Medication Therapy Management Pharmacists Research Articles

Effectiveness of an Advanced Clinical Decision Support System on Clinical Decision-Making Skills in a Call Center Medication Therapy Management Pharmacy Setting: A Pilot Study.

(1) Background: There is limited evidence related to the efficacy of advanced clinical decision support systems (CDSS) on the quantity of high-quality clinical recommendations in a pharmacy-related medication therapy management (MTM) setting. The study aimed to assess the effect of an advanced CDSS on the quantity of relevant clinical pharmacist recommendations in a call center MTM setting. (2) Methods: This pre-test/post-test with comparator group study compared clinical skills assessment scores between certified MTM pharmacists in March 2020. A Wilcoxon Signed Rank test assessed the difference between pre- and post-test scores in both groups. (3) Results: Of 20 participants, the majority were less than 40 years old (85%) with a Doctor of Pharmacy degree (90%). Nine were female. Intervention group participants had less than three years of experience as a pharmacist. The control group had less than three years (40%) or seven to ten years (40%) of experience. There was a significant increase in intervention group scores between pre- (median = 3.0, IQR = 3.0) and post-test segments (median = 6.5, IQR = 4.0, p = 0.02). There was no significant change between control group pre- and post-test segments (p = 0.48). (4) Conclusion: Pharmacist exposure to an advanced CDSS was associated with significantly increased quantity of relevant clinical recommendations in an MTM pharmacy setting.

Medication Therapy Management: 10 Years of Experience in a Large Integrated Health Care System.

Medication therapy management (MTM) was officially recognized by the federal government in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which requires Medicare Part D plans that offer prescription drug coverage to establish MTM programs (MTMPs) for eligible beneficiaries. Even though the term "MTM" was first used in 2003, pharmacists have provided similar services since the term "pharmaceutical care" was introduced in 1990. Fairview Health Services, a large integrated health care system, implemented a standardized pharmaceutical care service system in 1998, naming it a pharmaceutical care-based MTM practice in 2006. To present the clinical, economic, and humanistic outcomes of 10 years of delivering MTM services to patients in a health care delivery system. Data from MTM services provided to 9,068 patients and documented in electronic therapeutic records were retrospectively analyzed over the 10-year period from September 1998 to September 2008 in 1 health system with 48 primary care clinics. Patients eligible for MTM services were aged 21 years or older and either paid for MTM out of pocket or met their health care payer's criteria for MTM reimbursement; the criteria varied for Medicaid, Medicare, and commercially insured enrollees. All MTM was delivered face to face. Health data extracted from the electronic therapeutic record by the present study's investigators included patient demographics, medication list, medical conditions, drug therapy problems identified and addressed, change in clinical status, and pharmacist-estimated cost savings. The clinical status assessment was a comparison of the first and most recent MTM visit to measure whether the patient achieved the goals of therapy for each medical condition (e.g., the blood pressure of a patient with diabetes and hypertension will be less than 130/80 millimeters mercury [mmHg] in 1 month; the patient with allergic rhinitis will be relieved of his complaints of nasal congestion, runny nose, and eye itching within 5 days). Goals were set according to evidence-based literature and patient-specific targets determined cooperatively by pharmacists, patients, and physicians. Cost-savings calculations represented MTM pharmacists' estimates of medical services (e.g., office visits, laboratory services, urgent care visits, emergency room visits) and lost work time avoided by the intervention. All short-term (3-month) estimated health care savings that resulted from addressing drug therapy problems were analyzed. The expenses of these avoided services were calculated using the health system's contracted rates for services provided in the last quarter of 2008. The return on investment (ROI) was calculated by dividing the pharmacist-estimated savings by the cost of MTM services in 2008 (number of MTM encounters times the average cost of an MTM visit). The humanistic impact of MTM services was assessed using the results from the second patient satisfaction survey administered in 2008 (new patients seen from January through December 2008) for the health system's MTM program. A total of 9,068 patient records were in the documentation system as of September 30, 2008. During the 10-year period, there were 33,706 documented encounters (mean 3.7 encounters per patient). Of 38,631 drug therapy problems identified and addressed by MTM pharmacists, the most frequent were a need for additional drug therapy (n = 10,870, 28.1%) and subtherapeutic dosage (n = 10,100, 26.1%). In the clinical status assessment of the 12,851 medical conditions in 4,849 patients who were not at goal when they enrolled in the program, 7,068 conditions (55.0%) improved, 2,956 (23.0%) were unchanged, and 2,827 (22.0%) worsened during the course of MTM services. Pharmacist-estimated cost savings to the health system over the 10-year period were $2,913,850 ($86 per encounter) and the total cost of MTM was $2,258,302 ($67 per encounter), for an estimated ROI of $1.29 per $1 in MTM administrative costs. In the patient satisfaction survey, 95.3% of respondents agreed or strongly agreed that their overall health and well-being had improved because of MTM. Pharmacist estimates of the impact of an MTM program in a large integrated health care system suggest that the program was associated with improved clinical outcomes and cost savings. Patient satisfaction with the program was high. There was no external funding for this manuscript. The 3 authors are employees of Fairview Pharmacy Services. Ramalho de Oliveira had primary responsibility for the concept and design, writing, and revision of the manuscript, with the assistance of Brummel and Miller. Ramalho de Oliveira performed the data collection, and all 3 authors shared equally in data interpretation.

