Medication Therapy Management Interventions Research Articles

Impact of medication therapy management services on patient outcomes

This extensive analysis investigates the influence of Medication Therapy Management (MTM) services on patient outcomes, specifically emphasizing medication adherence, health-related quality of life, healthcare usage, and cost savings. We performed a comprehensive review and meta-analysis of relevant literature over the last decade to assess the efficacy of MTM services. The study included research that encompassed a wide range of patient demographics, with particular emphasis on individuals with chronic ailments and the elderly. The analysis demonstrated that MTM interventions had a substantial impact on enhancing drug adherence, leading to a noteworthy 10% rise in adherence rates when compared to conventional treatment. Moreover, MTM services have shown beneficial impacts on the health-related quality of life, especially in patients with chronic ailments like diabetes and hypertension. Patients who received MTM services reported enhanced physical and mental health ratings, suggesting a more extensive influence on their overall well-being. Furthermore, it was shown that MTM services effectively decrease healthcare consumption, resulting in a decrease in hospitalizations and trips to the emergency room. Significantly, those suffering from heart failure and numerous chronic ailments saw a noteworthy 20% decline in hospitalizations and a 15% drop in visits to the emergency room, respectively.

The impact of SyncPlus on workflow in an independent pharmacy

BackgroundMedication Synchronization (Med Sync) is a medication management strategy that aligns two or more medications to be refilled on the same date. Med Sync may improve several patient outcomes when implemented in a community pharmacy. SyncPlus is a Med Sync service developed at Crosby’s Drugs. Objectives for assessment of SyncPlus included evaluation of changes to delivery volume, number of delivered prescriptions, and number of medication therapy management interventions before and after SyncPlus implementation. Practice descriptionCrosby’s Drugs is an independent pharmacy in downtown Columbus, Ohio. The pharmacy offers several services to a largely Medicare-insured population. Practice innovationSyncPlus patients must fill all prescription medications at Crosby’s Drugs and take at least 5 chronic medications, excluding controlled substances and gabapentin. To enroll, patients verbally agree to review their profile with a technician. Patients complete a clinical consult with a pharmacist to address medication-related problems. Through shared decision-making, the patient and pharmacist determine an anchor drug and next fill date. Medications are short-filled as insurance coverage allows. Pharmacists and interns address medication-related problems and contact prescriber offices for refills and clarifications. Documentation and billing are conducted via the Outcomes platform. Evaluation methodsA 3-month retrospective chart review was performed before and after SyncPlus implementation. Internal pharmacy data and Outcomes data provided reports to address objectives. ResultsIn the three months after SyncPlus implementation, 10 patients were enrolled over three months. The sum of total deliveries dropped from 4478 to 3974. The number of prescriptions delivered were similar before and after SyncPlus implementation. During the 3 months post-implementation 89 Outcomes interventions were completed compared with 18 interventions in the three months prior. ConclusionsA medication synchronization program in an independent pharmacy may improve workflow efficiency by reducing deliveries and increasing opportunities for medication management for patients.

Acceptability of patient-centered, multi-disciplinary medication therapy management recommendations: results from the INCREASE randomized study

BackgroundPolypharmacy and inappropriate medications may be a modifiable risk factor for Alzheimer’s Disease and Related Dementias (ADRD). Medication therapy management (MTM) interventions may mitigate medication-induced cognitive dysfunction and delay onset of symptomatic impairment. The objective of the current study is to describe an MTM protocol for a patient-centered team intervention (pharmacist and non-pharmacist clinician) in a randomized controlled trial (RCT) directed at delaying the symptomatic onset of ADRD.MethodsCommunity dwelling adults 65 + years, non-demented, using ≥ 1 potentially inappropriate medications (PIM) were enrolled in an RCT to evaluate the effect of an MTM intervention on improving medication appropriateness and cognition (NCT02849639). The MTM intervention involved a three-step process: (1) pharmacist identified potential medication-related problems (MRPs) and made initial recommendations for prescribed and over-the-counter medications, vitamins, and supplements; (2) study team reviewed all initial recommendations together with the participants, allowing for revisions prior to the finalized recommendations; (3) participant responses to final recommendations were recorded. Here, we describe initial recommendations, changes during team engagement, and participant responses to final recommendations.ResultsAmong the 90 participants, a mean 6.7 ± 3.6 MRPs per participant were reported. Of the 259 initial MTM recommendations made for the treatment group participants (N = 46), 40% percent underwent revisions in the second step. Participants reported willingness to adopt 46% of final recommendations and expressed need for additional primary care input in response to 38% of final recommendations. Willingness to adopt final recommendations was highest when therapeutic switches were offered and/or with anticholinergic medications.ConclusionThe evaluation of modifications to MTM recommendations demonstrated that pharmacists’ initial MTM recommendations often changed following the participation in the multidisciplinary decision-making process that incorporated patient preferences. The team was encouraged to see a correlation between engaging patients and a positive overall response towards participant acceptance of final MTM recommendations.Trial registrationStudy registration number: clinicaltrial.gov NCT02849639 registered on 29/07/2016.

