Medication Therapy Management Clinic Research Articles

Cost-effectiveness of a pharmacist-led medication therapy management clinic for management of type 2 diabetes

BackgroundDiabetes imposes a substantial public health burden. Involvement of clinical pharmacists in diabetes disease management can improve health outcomes while managing expenditure. ObjectiveThis study aimed to evaluate the lifetime cost-effectiveness of a pharmacist-led medication therapy management clinic (MTMC) compared to usual care for individuals with type 2 diabetes mellitus, from a U.S. payer perspective. MethodsA cohort simulation Markov model was developed to simulate the occurrence of major complications of diabetes. Transition probabilities, MTMC treatment effects, health state costs, and utilities were based on data from electronic health records and published literature. Outcomes evaluated were lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effective ratio (ICER). Sensitivity analyses were conducted on all model inputs; scenario analyses assessed the impact of preventing additional diabetes complications on economic outcomes, and of reduced MTMC visit frequency. ResultsOver a lifetime, MTMC resulted in $160,145 total costs and 6.73 QALYs; usual care resulted in $152,806 total costs and 6.65 QALYs. The ICER for MTMC compared to usual care was $93,375 per QALY gained, indicating cost-effectiveness at a willingness-to-pay threshold of $100,000 per QALY gained. Scenario analyses showed that modeling additional complications or reduced visit frequency lowered the ICER. The results were most sensitive to MTMC costs, and hazard ratios for occurrence of stroke, myocardial infarction, and renal failure. ConclusionThe study demonstrates the potential cost-effectiveness of integrating clinical pharmacy services into comprehensive care strategies. Findings support the broader coverage and reimbursement of such services to optimize clinical outcomes and reduce long-term health care costs.

Medication Therapy Management Clinics: A Model to Improve Healthcare Access.

Medication Therapy Management Clinics: A Model to Improve Healthcare Access.

Cost-Effectiveness Analysis of a Pharmacist-Led Medication Therapy Management Program: Hypertension Management

ObjectivesUncontrolled hypertension is a common cause of cardiovascular disease, which is the deadliest and costliest chronic disease in the United States. Pharmacists are an accessible community healthcare resource and are equipped with clinical skills to improve the management of hypertension through medication therapy management (MTM). Nevertheless, current reimbursement models do not incentivize pharmacists to provide clinical services. We aim to investigate the cost-effectiveness of a pharmacist-led comprehensive MTM clinic compared with no clinic for 10-year primary prevention of stroke and cardiovascular disease events in patients with hypertension. MethodsWe built a semi-Markov model to evaluate the clinical and economic consequences of an MTM clinic compared with no MTM clinic, from the payer perspective. The model was populated with data from a recently published controlled observational study investigating the effectiveness of an MTM clinic. Methodology was guided using recommendations from the Second Panel on Cost-Effectiveness in Health and Medicine, including appropriate sensitivity analyses. ResultsCompared with no MTM clinic, the MTM clinic was cost-effective with an incremental cost-effectiveness ratio of $38 798 per quality-adjusted life year (QALY) gained. The incremental net monetary benefit was $993 294 considering a willingness-to-pay threshold of $100 000 per QALY. Health-benefit benchmarks at $100 000 per QALY and $150 000 per QALY translate to a 95% and 170% increase from current reimbursement rates for MTM services. ConclusionsOur model shows current reimbursement rates for pharmacist-led MTM services may undervalue the benefit realized by US payers. New reimbursement models are needed to allow pharmacists to offer cost-effective clinical services.

Improving Medication Adherence in an ACO Primary Care Office With a Pharmacist­Led Clinic: A Report From the ACORN SEED

