Medication Therapy Management Activities Research Articles

Identification and Characterization of Workflow Models for Medication Therapy Management in Community Pharmacies.

Community pharmacists providing medication therapy management (MTM) services report difficulty incorporating MTM services with dispensing and other pharmacy services. A variety of approaches exist due to a lack of an ideal standard for service integration. This study seeks to identify and characterize MTM workflow models in pharmacies of one geographic area of a large community pharmacy chain. Thirteen semi-structured interviews were conducted with pharmacists from thirteen different pharmacies. Interviews were audio-recorded, transcribed, and analyzed for common themes using an inductive qualitative approach. We did not find a high level of MTM task integration into the dispensing workflow in this setting. However, three main strategies used to delegate work of MTM activities were identified and defined: shared teamwork, delegated teamwork, and single delegation. Few MTM tasks were integrated into the dispensing workflow among interviewed pharmacies; most tasks were performed outside of workflow. The most common integration was performing patient interviews at pick up. There were no trends identified among high performing or low performing pharmacies. This work may provide a basis to define workflow models for further research to test implementation strategies within community pharmacies.

Implementation of a medication therapy management collaborative within a pediatric health system

ObjectivesTo describe the implementation of a medication therapy management (MTM) collaborative within a pediatric health system to ensure the safe use of medication. SettingOutpatient pharmacies and clinics within a pediatric health system in Central Ohio. Practice descriptionThe outpatient pharmacies conducted the daily operations of a community pharmacy following a standard, 4-point workflow. The ambulatory clinical pharmacists served on interdisciplinary teams within outpatient clinics to ensure the appropriate use of medication. Practice innovationA collaborative model was developed to offer MTM services to patients within outpatient pharmacies and clinics throughout the health system. The pharmacist responsibilities varied, with outpatient pharmacists focused on targeted medication reviews (TMRs) and ambulatory clinical pharmacists focused on comprehensive medication reviews (CMRs) and TMRs. EvaluationThe use of multiple plan-do-study-act cycles allowed for program improvements throughout implementation. Data collection included a pharmacy staff perception survey, mapping of MTM opportunities, and a quantitative report on the number, type, and intervention rate of all MTM activities. ResultsFour hundred nine MTM interventions, 349 TMRs (70 clinic based and 279 pharmacy based) and 60 CMRs, were completed throughout the first 6 months. Two hundred thirty-eight of the TMRs were pharmacist-initiated interventions that allowed pharmacists to provide medication counseling and follow-up with patients beginning new therapy. Ambulatory clinical pharmacists identified and resolved drug-related problems in greater than one-half of the CMRs completed. The intervention rates were 39% for CMRs and 44% for TMRs. ConclusionThe implementation of a collaborative MTM model provided an opportunity to address drug-related problems to ensure the appropriate use of medication. The model consisted of pharmacy staff members within 2 different patient care environments working together to complete MTM services for patients throughout the health system. The key elements of the program included the use of training sessions tailored to the pharmacy staff member’s role in MTM, incorporation of technician champions, and creation of pharmacist-initiated interventions.

Knowledge of and readiness for medication therapy management among community pharmacists in Lebanon.

Background To follow international standards, the Lebanese Order of Pharmacists would like to start to implement the medication therapy management in community pharmacies. Objective The objective of this study is to evaluate community pharmacists' knowledge of and readiness for medication therapy management. Setting Community pharmacists from all Lebanese regions. Method A cross-sectional observational descriptive study was conducted. Pharmacists at their workplace completed self-administered anonymous standardized questionnaires between June and December 2016, with no compensation in return. Statistical analysis was conducted using bi-variate and multi-variable methods. Main outcome measure The major dependent variable of interest was the willingness to engage in medication therapy management activities. Results While only 376 (46%) of the interviewed pharmacists declared to be familiar with this concept, the majority of interviewed pharmacists 646 (78.8%) agreed on the importance of patient-centered care. Although this service will not be remunerated at this stage, 529 (64.5%) were willing to attend advanced training sessions to become actively engaged in medication therapy management, particularly those who had adequate workflow, staff and time at their workplace (aOR = 1.51; p = 0.045) and those agreeing to review a patient's medication profile and provide interventions as part of their role (aOR = 6.10; p < 0.001). Conclusion Lebanese pharmacists have adequate knowledge and a positive attitude towards medication therapy management services implementation; however, barriers could arise such as inadequate time, workflow and physical space. Efforts should be exerted by the Lebanese Order of Pharmacist to extend the role of the pharmacist and its positive effect on patient outcome.

Pharmacists' perceptions of advancing public health priorities through medication therapy management.