Multiple beneficial outcomes of medication therapy management interventions in randomized control trials and non-randomized control trials: A protocol for systematic review and meta-analysis.

Medication therapy management (MTM) service is an effective method to reduce medication-related problems and improve patients' multiple kinds of outcomes. However, the lack of comprehensive review for MTM services has hindered its development. As a result, we are aiming to evaluate the current benefits of MTM services with multiple outcomes. An electronic search will be performed for randomized controlled trials (RCTs) or non-randomized control trials (NRCTs) that reported MTM services or pharmaceutical services as interventions from PubMed, The Cochrane Library, Embase, and ClinicalTrial. gov. The odds ratios, mean differences, and standard mean differences and their 95% confidence intervals (95% confidence intervals) will be calculated with fixed or random effect models. This study will evaluate the multiple benefits of MTM services in clinical endpoints, quality of life, economy, and drug-related problems. The results will review eligible studies released in the past twenty years and provide more comprehensive evidence of the efficacy of MTM services. Ethical approval is not applicable for this study.

A Systematic Review of Clinical Outcomes from Pharmacist Provided Medication Therapy Management (MTM) among Patients with Diabetes, Hypertension, or Dyslipidemia.

This study aimed to compare the clinical outcomes of pharmacist-provided medication therapy management (MTM) services as compared to no MTM services (i.e., standard of care) on outpatient clinical outcomes for patients with diabetes, hypertension, or dyslipidemia. A systematic literature review of PubMed, EMBASE, Cochrane library, International Pharmaceutical s, PsycINFO, Scopus, CINAHL electronic databases, grey literature, websites, and journals, was conducted from 1 January 2005–20 July 2021. The search field contained a combination of keywords and MeSH terms such as: “medication therapy management”, “pharmacist”, “treatment outcomes”. Studies published in United States, included adults ≥18 years old who received at least one pharmacist-provided MTM consultation and at least one group who received no MTM, and reported pre-specified clinical outcomes for diabetes mellitus, hypertension, or dyslipidemia were included. Of 849 studies identified, eight were included (cohort studies = 6, randomized controlled trials = 2). Clinical outcomes improved with MTM interventions, as evidenced by statistically significant changes in at least one of the three chronic conditions in most studies. Improvements were observed for diabetes outcomes (n = 4 studies), hypertension outcomes (n = 4 studies), and dyslipidemia outcomes (n = 3 studies). Overall, this study indicated that pharmacist delivered MTM services (versus no MTM services) can improve clinical outcomes for patients with diabetes, hypertension, and dyslipidemia.

Pharmacist-led medication therapy management of diabetes club patients at a primary healthcare clinic in Cape Town, South Africa: A retrospective and prospective audit