Background: As health care moves into the era of value-based medicine, both ambulatory and acute settings are being held accountable for the quality of care provided to patients. Previous studies have shown improved clinical outcomes through medication therapy management (MTM) due to improved medication adherence. Objective: The purpose of this study is to assess the effects of a pharmacist-led MTM clinic in an accountable care organization (ACO) affiliated primary care office on adherence to renin-angiotensin system (RAS) antagonists, diabetic medications, and/or statin medications reported through Healthcare Effectiveness Data and Information Set (HEDIS) Medicare Star Ratings. Methods: In this retrospective cohort study, data were collected via chart review of pharmacist-led MTM patient interviews and follow-ups between October 2015 and April 2017. Eligible patients were Humana HMO Medicare beneficiaries, with at least one chronic disease state, for which they were treated with a RAS antagonist, statin, or diabetic medication. The primary outcome of this investigation was a change in Star Rating scores for medication adherence to RAS antagonists, diabetic medications, and statins from pre- and postpharmacist MTM intervention. Results: A total of 102 patients were referred to the MTM clinic. Out of these, 32 had a follow-up visit, resulting in a total of 25 interventions. One year prior to MTM clinic implementation, most Star Ratings were consistently 3 (out of 5) for RAS antagonists, diabetic medications, and statins. Postintervention, ratings increased to 4 or 5 across these categories. Conclusion: Implementing a pharmacist-led MTM clinic in the ACO primary care setting improves Medicare Star Ratings in patients with chronic conditions.

Impact of a Medication Therapy Management Clinic on Glycosylated Hemoglobin, Blood Pressure, and Resource Utilization.

Medication therapy management is widely promoted to improve care. However, few well-controlled studies have evaluated its impact. We evaluated whether enrollment in a comprehensive medication therapy management clinic (MTMC) was associated with improved 12-month outcomes. This institutional review board approved study was a retrospective controlled cohort study in an academic health center serving low-income, African American and Latino populations. Between 2001 and 2011 MTMC patients were matched to control patients by age, gender, and comorbidities. Outcomes were mean change in glycosylated hemoglobin (A1C), diastolic (DBP) and systolic blood pressure (SBP), and emergency department (ED) and hospital admissions at 6 and 12 months. A difference-in-difference analysis was conducted for each outcome of interest, adjusting for observed, unmatched confounders. Patients with diabetes and receiving MTMC had greater A1C improvements, compared with controls, of 0.54% (P = 0.0067) at 6 months and 0.63% (P = 0.0160) at 12 months. At 6 months, SBP and DBP decreased in MTMC patients by 6.5 mm Hg (P = 0.0108) and 3.8 mm Hg (P = 0.0136) more than controls, respectively. At 12 months, those receiving MTMC services had SBP and DBP decreases, respectively, of 8.2 mm Hg (P = 0.0018) and 1.7 mm Hg (P = 0.2691) compared with controls. ED and hospital visits were not statistically significantly different between groups. Conclusion and Relevance: This MTMC potentially improved outcomes for referred patients in whom target goals were difficult to achieve and can serve as a model for other similar medication management programs.

Retrospective analysis of billing at a standalone medication therapy management clinic.

Results of a study comparing reimbursement for medication therapy management (MTM) services with a resource-based relative value scale (RBRVS) versus a time-based billing model are reported. Reimbursement claims for MTM services provided by a standalone clinic during a 6.5-year period were reviewed. Actual billing amounts calculated according to Minnesota's RBRVS for MTM services, which emphasizes case complexity as a determinant of payment rates, were compared with hypothetical billing amounts calculated using a strictly time-based method designed to more accurately capture the costs of providing MTM services. A paired t test was conducted to analyze differences in the billable amounts calculated via the two methods. Reimbursement claims for a total of 525 face-to-face MTM encounters with 60 patients were analyzed. Using the RBRVS method, the mean ± S.D. billing amount per encounter was $83.71 ± $36.67; using the strictly time-based method, the mean ± S.D. billing amount was $111.83 ± $34.55 per encounter (mean difference, $28.12; p < 0.0001). These findings indicate that the use of time-based versus RBRVS-based billing methodology would have resulted in an additional $14,763 in MTM services reimbursement for the 525 evaluated encounters. The RBRVS-based method consistently resulted in a lower billing amount per encounter than the strictly time-based billing method, suggesting that reimbursement for MTM services may not be aligned with the actual costs of providing those services.

Implementation and Clinical Outcomes of an Employer-Sponsored, Pharmacist-Provided Medication Therapy Management Program.