Community health worker perspectives of an academic community medication therapy management collaboration

ObjectiveTo qualitatively assess community health workers’ (CHWs’) perceptions of the challenges and benefits associated with participating in a collaborative, interprofessional medication therapy management (MTM) program for rural, underserved, predominantly Latinx, patients with diabetes and hypertension. MethodsNine CHWs participated in a 1-hour, semistructured focus group that explored their experiences while assisting in the delivery of MTM services through an academic community partnership between an MTM provider and participating rural clinics. Audio recordings of the focus group were transcribed and thematically analyzed by 2 independent reviewers. ResultsAll program-involved CHWs participated in the focus group. Qualitative analysis identified 2 overarching themes: (1) opportunities and (2) challenges. Opportunities were further subcategorized as benefits to (1) CHWs, (2) patients, or (3) academic community MTM research. The CHWs perceived that they served as a liaison among the medical provider (prescriber), patient, and MTM pharmacist. Benefits to the patients focused on the integration of CHWs as essential to patient recruitment, especially for those who were reluctant to participate or receive a phone call from a stranger. The major challenges identified were (1) interruptions in workflow and (2) communication between CHWs and the health care practitioners (physicians, nurse practitioners, pharmacists). Specifically, the CHWs universally agreed that they needed more time after receiving patient report, scheduling a visit with the patient, and communicating with the patient’s health care provider to better understand the individual’s circumstances and needs. ConclusionThis study identified perceived opportunities and challenges faced by CHWs and chronically ill, rural Latinx patients in the acceptance of MTM program. These findings may be useful for all interprofessional health care team members to better understand and appreciate the role of CHWs, while simultaneously enhancing and improving respective medication adherence efforts, and to improve collaborative, academic community programs in the future.

Impact evaluation of a four-year academic-community partnership in provision of medication management and tertiary prevention services for rural patients with diabetes and/or hypertension.

Medication therapy management (MTM) services, including targeted, pharmacist-delivered, tertiary prevention interventions, were provided to rural patients with chronic diseases via an academic-community partnership. The purpose of this investigation was to evaluate the overall program and pre/post patient outcomes from this four-year, multi-site collaboration. Five community health sites collaborated with a university-based MTM provider to deliver services in Arizona (2012–16). Eligible patients: were 18 or older (median 65 years); had a diagnosis of diabetes and/or hypertension; and resided in a rural community. Participants received an initial telephone consultation with the MTM pharmacist; follow-up consultations were conducted after 30 or 90 days for high- and low-risk patients, respectively. Community partner staff collected clinical data and addressed pharmacists’ recommendations. Descriptive analysis and bivariate analyses of pre- and post-intervention results were conducted. Most (n = 410, 70%) of the 577 participants receiving an initial and follow-up consultation with the MTM pharmacist had both diabetes and hypertension. These individuals showed statistically significant improvements in fasting blood glucose (p < 0.0001), hemoglobin A1C (p = 0.0082) and systolic blood pressure (p = 0.009) while those with only one condition did not demonstrate significant changes. While the pre/post changes in chronic disease control indicators were statistically significant, the clinical significance was low to moderate. Patients with both comorbid diabetes and hypertension experienced benefit from collaborative, targeted MTM pharmacist-delivered, tertiary prevention interventions in tandem with community-based pharmacy resources. This multi-site MTM program showed promise in increasing patients’ use of these services, yet effective strategies are needed to expand recruitment of eligible patients in the future.