Background. Diabetes mellitus (DM) is a complex chronic condition and remains a public health concern worldwide. In South Africa (SA), many patients with DM access public sector primary healthcare clinics, and those who are considered to be stable are referred to the club system, which is managed by a multidisciplinary team. Patients who have DM are often diagnosed with concurrent medical conditions, resulting in multiple medication therapies that lead to medication therapy problems (MTPs). Prescriber adherence to standard treatment guidelines (STGs) is aimed at improving glycaemic control to minimise complications and decrease healthcare costs. The pharmacist’s role in medication therapy management (MTM) for DM is underutilised in public sector healthcare facilities. Objectives. To evaluate the implementation of a pharmacist-led MTM intervention to optimise the management of stable patients with type 2 DM attending a diabetes club at a Cape Town community day centre. Methods. An evaluation study design using a case study approach was conducted over 8 months from November 2016 to June 2017. A retrospective and prospective audit was conducted from patient folders of stable patients who attended the club. Quantitative data were extracted from the folders. A trained pharmacist audited baseline (pre-intervention) data. Prescribing staff were notified of therapeutic discrepancies through written pharmacist’s pharmacotherapeutic recommendations (intervention). Pharmacist-led interventions audited prescriber adherence to SA STGs and the Essential Medicines List, and prescriber responses to the pharmacist’s recommendations (post-intervention) were recorded as accepted, partially accepted or rejected. Estimated costs were calculated for rational and irrational prescribing of aspirin during the MTM process. Results. Of 104 patient folders audited, most were for females (n=70; 67.3%). A total of 453 MTPs were identified, averaging four interventions per folder reviewed. The most common MTPs identified were the absence of basic clinical data: body mass index not documented (22.5%) in the folder, no medical indication noted (19.2%), and laboratory tests not requested (18.3%) by clinicians. Prescriber acceptance of the pharmacist’s recommendations was found to be low (26.8%), suggestive of clinical inertia. Aspirin was found to be irrationally prescribed to patients with DM (15.4%). Conclusion. Pharmacists can identify, resolve and prevent MTPs and rationalise appropriate medication therapy in patients with DM. Prescriber uptake of pharmacists’ pharmacotherapeutic recommendations seems overlooked. Pharmacist-led workshops to advocate for rational prescribing are needed to mitigate MTPs among stable patients with type 2 DM at public sector healthcare facilities.

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 >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 < 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 >0.70 for all domains except for ‘impact on patient's life’ (0.52). The ICC was significant (P < 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 < .001), the total number of DRPs (1245 versus 794; P < .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 < 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.

Impact of medication therapy management interventions on drug therapy problems, medication adherence and treatment satisfaction among ambulatory heart failure patients at Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia: a one-group pre–post quasi-experimental study

ObjectiveTo determine the impact of medication therapy management interventions on drug therapy problems (DTPs), medication adherence and treatment satisfaction among ambulatory heart failure (HF) patients.Study design, setting and participantsA one-group pre–post quasi-experimental study was conducted on 423 ambulatory HF patients at Tikur Anbessa Specialised Hospital (TASH), Addis Ababa, Ethiopia. All ambulatory HF patients ≥18 years old attending the adult cardiac clinic of TASH and having a complete medical record and fully met the inclusion criteria were taken as study participants.InterventionsEducational interventions along with a brochure with information on the nature of HF disease and its treatment were provided to study participants. DTPs encountered were resolved by a team of pharmacists and physicians.ResultsIn the preintervention phase, 288 DTPs were identified with a mean (SD) of 1.3±1.1. A significant reduction of DTPs (0.67±1.1, p<0.001) was observed in the postintervention phase compared with the preintervention phase. At the postintervention phase, 36.4%, 61.9% and 1.7% of HF patients were highly, medium and low adherent to their treatment regimens, respectively. The total composite score for treatment satisfaction of the study participants was 80.35%.ConclusionsThe findings of this study demonstrated that by teaming up clinical pharmacists with cardiologists and cardiology fellows, it was possible to reduce the occurrence of DTPs, improve medication adherence and increase treatment satisfaction of HF patients attending at the outpatient cardiac clinic.

Medication Therapy Management for Texas MediCAID Patients With Asthma and Chronic Obstructive Pulmonary Disease—A Pilot Study