Our objective was to describe the implementation and clinical outcomes of an employer-sponsored, pharmacist-provided medication therapy management (MTM) program for health plan beneficiaries with diabetes mellitus and/or hypertension. We conducted a single-center retrospective medical record review. The setting was a Pharmacy MTM Clinic at a self-insured health system consisting of six hospitals and several ancillary facilities. A total of 161 health plan beneficiaries with diabetes identified during annual wellness screenings for the health plan in 2012 and 225 health plan beneficiaries with diabetes and/or hypertension identified during annual wellness screenings for the health plan in 2013 were referred to the MTM clinic based on specific criteria. In 2012 the health system expanded its existing wellness program by implementing a voluntary diabetes care program for health plan beneficiaries with uncontrolled diabetes (hemoglobin A(1c) [A1C] 7% or higher); a similar program was added for hypertension for the 2013 plan year. All participants' A1C and blood pressure results were tracked from the date of their wellness screening through the end of the plan year. The pharmacists involved had the capability to directly implement drug regimen changes according to hospital protocol or provide recommendations to the physician, as specified by the referring physician. For the 2012-2013 plan year, the mean difference in A1C from baseline to program completion was -0.38% (95% confidence interval [CI] -0.58 to -0.18%, p<0.05). For beneficiaries with a baseline A1C of 7% or higher, the mean difference was -0.69% (95% CI -0.99 to -0.39%, p<0.05). For the 2013-2014 plan year, the mean difference in A1C from baseline to program completion was -0.62% (95% CI -0.81 to -0.44%, p<0.05). In that year, the mean difference in A1C for beneficiaries with A1C 7% or higher was -0.97% (95% CI -1.23 to -0.72%, p<0.05). For those referred for hypertension, a mean difference of -13 mm Hg (95% CI -18.59 to -7.73, p<0.05) from baseline to program completion was seen in systolic blood pressure, and the mean difference in diastolic blood pressure was -7 mm Hg (95% CI -9.92 to -4.04, p<0.05). This study demonstrated that health plan beneficiaries who participated in the employer-sponsored, pharmacist-provided MTM program had significant decreases in A1C and blood pressure.

Satisfaction With Medication Therapy Management Services at a University Ambulatory Care Clinic

A survey was issued to patients enrolled in the Medication Therapy Management Clinic (MTMC) at University of Illinois Hospital and Health Sciences (June 2011-January 2012) in order to assess satisfaction with pharmacy services provided by pharmacists. A 23-item survey was offered to 65 patients in the MTMC program before or after clinic visits. Since there is a paucity of data indicating the level of satisfaction with MTM services provided by pharmacists, this survey may contribute to the process of building a greater collaboration between the pharmacist and patient. Sixty-two of 65 patients completed the survey; satisfaction with MTMC pharmacists was demonstrated to be significantly positively correlated with overall satisfaction with the MTMC. Patient satisfaction is not significantly different according to age, gender, ethnicity, or number of disease states. Satisfaction with the pillbox service is not significantly different between younger and older patients. It was also noted that patients taking a greater number of medications had higher levels of satisfaction. Most patients indicated that they were satisfied with the MTMC pharmacists and services; further study linking patient satisfaction with MTM services to improved patient outcomes may allow our MTMC to serve as a model for other pharmacist-managed MTMCs serving similar patient populations.

Factors Influencing Enrollment in the Medication Therapy Management Clinic at an Academic Ambulatory Care Clinic

Purpose: In 2001, the University of Illinois Hospital and Health Sciences System (UI Health) established a pharmacist-run, referral-based medication therapy management clinic (MTMC). Referrals are obtained from any UI Health provider or by self-referral. Although there is a high volume of referrals, a large percentage of patients do not enroll. This study was designed to determine the various factors that influence patient enrollment in the MTMC. Methods: This study was a retrospective chart review of demographic and patient variable data during years 2010 and 2011. Disabilities, distance from MTMC, mode of transportation, past medical history, and appointment dates were extracted from the medical records. Results were analyzed using descriptive statistics and logistic regression analysis. Results: A total of 103 referrals were made; however, only 17% of patients remain enrolled in MTMC. The baseline demographics included a mean age of 63 years, 68% female, 70% African American, and 81% English speaking. Patients lived an average of 8 miles from MTMC; most utilized public or government-supplemented transport services; 24% of patients reported some type of disability, most commonly utilizing a walker or a wheelchair. On average, patients were prescribed 13 medications with hypertension (70%), diabetes (56%), and hyperlipidemia (48%) being the most common chronic disease states. The reason for referral included medication management, education, medication reconciliation, and disease state management. Five patients were unable to be contacted to schedule an initial appointment. Additionally, 18 patients failed their scheduled initial appointment and did not reschedule. Logistic regression analysis demonstrated distance traveled for clinic visit, age, and history of hypertension affected the probability of patients showing for their appointments (chi-square = 19.7, P < .001). Conclusion: This study demonstrated that distance from MTMC is the most common barrier in patient enrollment; therefore, strategies to improve patient access are necessary.