Background:Public health priorities can be addressed by pharmacists through channels such as medication therapy management (MTM) to optimize patient and population outcomes. However, no studies have specifically assessed pharmacists’ perceptions of addressing public health priorities through MTM.Objective:The objective of this study was to assess pharmacists’ opinions regarding the feasibility and appropriateness of addressing seven areas of public health priority through MTM services to impact public health in direct patient care settings.Methods:An anonymous 37-question electronic survey was conducted to evaluate Ohio pharmacists’ opinions of advancing seven public health priorities identified from Healthy People 2020 (family planning, preconception care, smoking cessation, immunizations, nutrition/biometric wellness assessments, point-of-care testing, fall prevention) through MTM activities; to identify potential barriers; and to collect demographic information. The cross-sectional survey was sent to a random sample of 500 pharmacists registered with the Ohio State Board of Pharmacy.Results:Seventy-six pharmacists responded to the survey, resulting in a 16% response rate. On average, it took respondents 5-10 minutes to complete the survey. The majority of respondents thought that each of the seven public health priorities were “important” or “very important” to patient health; the most commonly identified areas included smoking cessation, immunizations, and fall prevention (97.5%). When asked to indicate which of the seven areas they thought they could potentially have a role to provide services through MTM, on average pharmacists picked 4 of the priority areas. Only 6.6% indicated there was no role for pharmacists to provide MTM services for any of the listed categories. Staffing, time, and reimbursement represented the most commonly perceived barriers for pharmacists in providing MTM services. Fifty-seven percent indicated an interest in learning more about MTM, with 98% of responders selecting continuing education as the preferred source.Conclusion:The majority of pharmacists indicated they could make an impact on public health priorities through MTM services.

Innovations

Innovations

Challenges to implementation of MTM services

Challenges to implementation of MTM services

Pharmacy Practice in Virginia in 2011

Opportunities for pharmacy practice reform exist at state and national levels. The Virginia Commonwealth University (VCU) School of Pharmacy created a working group to assess these opportunities with a mission to advance pharmacy practice in Virginia. To assess the perceptions of chronic and acute care pharmacy practice and confidence in providing patient care and medication therapy management (MTM) activities and characterize current work activities of pharmacists in Virginia. A cross-sectional, online survey was used. VCU School of Pharmacy pharmacist preceptors, students, and faculty members were eligible. The questionnaire contained items that assessed perceptions of chronic and acute care pharmacy practice and confidence in patient care and MTM activities. Demographic and practice site characteristics were also collected. A total of 974 preceptors, 515 students, and 78 faculty members were invited to participate, and 335 preceptors, 155 students, and 41 faculty members had usable responses, yielding response rates of 34%, 30%, and 53%, respectively. Preceptors, students, and faculty members favorably viewed direct patient care roles in the chronic and acute care settings. Pharmacists were very confident or confident in performing many patient care and MTM activities. They were least confident in considering genetic characteristics when adjusting medications and creating business plans for new services. Many pharmacists in chronic and acute care settings provided some type of patient care service, but few were regularly providing services. Inadequate time, staffing, and reimbursement, and lack of perceived value from patients and providers were most frequently cited as barriers to service provision. VCU preceptors, students, and faculty members overwhelmingly believe that pharmacists should provide direct patient care and MTM activities. To transform pharmacy practice, it will be important to define the pharmacist's role, responsibilities, and expected outcomes and to consider time, staffing, and compensation as well as to engage patients and providers.

MTM: Improving positioning and integration

MTM: Improving positioning and integration

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.

Provision of Medication Therapy Management to University Faculty and Staff Members by Third-year Pharmacy Students

To develop and implement a medication therapy management (MTM) curriculum and assess students' skills and attitudes after the provision of MTM services to faculty and staff members. Third-year students enrolled in a pharmaceutical care laboratory course received lectures and participated in MTM activities in preparation for an MTM encounter. Students conduced MTM sessions with university faculty and staff members, providing comprehensive medication review, blood pressure checks, and optional blood glucose and cholesterol (total cholesterol and HDL) screenings. A faculty-developed rubric was used to evaluate students' ability to explain MTM to the participant and address medication-related problems. Students' responses on pre- and post-encounter survey instruments showed their confidence to provide MTM services, communicate with participants and other health care providers, and provide point-of-care screening services had increased. Incorporating MTM into an existing laboratory course increased students' confidence and perceived ability to provide MTM services.

Attitudes of Medicare beneficiaries toward pharmacist-provided medication therapy management activities as part of the Medicare Part D benefit

Attitudes of Medicare beneficiaries toward pharmacist-provided medication therapy management activities as part of the Medicare Part D benefit