Background: Pharmacists can play an important role in providing medication therapy management (MTM) services, which focus on appropriate medication use. This pilot study aimed to describe pharmacists’ MTM service provision, results/outcomes of pharmacists’ recommendations and resolution/acceptance rate among patients with high-risk asthma and/or chronic obstructive pulmonary disease (COPD). Methods: This was a prospective descriptive study of MTM services provided by community pharmacists to Texas Medicaid patients (5-63 years) with “high risk” asthma or COPD. Patients received in-person and telephone consultations that included medication review, asthma control test assessment, and education on adherence and proper medication/device use. Data extracted from MTM software was used to describe: reasons for MTM services, type of pharmacists’ interventions, outcomes of pharmacists’ recommendations and acceptance rate. Results: Twenty-eight pharmacists provided 139 MTM interventions with 63 patients (2.2 interventions per patient). The most frequent intervention reason was complex drug therapy (53.2%), underuse of medication (8.6%), need for drug therapy (8.6%), new or changed prescription therapy (6.5%), and administration technique (5.0%). The resolution rate was 77.7%. Patient and prescriber, respectively, refused recommendation in 12% and 6% of the interventions. Outcomes included comprehensive medication review (46.7%), improved adherence (6.5%), therapeutic success (6.5%), improved administration technique (5.0%), and initiation of new therapy (5.0%). Conclusion: Through the provision of MTM, pharmacists were able to identify and intervene with medication-related problems. These interventions are instrumental in helping patients better manage their asthma/COPD. The high resolution rate was encouraging. Larger scale studies are needed to assess clinical and economic outcomes.

Retrospective evaluation of preconception care opportunities in a chain community pharmacy setting

ObjectivesCertain prescription medications should be avoided during pregnancy to reduce the risk of fetal harm. Identification of these medications to minimize exposure may be achieved through the integration of preconception care recommendations into medication therapy management (MTM) services. The primary objective of this study was to identify missed opportunities for pharmacists to provide preconception care support related to medications associated with adverse pregnancy outcomes for reproductive-aged women who received MTM consultations at a regional supermarket pharmacy chain. Secondary objectives examined the concurrent use of prenatal vitamins, folic acid, or hormonal contraception in patients receiving medications associated with adverse pregnancy outcomes. MethodsThe study examined all MTM and prescription drug claims submitted by a regional chain of supermarket pharmacies from January 1, 2018 to June 30, 2019, to identify female patients aged 15-45 years who received MTM services. Prescription claims were cross-referenced to determine which of these patients also received medications associated with adverse pregnancy outcomes. To identify patients with long-term use of opioids and nonsteroidal anti-inflammatory drugs, a restriction based on days supplied was then applied. ResultsOf the 2020 female patients who received MTM services and filled at least 1 prescription during the study period, 731 (36.2%) were found to have received at least 1 medication associated with adverse pregnancy outcomes for the minimal days’ threshold. Of these, 509 (69.6%) lacked evidence of concurrent prescription contraception, and 74 (10.1%) had a concurrent prescription for folic acid or prenatal vitamins. ConclusionThe use of medications associated with adverse pregnancy outcomes was widespread in this sample of reproductive-aged women. The findings of this study indicate the need for additional research to investigate the implementation of targeted MTM interventions to build standard workflow processes and facilitate pharmacists’ management of this critical clinical issue.

Pengaruh Medication Therapy Management (MTM) terhadap Outcome Klinik dan Kualitas Hidup Pasien Hipertensi di Puskesmas Kota Yogyakarta

Medication therapy management (MTM), is a service model aimed at helping general health problems by preventing morbidity and mortality. Hypertension is a non-communicable disease which is a serious health problem which requires long-term therapy. This study aims to see the effect of MTM on clinical Outcomes and quality of life of patients in hypertensive patients. This type of research is a quasi experimental one group with a pretest-posttest design. Analysis using paired sample t-test and Wilcoxon test with a significance used P &lt;0,05. Respondents were 70 people, 67,1% were women. The characteristics of the majority age are 55-64 years with a percentage of 51,4%, the majority of education level is high school with 42,8%, non-civil servant jobs with a percentage of 45,7%, the length of diagnosis is dominated by 1-10 years (77,1%) and comorbidities diabetes mellitus occurred the most (10,0%). The results showed that the quality of life increased from before getting MTM 54,4 ± 8,9 and after MTM intervention 60,4 ± 6,6 (P value &lt;0,001). Clinical outcome from systolic 159,2 ± 8,9 mmHg and diastolic 103,8 ± 8,0 mmHg before MTM to 144,1 ± 14,4 mmHg for systolic and 89,7 ± 8,8 mmHg for diastolic with p value &lt;0,001 (p &lt;0,05) for systolic blood pressure and p value: 0,016 (p &lt;0,05) after receiving MTM intervention. Medication Therapy Management (MTM) has a significant influence on improving the quality of life and clinical Outcomes of hypertensive patients. The higher the quality of life of patients, blood pressure becomes more controlled.

