median of the attitude score was 23 (19–26) out of 30) towards MTM services. The participating pharmacists recognized performing or obtaining necessary assessments of patient’s health status as the most frequently provided MTM service (84.8%), while the least one was documenting the care delivered and communicating essential information to other healthcare providers (62%). Furthermore, collecting patient-related information was the most commonly recognized challenge to MTM service provision (36.8%), followed by referring the patient to a physician or consultant (36%) and collaboration with them (35.6%). The most reported barrier was negative physician attitudes (40.4%), followed by the lack of training on MTM provision (38.4%), and lack of adequate support staff (37.2%). ConclusionEfforts are needed to enhance collaboration between pharmacists and other health care professional, to develop documentation systems that would preserve and facilitate access to patient information, and to implement appropriate training programs which aim to overcome the challenges and barriers for MTM implementation.

Impact of medication therapy management on pharmacotherapy safety in an intensive care unit.

Background Drug-related problems are mostly preventable or predictable circumstances that may impact on health outcomes. Clinical pharmacy activities such as medication therapy management can identify and solve these problems, with potential to improve medication safety and effectiveness. Objective To evaluate ability of medication therapy management service to detect drug-related problems and prevent adverse drug events. This study also aimed to assess the risk factors for drugrelated problem occurrence. Setting Medical intensive care unit of a public tertiary hospital in Brazil. Methods Patients were evaluated by a clinical pharmacist, whoprovided medication therapy management service. Detected drug-related problems were categorized according to the Pharmaceutical Care Network Europe methodology and analyzed in multinomial regression to identify risk factors. Main outcome measure Potential risk factors for drug-related problem occurrence. Results The proposed medication therapy management service allowed detection of 170 drug-related problems that had potential to reach patients causing harm and other 50 unavoidable adverse events. Drug-related problems identified were more often associated with antibacterial use, caused by improper combinations or inadequate drug dosage. These problems required interventions that wereaccepted by the multidisciplinary team, resulting in more than 85% adherence and total problem solving. Main risk factors identified were previous diagnosis of kidney injury (OR = 8.38), use of midazolam (OR = 7.96), furosemide (OR = 5.87) and vancomycin (OR = 4.82). Conclusion Medication therapy management proved to be an effective method not only for drug-related problem detection, but also for adverse drug event prevention, contributing to improve patient safety.

Impact of medication therapy management on knowledge, attitude and practice among diabetic patients

ObjectivesThe objective of the study was to assess the impact of knowledge, attitude and practice on medication therapy management in diabetic patients in South Kerala, India. This study was designed exclusively to identify the pharmacist's role in patient care using the pharmacist-led MTM programme. MethodsA 15 item questionnaire was designed to assess the knowledge, attitude and practice on diabetic patients. KAP questionnaire consists of 7 knowledge questions, 3 attitude questions and 5 practice questions. 104 diabetic patients from general medicine were selected for the study for 6 months duration. The questionnaire was given to the patients before and after providing MTM service to the patients. Key findingsThe study revealed that the knowledge and attitude of diabetic patients were improved after providing MTM service whereas practice was not improved supporting the previous study evidences. ConclusionThe study identified that the pharmacist-led MTM programme has the potential to improve optimal diabetes management by involving the patients as a part of the health care team. The ability of the clinical pharmacist to build trusting relationships with patients and providers is essential for the success of such a programme.

Eligibility For And Enrollment In Medicare Part D Medication Therapy Management Programs Varies By Plan Sponsor.