Integrating Pharmacist MTM Services into Medical Clinics as Part of a Health Department Partnership Project.

Medication therapy management (MTM) services are an essential way for pharmacists to provide cognitive services to patients and receive reimbursement. Traditional MTM delivery has been identified as suboptimal, often done by telephone without any provider-patient relationship. New ways for delivering MTM need to be explored to optimize the pharmacist's role in this area and help establish the pharmacist as an essential part of the interprofessional team. A local public health department partnership with regional medical offices integrated pharmacist MTM services on site as part of patients' routine medical care. Referral criteria were established to identify patients who would be good candidates for services. Efforts were made to provide the initial consultation in the medical office, with follow-up consults being based upon patient preferences. Over a 3-year period, 180 patients received 361 pharmacy MTM consultations, averaging 40 minutes in length. A comprehensive medication review was performed on 87% of patients receiving these consults. The pharmacy team identified 719 medication-related problems, and improved participating patients' adherence rates. Pharmacy recommendations were accepted as is or modified by providers 55% of the time. Patients reported high satisfaction with the pharmacy services. A novel pharmacist MTM program integrated into provider offices demonstrated a positive impact on the clinics and on patients served, and successfully overcame barriers to successful MTM completion.

Key components of success in a randomized trial of blood pressure telemonitoring with medication therapy management pharmacists

ObjectivesThe Hyperlink trial tested a 12-month intervention of home blood pressure (BP) telemonitoring with pharmacist case management in adults with uncontrolled hypertension. The intervention resulted in improved BP control compared with usual care at both 6 (72% vs. 45%; P < 0.001) and 12 months (71% vs. 53%; P = 0.005). We sought to investigate factors contributing to intervention success. DesignMixed-methods analysis of process of care data, patient focus groups, and pharmacist interviews. ParticipantsData from 228 intervention patients were examined from the original 450 patients randomly assigned from 16 primary care clinics. Five patient focus groups and 4 pharmacist interviews were conducted to ascertain the patient and pharmacist perspective. Focus group and interview data were coded, and themes relevant to pharmacists were identified. Outcome measuresHome BP readings of less than 135/85 mm Hg and patient focus group and pharmacist interview themes. ResultsMean BP at the intake visit was 148/85 mm Hg. Antihypertensive medications were adjusted in 10% of patients at the initial in-person visit, 33% at phone visit 1, 36% at phone visit 2, and 19% at phone visit 3. Thereafter, medication changes declined. The mean home BP for patients at the first phone visit was 136/80 mm Hg, 126/74 mm Hg at 3 months, and 123/73 mm Hg at 5 months, with little change thereafter. Key components of success from patient and pharmacist interviews included a strong patient–pharmacist relationship, individualized treatment plans, and frequent phone contact with the pharmacist. ConclusionFrequent adjustments to the antihypertensive treatment regimen based on home BP telemonitoring resulted in rapid lowering of BP. Our results suggest that an intensive telephone-based intervention with the key components of medication adjustments, a strong patient and pharmacist relationship, and individualized treatment plans can achieve BP control in only 3 months in many patients with uncontrolled hypertension.