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.

One-Year Evaluation of a Targeted Medication Therapy Management Intervention for Older Adults.

Older adults are especially susceptible to adverse effects of inappropriate medication therapy, and anticholinergic medications are common culprits for cognitive dysfunction due to their action on the central nervous system. Medication therapy management (MTM) interventions can aid in deprescribing and reducing inappropriate medication use in older adults. However, there is sparse literature on the long-term sustainability of these interventions. To (a) investigate whether the deprescribing of anticholinergic medications during an 8-week randomized controlled trial (RCT) of a targeted MTM intervention is sustained at 1-year postintervention follow-up and (b) compare anticholinergic utilization trends in the study population with a large sample of similar individuals not exposed to the intervention. Participants in the targeted MTM (tMTM) RCT had normal cognition or mild cognitive impairment and were recruited from enrollees in a longitudinal study at the University of Kentucky Alzheimer's Disease Center (ADC) and thus have pertinent medical information gathered approximately annually. In this posttrial observational follow-up, sustainability of the anticholinergic deprescribing intervention was assessed in participants in the RCT, and anticholinergic medication use trends were described from the RCT baseline (which occurred immediately following an ADC visit) to the next annual visit in all participants. Mean change in anticholinergic burden from RCT baseline to the next annual visit was estimated using analysis of covariance, and participants were compared with 2 external samples. Anticholinergic burden was measured using the Anticholinergic Drug Scale (ADS). The odds of decreasing baseline anticholinergic burden and number of total and strong anticholinergic medications at the follow-up study time point was assessed using logistic regression. Of the deprescribing changes made during the initial RCT, 50% were sustained after 1 year. Participants in the tMTM trial reported decreases in the use of anticholinergic antihistamines and bladder agents (-6.5 and -4.4%, respectively), but there was no change in the use of anticholinergic agents targeted at the central nervous system. While the anticholinergic burden of RCT participants decreased over 1 year (adjusted mean ADS change [95% CI] = -0.33 [-0.72, 0.07]), it was not different than the change observed in 2 external samples at the trial center (-0.20 [-0.42, 0.02]) and nationally (-0.33 [-0.39, -0.26]). There were no statistically significant differences between trial participants and external samples in the odds of decreasing anticholinergic burden nor in decreasing the number of total, or strongly anticholinergic, medications at the 1-year follow-up. This study demonstrates that the sustainability of deprescribing is limited to the period of intervention, rather than affording lasting effects even over periods as short as 1 year, which was demonstrated not only in the small group of RCT participants but also by comparison with external groups. Future work should extend the duration of intervention and follow-up periods for MTM interventions to allow further insights regarding the sustainability of deprescribing efforts in older adults. The original trial was supported by a pilot study award from the University of Kentucky Center for Clinical and Translational Sciences (UL1TR000117). Additional support for this study was provided by the National Institutes of Health/National Institute on Aging (R01 AG054130). Jicha reports contract research for Esai, Biohaven, Alltech, Suven, Novartis, and Lilly. The other authors have nothing to disclose.

INtervention for Cognitive Reserve Enhancement in delaying the onset of Alzheimer\u2019s Symptomatic Expression (INCREASE), a randomized controlled trial: rationale, study design, and protocol