Understanding the medication experiences of Thai patients attending a medication therapy management clinic

Understanding the medication experiences of Thai patients attending a medication therapy management clinic

Clinical and Behavioral Impact of Pharmaceutical Care Services in Community Pharmacies in Puerto Rico

Background: Medication Therapy Management (MTM) is an area in which pharmacists have the opportunity to provide pharmaceutical care by working directly with the patients and their physicians to optimize the patient’s pharmacological therapy. The objective of this research is to determine the relationship between MTM practices and changes in clinical markers of disease and behavioral attitudes of Puerto Rican patients at community pharmacies. Methods: The study is a retrospective chart review design. A total of thirty-five patients participated in the first encounter, which consisted in an individualized clinic visit following a standardized MTM format. Follow-up was provided as appropriate for clinical evaluation. A trend analysis and paired t-test was planned to assess the impact of MTM interventions on blood pressure, lipid levels, and hemoglobin A1C with respect to baseline measurements. Adherence was assessed by calculating the medication possession ratio for all medication filled from the initial MTM clinic visit to the end of the study period. Results: An average positive trend for clinical markers of de could be observed. Adherence in general improved from an average of MPR of 0.54 to an MPR of 0.63. However, the desired level for adherence was not reached in all patients. Conclusion: Although recruitment was low this study showed an average improvement in clinical markers of disease and adherence of patients receiving MTM services in three community pharmacies in the metropolitan area of Puerto Rico. Due to the lack of statically significant data the results cannot be extrapolated to

Medication therapy management clinic: perception of healthcare professionals in a University medical center setting

To determine the overall perception and utilization of the pharmacist managed medication therapy management (MTM) clinic services, by healthcare professionals in a large, urban, university medical care setting. This was a cross-sectional, anonymous survey sent to 195 healthcare professionals, including physicians, nurses, and pharmacists at The University of Illinois Outpatient Care Center to determine their perception and utilization of the MTM clinic. The survey consisted of 12 questions and was delivered through a secure online application. Sixty-two healthcare professionals (32%) completed the survey. 82% were familiar with the MTM clinic, and 63% had referred patients to the clinic. Medication adherence and disease state management was the most common reason for referral. Lack of knowledge on the appropriate referral procedure was the prominent reason for not referring patients to the MTM clinic. Of the providers that were aware of MTM services, 44% rated care as 'excellent', 44% as 'good', 5% as 'fair', and 0% stated 'poor'. Strengths of MTM clinic identified by healthcare providers included in-depth education to patients, close follow-up, and detailed medication reconciliation provided by MTM clinic pharmacists. Of those familiar with MTM clinic, recommendations included; increase marketing efforts to raise awareness of the MTM clinic service, create collaborative practice agreements between MTM pharmacists and physicians, and ensure that progress notes are more concise. In a large, urban, academic institution MTM clinic is perceived as a valuable resource to optimize patient care by providing patients with in-depth education as it relates to their prescribed medications and disease states. These identified benefits of MTM clinic lead to frequent patient referrals specifically for aid with medication adherence and disease state management.