Medicare Part D prescription drug plans must offer medication therapy management to beneficiaries with multiple chronic conditions and high drug expenditures. However, plan sponsors have considerable latitude in setting eligibility criteria. Newly available data indicate that enrollment rates in medication therapy management among stand-alone prescription drug plans and Medicare Advantage drug plans averaged only 10percent in 2012. The enrollment variation across plan sponsors-from less than 0.2percent to more than 57.0percent-was associated with the restrictiveness of their eligibility criteria. For example, enrollment was 16.4percent in plans requiring two chronic conditions versus 9.2percent in plans requiring three, and 12.7percent in plans requiring the use of any Part D drug versus 4.4percent in plans requiring the use of drugs in specific classes. This variation represents inequities in access to medication therapy management across plans and results in missed opportunities for interventions that might improve therapeutic outcomes and reduce spending. The new Part D Enhanced Medication Therapy Management model of the Centers for Medicare and Medicaid Services has the potential to significantly increase the impact of medication therapy management by aligning financial incentives with improvements in medication use and encouraging innovation.

Impact of medication therapy management in patients with Parkinson's disease.

Since the new German Apothekenbetriebsordnung was released, medication therapy management (MTM) has increased in importance. MTM is intended to improve the quality of life of patients. The aim of this study was to improve the quality of life of patients with Parkinson's disease through an MTM by a community pharmacist. The patients were recruited in cooperation with the Deutsche Parkinson Vereinigung e.V. (dPV) in Germany. Methods All patients were evaluated at baseline (t0) and after a follow-up of 4 months (t1). During the intervention period, the pharmacists implemented an MTM with standardized pharmaceutical care. Main outcome measure The effects of the interventions were measured by the Unified Parkinson Disease Rating Scale (UPDRS) and the Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS). In this study, 90 patients with Parkinson's disease were included. The most common intervention was to find a therapy for untreated comorbidities. The UPDRS or MDS-UPDRS improved significantly after the intervention period by a median change rate of 1 (p < 0.05) or rather 2 (p < 0.05) compared to the baseline. The study shows that the quality of life in Parkinson's disease patients improved significantly through MTM.

PHS143 - Impact of Medication Therapy Management (MTM) pilot program on Healthcare Utilization and costs among Texas medicaid patients with Hypertension

PHS143 - Impact of Medication Therapy Management (MTM) pilot program on Healthcare Utilization and costs among Texas medicaid patients with Hypertension

Pilot study: incorporation of pharmacogenetic testing in medication therapy management services.

Aim: To describe the rationale and design of a pilot study evaluating the integration of pharmacogenetic (PGx) testing into pharmacist-delivered medication therapy management (MTM). Study rationale: Clinical delivery approaches of PGx testing involving pharmacists may overcome barriers of limited physician knowledge about and experience with testing. Study design: We will assess the addition of PGx testing to MTM services for cardiology patients taking three or more medications including simvastatin or clopidogrel. We will measure the impact of MTM plus PGx testing on drug/dose adjustment and clinical outcomes. Factors associated with delivery, such as time to prepare and conduct MTM and consult with physicians will be recorded. Additionally, patient interest and satisfaction will be measured. Anticipated results: We anticipate that PGx testing can be practically integrated into standard a MTM service, providing a viable delivery model for testing. Conclusion: Given the lack of evidence of an effective PGx delivery models, this study will provide preliminary evidence regarding a pharmacist-delivered approach.

PHS115 - Impact Of Medication Therapy Management (MTM) Services On Health Care Costs In Polypharmacy Patients: Evidence From Retrospective Claims Analysis Of Commercially Insured Us Population

PHS115 - Impact Of Medication Therapy Management (MTM) Services On Health Care Costs In Polypharmacy Patients: Evidence From Retrospective Claims Analysis Of Commercially Insured Us Population

Impact of Medication Therapy Management on Underserved, Primarily Hispanic Patients with Diabetes