BackgroundThe course of Alzheimer’s disease (AD) includes a 10–20-year preclinical period with progressive accumulation of amyloid β (Aβ) plaques and neurofibrillary tangles in the absence of symptomatic cognitive or functional decline. The duration of this preclinical stage in part depends on the rate of pathologic progression, which is offset by compensatory mechanisms, referred to as cognitive reserve (CR). Comorbid medical conditions, psychosocial stressors, and inappropriate medication use may lower CR, hastening the onset of symptomatic AD. Here, we describe a randomized controlled trial (RCT) designed to test the efficacy of a medication therapy management (MTM) intervention to reduce inappropriate medication use, bolster cognitive reserve, and ultimately delay symptomatic AD.Methods/designOur study aims to enroll 90 non-demented community-dwelling adults ≥ 65 years of age. Participants will undergo positron emission tomography (PET) scans, measuring Aβ levels using standardized uptake value ratios (SUVr). Participants will be randomly assigned to MTM intervention or control, stratified by Aβ levels, and followed for 12 months via in-person and telephone visits. Outcomes of interest include: (1) medication appropriateness (measured with the Medication Appropriateness Index (MAI)); (2) scores from Trail Making Test B (TMTB), Montreal Cognitive Assessment (MoCA), and California Verbal Learning Test (CVLT); (3) perceived health status (measured with the SF-36). We will also evaluate pre- to post-intervention change in: (1) use of inappropriate medications as measured by MAI; 2) CR Change Score (CRCS), defined as the difference in scopolamine-challenged vs unchallenged cognitive scores at baseline and follow-up. Baseline Aβ SUVr will be used to examine the relative impact of preclinical AD (pAD) pathology on CRCS, as well as the interplay of amyloid burden with inappropriate medication use.DiscussionThis manuscript describes the protocol of INCREASE (“INtervention for Cognitive Reserve Enhancement in delaying the onset of Alzheimer’s Symptomatic Expression”): a randomized controlled trial that investigates the impact of deprescribing inappropriate medications and optimizing medication regimens on potentially delaying the onset of symptomatic AD and AD-related dementias.Trial registrationClinicalTrials.gov, NCT02849639. Registered on 29 July 2016.

GAPcare: The Geriatric Acute and Post-Acute Fall Prevention Intervention for Emergency Department Patients - A Qualitative Evaluation.

Background:Three million US emergency department (ED) visits occur for falls each year. The mortality of falls is increasing and only one fourth of older adults report their fall to their primary care provider, suggesting that valuable preventative opportunities are missed. A fall prevention intervention initiated in the ED immediately after a fall has the potential to reduce subsequent falls, but ED providers lack the time and resources to complete fall risk assessments on their patients. GAPcare, the Geriatric Acute and Post-Acute Fall Prevention Intervention, was developed to address this need.Methods:GAPcare combines a pharmacist-led medication therapy management intervention with a physical therapist (PT)-administered fall risk assessment and disposition planning. A key objective of this pilot randomized controlled trial (RCT) was to create a patient and caregiver-centric intervention. This manuscript reports on the results of the qualitative companion study in which we conducted in-depth interviews with patients and caregivers to determine their lived experience with the intervention, barriers and perceived impact of the intervention, and to obtain their recommendations for the improvement of GAPcare. We recruited patients and their caregivers from the RCT into 30 minutes interviews in the participants’ home singularly or in dyads (patient and caregiver together). Interviews were audio-recorded, transcribed, and double-coded. We used applied thematic analysis to guide the data analysis.Results:We conducted 20 interviews; patients (n=12), caregivers (n=11). Patients were on average 83 years old, 7/12 were female, and 2/14 had cognitive impairment. 6/11 caregiver interviews were in reference to a patient with dementia. Patients and caregivers reported they embraced the experience of motivational interviewing elements, citing its collaborative and inclusive nature. Caregivers in particular said they felt that PT helped their loved one recognize and overcome functional limitations. Barriers included lack of time, the burden of coordinating multiple service providers once home, and concerns that PT would be ineffective or increase pain. Areas for improvement included better screening for those who would benefit from the individual components (pharmacy vs. PT consultation), improving identification of GAPcare pharmacists and PTs vs. other hospital staff in the ED, and expanding the role of GAPcare personnel to provide culturally competent, comprehensive care to improve adherence and medication education.Conclusions:We found that GAPcare, a new team-based intervention for fall prevention in the ED, was welcomed by patients and their caregivers. Several suggestions to improve the intervention were made that will inform the screening, content, and communication with patients in GAPcare.