Development of an Active Follow-up Process in a Stand-alone Medication Therapy Management (MTM) Clinic

Without following-up with patients, one cannot determine the outcomes of interventions made with patients. To ensure follow-up was occurring in a stand-alone MTM clinic, a process for active follow-up and an easy-to-use way to trigger and document follow-up was developed.&#x0D; &#x0D; Type: Clinical Experience

Development of a pharmacist–psychiatrist collaborative medication therapy management clinic

ObjectiveTo describe a needs assessment, practice description, practice innovation and reimbursement of a psychiatric pharmacist medication therapy management (MTM) clinic with related challenges and opportunities. SettingAn MTM clinic established in collaboration with the Outpatient Psychiatric Services (OPS) at the University of California San Diego (UCSD), under contract with the San Diego County Health and Human Services Agency Adult and Older Adult Mental Health Services (A/OAMHS). Practice descriptionTwo board-certified psychiatric pharmacists provided direct patient care using a collaborative practice protocol 3days per week. Clinical services included pharmacotherapy management, laboratory monitoring, medication counseling, and psychosocial referrals to other providers. Practice innovationPayment to UCSD OPS for clinical services was based on a contract between the San Diego County A/OAMHS and the clinic. Two pharmacists co-managed mental health patients and billed for medication management based on face-to-face contact time (medication minutes) and documentation time with each patient. Main outcome measuresNumber of patients comanaged, dropout rates, visit duration, and billed minutes. ResultsFrom May 2009 to December 2010, two pharmacists comanaged 68 patients, mean (± SD) age 48.6±11.6years, diagnosed with major depressive, schizophrenic, schizoaffective, and/or bipolar disorder. A total of 56 (82.3%) patients were clinically stable and remained on the pharmacist caseload, but 12 (17.6%) patients were lost to follow-up (10 lost contact, 1 moved, 1 expired). On average, patients had 7.7 patient visits , for 491 total visits (with an average of 26minutes per visit) that were billed at a rate of $4.82 per minute for medication minutes, translating to $84,542.80. ConclusionWith provider education and appropriate physician champions, pharmacists are able to work collaboratively with psychiatrists in a mental health clinic.

College of pharmacy–based medication therapy management program for a university system

To document and evaluate the design and operation of a medication therapy management (MTM) benefit and associated MTM clinic developed by the University of Minnesota College of Pharmacy as a covered health plan benefit for University of Minnesota, Duluth (UMD) employees, early retirees, and their dependents. Office-based, nondispensing pharmacy at UMD. College of Pharmacy, Duluth faculty developed and provided MTM services as a covered health benefit for UMD beneficiaries. Partnership between a university campus and a college of pharmacy to design and implement an MTM benefit as part of the university health plan covering current employees, early retirees, and dependents. MTM benefit design, MTM clinic implementation, patient complexity comparisons, and drug therapy problems identified and addressed. Of 1,000 eligible beneficiaries, 68 (∼7%) took advantage of the MTM benefit, consistent with national participation rates but lower than the 25% goal for participation. Beneficiaries receiving MTM services were three times more complex in terms of health resource use than the "typical" UMD beneficiary and were experiencing 7.22 drug therapy problems per patient. The UMD MTM clinic was successful in providing UMD beneficiaries access to MTM services. The MTM benefit was subsequently offered throughout the entire University of Minnesota system (Crookston, Duluth, Minneapolis-St. Paul, and Morris).

Model for medication therapy management in a university clinic

Experience with a referral-based medication therapy management (MTM) clinic in a university medical center is described. The MTM clinic's mission is to assist patients who take multiple medications due to multiple chronic conditions with the management of their drug therapy to improve or maintain their health and prevent or minimize drug-related problems. The clinical services provided at the clinic have evolved into a comprehensive program providing five distinct service areas: access, adherence, coordination of care, medication therapy review, and education. During initial visits, patient information is collected, patients are interviewed, medications are reconciled, and the pharmacist identifies and attempts to solve any immediate drug-related problems and concerns. Routine visits are scheduled monthly to coincide with a patient's medication refills. On a typical day, a minimum of two MTM pharmacists and one pharmacy technician staff the clinic. On two days of the week, three MTM pharmacists are available in the clinic. The clinic averages 9-13 scheduled patient visits per day. The MTM clinic functions as a subset of the outpatient pharmacy and is merged financially in the general operational budget of the ambulatory care pharmacy. This model of MTM patient care is intensive and comprehensive and is significantly different from the majority of MTM models currently provided by Medicare Part D plans. A referral-based MTM clinic managed by pharmacists at a university medical center outpatient pharmacy provides care to patients with the goal of improving medication access, medication adherence, continuity of care, medication therapy management, and patient education.