Diabetes-related complications are more pronounced in Hispanic patients versus patients of other ethnicities. It is documented that medication therapy management (MTM) can improve diabetes outcomes; however, data regarding Hispanic patients are limited. To evaluate the impact of MTM on hemoglobin A1c (A1C), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) in underserved, primarily Hispanic patients who use a safety-net clinic as their medical home. A retrospective, observational study of uninsured, primarily Hispanic patients with diabetes who received MTM from October 2009 through March 2011. Patients were stratified into 2 cohorts: A1C less than 9% and A1C greater than or equal to 9%. Patients were also stratified by frequency of MTM visits and insulin use, regardless of A1C. A chart review was conducted to evaluate diabetes-related outcomes pre- and postimplementation of MTM. The primary study outcome was reduction of A1C. Secondary outcomes included reduction of BP and LDL-C and reduction of A1C based on MTM visit frequency or insulin use. Sixty-four patients with at least 1 MTM visit and pre- and postimplementation A1C data were included. In the cohort with A1C greater than or equal to 9%, mean (SD) A1C values decreased from 10.9% (1.4%) to 8.8% (1.5%) versus the cohort with A1C less than 9%, whose A1C changed minimally, from 7.2% (0.9%) to 7.4% (1.4%). Regardless of their A1C, patients who were using insulin at baseline had a change in A1C of -0.8% (1.5%) versus -0.1% (1.6%) in those who were not using insulin at baseline (p = 0.04); patients who participated in multiple MTM visits had a significant reduction in A1C, from 9% to 8.3% (95% CI -1.26 to -0.03; p = 0.02) compared with patients participating in only 1 MTM visit. Pharmacist-provided MTM can significantly improve diabetes control in uninsured, primarily Hispanic patients with poorly controlled diabetes and in those who are using insulin. Multiple MTM visits also yielded significant A1C reductions.

The impact of medication therapy management in older oncology patients

This project aimed to identify common drug-related problems (DRP) among elderly cancer patients, to determine the effectiveness of medication therapy management (MTM) service in resolving DRP, to determine the clinical significance of pharmacist interventions, and to determine patients' satisfaction level of MTM service. Elderly cancer patients (age ≥65) who were at least on one chronic medication would be eligible for the MTM service. Any DRP that was detected would be recorded and steps to resolve it were taken. Pre- and post-service patient satisfaction surveys (PSS) were conducted before and after MTM. All interventions performed by MTM pharmacists were subjected to independent evaluation by a panel of three judges. One hundred eighteen patients received at least one session of MTM. We identified and attempted to resolve 361 DRPs, and the most common DRPs were drug interactions (117 cases, 32.4 %), adverse effects (114 cases, 31.6 %), and non-adherence (48 cases, 13.3 %). Forty-four interventions were performed by pharmacists and forty cases (91 %) were accepted by physicians. Almost two third of these interventions were deemed significant (or higher) by the judges. Seventy-two patients completed PSS. There was statistically significant improvement in patients' satisfaction level after the service was provided. MTM is an important platform in identifying and managing DRPs. Patients are generally satisfied with MTM services.

PCV107 Impact of Medication Therapy Management (MTM) on Improving Diabetes Care: A Difference-in-Differences Approach

PCV107 Impact of Medication Therapy Management (MTM) on Improving Diabetes Care: A Difference-in-Differences Approach

Simulated Medication Therapy Management Activities in a Pharmacotherapy Laboratory Course

To measure the impact of medication therapy management (MTM) learning activities on students' confidence and intention to provide MTM using the Theory of Planned Behavior. An MTM curriculum combining lecture instruction and active-learning strategies was incorporated into a required pharmacotherapy laboratory course. A validated survey instrument was developed to evaluate student confidence and intent to engage in MTM services using the domains comprising the Theory of Planned Behavior. Confidence scores improved significantly from baseline for all items (p < 0.00), including identification of billable services, documentation, and electronic billing. Mean scores improved significantly for all Theory of Planned Behavior items within the constructs of perceived behavioral control and subjective norms (p < 0.05). At baseline, 42% of students agreed or strongly agreed that they had knowledge and skills to provide MTM. This percentage increased to 82% following completion of the laboratory activities. Implementation of simulated MTM activities in a pharmacotherapy laboratory significantly increased knowledge scores, confidence measures, and scores on Theory of Planned Behavior constructs related to perceived behavioral control and subjective norms. Despite these improvements, intention to engage in future MTM services remained unchanged.