Pharmacist medication therapy management in home health care: Investigation of a sustainable practice model

ObjectivesThe objective of this study was to quantify the financial impact of a pharmacist-driven pilot medication therapy management (MTM) program within a visiting nurse service (VNS) and identify types of medication-related problems affecting the home health care population. MethodsPatients were contacted to schedule a home visit with the primary investigator. At the appointment, a comprehensive medication review (CMR) was completed, and data collected included primary reason for VNS care, comorbid diagnoses, number of prescription and nonprescription medications at time of visit, and type of pharmacist-identified medication therapy intervention(s). The VNS is a nonprofit independent home health care agency serving patients of all ages and health conditions. Patients admitted with primary insurance coverage through Blue Cross Blue Shield (BCBSRI) Blue Chip for Medicare and 65 years of age and older were eligible for inclusion. Intervention categories were aligned to coordinate with current billable OutcomesMTM claim categories. Dollar allocation for each intervention severity level was assigned according to the predetermined Medicare cost savings predicted value from BCBSRI. Interventions were assigned cost-saving value by the severity level to estimate savings. ResultsTwenty-five patients received CMRs. Patients averaged 5.92 chronic health conditions, 8.48 Part D drugs, and 3.88 over-the-counter medications. Two hundred eighteen medication-related problems were identified spanning 13 intervention categories. Intervention severity level was assigned to the medication-related problems, with calculated cost savings from pharmacist interventions totaling $124,352. ConclusionThis pilot study demonstrated the positive economic impact of a pharmacist-run MTM program at VNS for patients with multiple chronic conditions and medication-related problems. Potential societal benefits include that community members admitted to VNS will continue to have access to a pharmacist as a standard of care with the continuation of this MTM program.

Impact of Comprehensive Medication Management on Hospital Readmission Rates.

In 2012, the Fairview Health System implemented a formal care transitions process that included referrals to outpatient services provided by medication therapy management (MTM) pharmacists, among other clinical services. This analysis evaluates the impact of the MTM-provided comprehensive medication management (CMM) service on readmission rates. Retrospective electronic medical record (EMR) data were used to identify hospital admissions between December 1, 2012, and July 31, 2015. Thirty- and 60-day readmission rates were calculated in both a CMM and comparator cohort. Readmission rates also were stratified by readmission risk category. A total of 43,711 patients, contributing 57,673 hospitalizations, were included in the analysis. Of those, 1291 hospitalizations had a CMM visit within 30 days of discharge (median 6 days) and were considered the CMM cohort. Patients who received a CMM visit had a significantly lower rate of 30-day readmissions (8.6% vs. 12.8%, P < 0.001). The 60-day readmission rate remained lower among CMM patients but did not reach statistical significance (15.6% vs. 17.6%; P = 0.0528). When patients in each cohort were stratified by readmission risk category, the CMM cohort had a statistically significant lower rate of 30-day readmission in the highest risk groups (Average: 7.1% vs. 9.5%, P = 0.025; Elevated: 9.9% vs. 21.4%, P < 0.001; High: 18.3% vs. 35.9%, P < 0.001; Extreme: 36.4% vs. 77.7%, P = 0.006). CMM performed by an MTM pharmacist reduces the rate of readmission at 30 days post discharge and may have the largest impact among patients at highest risk of readmission.

Identifying and characterizing preventable adverse drug events for prioritizing pharmacist intervention in hospitals.

The approach and results for identifying and characterizing preventable adverse drug events (pADEs) that are key targets for pharmacist medication therapy management (MTM) are summarized. This study was part of a larger effort aimed at developing an electronic health record-based prediction model (the complexity score, or C-score) that ranks hospitalized patients according to their risk for pADEs. An environmental scan of published epidemiologic pADE studies and national patient safety priority areas was conducted. The final list of candidate pADEs was then disseminated to ASHP members and a national technical expert panel (TEP) to evaluate the importance, prevalence, severity, preventability, and measurability of these pADEs. Polychoric correlation tests were performed to evaluate and quantify associations between importance and any of the constructs' mean rankings for each individual pADE. The environmental scan yielded a total of 21 candidate pADEs, including drug-induced acute kidney injury, falls, respiratory depression, altered mental status, hemorrhage, hepatic failure, hypoglycemia, seizures, hypotension and bradycardia, ileus, blood dyscrasias, severe electrolyte imbalances, prolonged hyperglycemia, uncontrolled hypertension, uncontrolled arrhythmia, stress ulcers, hospital-acquired infections, uncontrolled hospital-acquired or community-acquired infection, uncontrolled pain, and venous thromboembolism. The survey confirmed all pADEs were important. Ranking of overall importance was mainly driven by perceived pADE severity and, to a lesser extent, by preventability and prevalence ratings. A literature review and survey of ASHP and TEP members were used to compile a list of important hospital-acquired pADEs for incorporation into a model for prioritizing patients for MTM services.