Kesiapan Apoteker dalam Memberikan Layanan Medication Therapy Management

Optimizing the implementation of the referral program is one of BPJS 'top programs. BPJS Health implements a referral program based on Medication Therapy Management. Medication therapy management interventions can reduce the frequency of drug-related problems, including non-compliance, and reduce health care costs. The purpose of this study was to evaluate the readiness of pharmacists in providing medication therapy management services This research uses a descriptive method by using a questionnaire as an instrument for data retrieval. The sampling technique is convenience sampling. The population is pharmacists who practice pharmaceutical services and are willing to fill out questionnaires. The result most pharmacists feel they have enough clinical knowledge and experience to provide MTM services. There are still many pharmacist workplaces (Puskesmas, Pharmacies and hospitals) that have not yet prepared to provide MTM services. Pharmacists think they have a desire to provide MTM services and have sufficient access to information in designing appropriate MTM services and pharmacists should be involved in providing MTM services. The obstacles faced by pharmacists in providing MTM services are insufficient time, insufficient human resources, limited space, limited information regarding MTM services, and the costs needed to implement MTM. Pharmacists are willing to provide Medication Therapy Management services but many obstacles remain. Training is needed so that pharmacists become more confident in providing clinical services

The Discharge Companion Program: An Interprofessional Collaboration in Transitional Care Model Delivery.

To reduce readmission rates and avoid financial penalties from the Centers for Medicare and Medicaid Services, hospitals are seeking to implement innovative transitions of care (TOC) programs. This retrospective study evaluated the Discharge Companion Program (DCP), a pharmacist- and nurse-coordinated interprofessional, collaborative TOC program. Adult patients (18 years and older) from a single hospital, discharged with at least one qualifying diagnosis, were eligible for this service. The hospital transitional care coordinator nurse referred qualified patients to the DCP nurse coordinator, who scheduled telephonic medication therapy management (MTM) reviews with the DCP pharmacist at one- and three-weeks postdischarge. Hospital records and DCP documentation were reviewed to describe respective interventions and assess the impact on 30-day readmissions. A total of 456 patients were referred to the DCP between 31 August, 2015 and 7 September, 2016. Of the 340 patients who participated (DCP group), 44 (13%) compared to 17% (n = 20) of the usual care, were readmitted within 30-days postdischarge. The DCP pharmacists conducted 1242 clinical interventions with participants, demonstrating the benefits of an interprofessional TOC model involving multiple, pharmacist-delivered MTM intervention touchpoints within 30 days post-hospital discharge.

Community pharmacists’ lack of access to health records and its impact on targeted MTM interventions

ObjectivesTo describe the adequacy of health record information available to community pharmacists when completing medication therapy management (MTM) interventions and to quantify the time spent on interventions that are ultimately revealed as invalid. MethodsThis prospective cross-sectional study analyzed cases of high-risk medication use in the elderly and statin use in persons with diabetes identified by 3 MTM platforms across 15 grocery chain pharmacies. MTM interventions were completed by phone and fax following a usual care protocol. Collected data included case validity (defined as the case truly requiring a pharmacist’s involvement), case success (defined as achieving the targeted goal of the intervention), time spent on the intervention, and a determination of whether information from an electronic health record (EHR) could have eliminated patient or prescriber contact. ResultsAmong 163 cases analyzed, 54% were found to be valid and 30% successful. The most common reasons for invalidity were allergy or contraindication, patient already taking a statin, and patient not having the targeted condition. Overall, 14% of cases were valid and successful, 40% valid and unsuccessful, 17% invalid and successful, and 29% invalid and unsuccessful. Valid successful cases averaged 15.3 minutes per case, valid unsuccessful cases averaged 9.2 minutes, invalid successful cases averaged 4.2 minutes, and invalid unsuccessful cases averaged 5.1 minutes. Based on the case-by-case determination of the researchers, EHR information would have completed 39% of cases without patient or prescriber contact. The average time spent on cases needing EHR access was 5.5 minutes, compared with 9.5 minutes for cases in which EHR access would not have helped. ConclusionCommunity pharmacists performing MTM interventions are hindered by lack of access to patient health information, imprecise patient targeting by MTM platforms, and cumbersome communication between pharmacists and prescribers.

Comparison of Medication Therapy Management Services and Their Effects on Health Care Utilization and Medication Adherence.