PS2-04: Impact of Medication Therapy Management Delivered to Home-based Medicare Beneficiaries

Background: Medication Therapy Management (MTM) is a voluntary patient-participation program mandated for Medicare Part D sponsors by the Centers for Medicare and Medicaid Services for chronically-ill beneficiaries with high medication costs/utilization. MTM is intended to optimize therapeutic outcomes for individual patients. The objective of this study was to assess the impact of a pharmacist-managed MTM program on mortality, healthcare utilization, and prescription medication costs and quantify drug- related problems (DRP) identified during MTM. Methods: This quasi-experimental, controlled study was conducted at Kaiser Permanente Colorado, a group model HMO, among beneficiaries who were targeted for MTM in 2006. The MTM intervention was designed to identify potential DRP, educate the patient/caregiver about appropriate medication use, and ensure that the patient was appropriately integrated into clinical services. Data were collected from administrative databases and manual chart abstractions. Study outcomes included all-cause death (primary outcome), hospitalization, and ED visit rates and medication cost changes in the 180 days post-MTM targeting (follow-up) and quantification of DRP. Multivariate logistic regression was used to adjust the outcomes for baseline risk and other potential confounders. Beneficiaries who declined MTM and experienced death, hospitalization, or ED visit received a mock MTM intervention. Results: A total of 459 (Opt-in) and 336 (Opt-out) beneficiaries who agreed and declined, respectively, to receive MTM were included in the analysis. At baseline, groups were similar in age, sex, disease burden, healthcare utilization, and medication spend. Opt-in compared to Opt-out beneficiaries were less likely to die; adjusted odds ratio (AOR)=0.5, 95% confidence interval (CI)=0.3–0.9) but more likely to have had a hospitalization (AOR=1.4; 95% CI=1.1–2.0) and an increase in medication costs (AOR=1.4, 95% CI=1.1–1.9) during follow-up. There was no difference in ED visit rates. At least one DRP was identified in >83% of beneficiaries in both groups, with the most common DRP being drug interaction. Conclusions: Our investigation supports the use of MTM, with its optimization of medication therapy and increased coordination of information between healthcare providers and patients, since it may positively impact mortality in a population of high-risk Medicare beneficiaries.

Assessment of the Impact of Medication Therapy Management Delivered to Home-Based Medicare Beneficiaries

Medication Therapy Management (MTM) is a voluntary patient participation program mandated for Medicare Part D sponsors by the Centers for Medicare and Medicaid Services for chronically ill beneficiaries with high medication costs/utilization. To assess the impact of an MTM program on mortality, healthcare utilization, and prescription medication costs and to quantify drug-related problems (DRPs) identified during MTM. This nonrandomized controlled study was conducted among beneficiaries who were targeted for MTM in 2006. The MTM intervention was designed to identify potential DRPs, educate the patient/caregiver about appropriate medication use, and ensure that the patient was appropriately integrated into clinical services. Data were collected from administrative databases and manual chart abstractions. Study outcomes included all-cause death (primary outcome), hospitalization, and emergency department (ED) visit rates and medication cost changes in the 180 days following MTM targeting and quantification of DRPs. Multivariate logistic regression was used to adjust the outcomes for baseline risk and other potential confounders. A mock MTM intervention was performed for beneficiaries who declined MTM and died, were hospitalized, and/or made an ED visit. A total of 459 opt-in and 336 opt-out beneficiaries who agreed and declined, respectively, to receive MTM were included in the analysis. Beneficiaries who opted in were less likely to die compared with beneficiaries who opted out (adjusted OR [AOR] 0.5; 95% CI 0.3 to 0.9) but were more likely to have had a hospitalization (AOR 1.4; 95% CI 1.1 to 2.0) and an increase in medication costs (AOR 1.4; 95% CI 1.1 to 1.9) during follow-up. There was no difference in ED visit rates. At least one DRP was identified in more than 83% of beneficiaries in both groups, with the most common DRP being drug-drug interaction. Our investigation supports the use of MTM, with its increased coordination of information between healthcare providers and patients, since it may impact mortality positively in a population of high-risk Medicare beneficiaries.