Medication therapy management (MTM) programs are designed to improve clinical outcomes and enhance appropriate medication use. Comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) are 2 broad interventions defined within MTM services. While MTM services have been extensively researched, there are few comparisons of CMR versus non-CMR interventions. Given the variability in MTM interventions and lack of a consistent TMR definition in the literature, this study sought to compare CMRs and TMRs that were clearly defined based on Centers for Medicare & Medicaid Services (CMS) criteria. To (a) compare acute inpatient admissions and emergency department (ED) visits between patients participating in MTM services (CMR, TMR, or both) and eligible nonparticipating patients and (b) examine the effect of receiving TMR services on medication adherence. This was a retrospective cohort study of patients with Medicare Part D coverage who received MTM services and a 1:1 propensity score-matched control group. Participants had to be eligible for MTM services in 2014 or 2015 based on CMS requirements. CMRs were offered to all MTM-eligible patients, while TMRs were completed based on clinical rules that helped identify medication-related problems (MRPs). The date of MTM intervention, or eligibility for the control group, was considered the index date. Participants had to be continuously enrolled in a Medicare Advantage plan that included prescription drug coverage during the study period and have at least 6 months of data before and after the index date. Medical and pharmacy claims were assessed to examine trend-adjusted inpatient admissions and ED visits from pre-index to post-index date for participants and matched controls. In 2014 and 2015, receipt of TMR interventions was associated with statistically significant reductions in acute inpatient admissions. In 2014, there were 55.2 fewer admits per 1,000 individuals (95% CI = 29-81) and 30.8 fewer admits per 1,000 individuals in 2015 (95% CI = 20-42). Receipt of CMR-only interventions was associated with fewer acute inpatient admissions only when coupled with preidentification of MRPs (36.8 [95% CI = 25-49] fewer admits per 1,000 individuals). In 2015, there were significant reductions in ED visits for participants receiving TMR-only interventions or TMR/CMR interventions (26.1 [95% CI = 11-41] and 12.0 [95% CI = 1-23] fewer ED visits per 1,000 individuals, respectively). In both years, a larger percentage (0.4% for oral diabetes medications; 7.7% for antihypertensives; 3.0% for statins) of MTM participants had greater improvements in medication adherence in the post-index period compared with controls. Receiving MTM services targeted at resolution of MRPs (TMR or CMR/TMR) resulted in positive reductions in health care utilization and increases in medication adherence. Given the importance of optimal medication utilization, this study highlights the need for additional focus on resolution of MRPs through TMRs and CMRs that can support improved clinical outcomes. No outside funding supported this study. Researchers completed the work as part of their employment with Humana. All authors are or were employees of Humana at the time of the study. There are no other conflicts of interest to disclose. This study was previously presented at AMCP Nexus 2017 on October 16, 2017, in Dallas, TX.

The Tennessee medication therapy management program: A hybrid type 2 effectiveness-implementation trial study protocol.

Pharmacist-led medication therapy management (MTM) programs are considered evidence-based and have clearly defined core components. Despite this, MTM programs are often implemented without fidelity due to notable implementation barriers, such as physician-pharmacist relationships and pharmacist access to patient medical records. To improve MTM implementation, the Tennessee Medicaid program developed a MTM intervention that incorporates implementation strategies to address some of the known barriers to implementation (e.g., formalizing pharmacist-physician relationships through collaborative practice agreements, ensuring pharmacists' access to medical records). The purpose of this hybrid type 2 effectiveness-implementation study is to (1) assess the effectiveness of the MTM pilot program in Tennessee (e.g., medication adherence, healthcare utilization, quality and cost of care) and (2) assess the implementation of the MTM pilot program (e.g., feasibility, appropriateness, acceptability, penetration). The Tennessee MTM pilot program is being assessed as a hybrid type 2 effectiveness-implementation study with a quasi-experimental design. A mixed methods approach (QUAN+QUAL) for the purpose of complementarity (e.g., answering related research questions). Data will include surveys, interviews, MTM platform encounter information, and medical and pharmacy claims. Initial analyses will include data between January 2018 and December 2019. The study will further add to the evidence base of MTM interventions by testing an intervention that addresses known barriers to implementation and simultaneously collecting data on effectiveness and implementation to speed up MTM translation. The Tennessee MTM program is expected to serve as a guide to other states seeking to expand pharmacist-delivered clinical services to their Medicaid members, particularly those intending to incorporate MTM into programs seeking to improve primary care delivery. Further, by improving the implementation of MTM, the pilot program is expected to improve the reliability of MTM program benefits including healthcare quality and cost and patient outcomes.