Improved HIV markers and decreased emergencyroom usage and hospital admission with initiation of a pilot specialty pharmacy at a southeastern Ryan –White –funded clinic over a three year period

BackgroundSpecialty pharmacy (SP) provides timely medication delivery to patients and seeks to improve patient adherence through monthly pharmacist medication therapy management (MTM). Patients living with HIV/AIDS have both high cost medications and complex disease states and thus will benefit from SP. We report on the outcome of HIV therapy after 3 years of a pilot SP ina southern inner city RW funded clinic.MethodsThis is a single center retrospective chart review of patients at our clinic who were enrolled in the SP from 6/3/13–5/1/16 for at least 6 months. Baseline demographic characteristics and HIV markers (CD4, viral load) were collected. Outcomes of interest were: change in CD4 count, percent with viral suppression (VS), emergency room (ER) and hospital admission usage, as well as percent of scheduled providers’ appointment kept. Each individual had the same follow up time before and after SP initiation. Bivariate analysis compared outcomes preSP and during SP using Chi-square or Fisher exact tests for categorical and Wilcoxon rank-sum test for continuous variables.ResultsDuring the 3-year period, there were 212 individuals referred to SP, of which 170 participated in the program. There were 92(54%) men, 136(80%) black. The median age was 48.3 years (IQR: 28.5–56.3). The average duration of follow up pre and during SP was 22.1(IQR: 16.5–27) months. In terms of insurance, 69(40%) had Medicare, 22(13%) had Medicaid, 22(13%) had private insurance, 54(32%) received AIDS drug Assistance Program (ADAP), and 3(2%) had Ryan White. Patients resided an average distance from the clinic of 17.4(IQR: 8.8–25) miles. The respective outcomes before and during SP were: CD4: 350(IQR: 181–551) vs. 413(IQR: 263–611 cells/mL (P < 0.0001), VS in 78 ± 30% vs. 91 ± 20% (P < 0.0001). The proportion of patients with emergency room usage or hospital admissions was 68(40%) vs. 49(29%) (P = 0.036). There was no difference in the rate of kept providers’ appointment (66.6 %(IQR: 53.8–78.6%) vs. 63.8 %(50-77%) (P = 0.19). There was no reported death during the follow –up period.ConclusionThis pilot SP program at the RW clinic showed statistically significant improvement of CD4 count and VS, as well as 40 % decrease in odds of using ER or hospital admission. Further studies are needed to determine whether SP is beneficial to people living with HIV/AIDS in other settings.Disclosures M. Patel, ViiV: Scientific Advisor, Consulting fee

Effect of an Advanced Pharmacy Practice Experience on Medication Therapy Management Services in a Centralized Retail Pharmacy Program.

Medication therapy management (MTM) delivery is increasingly important in managed care. Successful delivery positively affects patient health and improves Centers for Medicare & Medicaid Services star ratings, a measure of health plan quality. As MTM services continue to grow, there is an increased need for efficient and effective care models. The primary objectives of this project were to describe the delivery of MTM services by fourth-year Advanced Pharmacy Practice Experience (APPE) students in a centralized retail pharmacy system and to evaluate and quantify the clinical and financial contributions of the students. The secondary objective was to describe the engagement needed to complete comprehensive medication reviews (CMRs) and targeted interventions. From May 2015 to December 2015, thirty-five APPE students from the University of Colorado Skaggs School of Pharmacy provided MTM services at Albertsons Companies using the OutcomesMTM and Mirixa platforms. Students delivered patient care services by phone at the central office and provided face-to-face visits at pharmacies in the region. With implementation of the MTM APPE in 2015, the team consisted of 2 MTM pharmacists and pharmacy students, as compared with 1 MTM pharmacist in 2014. The number of CMRs and targeted interventions completed and the estimated additional revenue generated during the 2015 time period were compared with those completed from May through December 2014. The patient and provider engagement needed to complete the CMRs and targeted interventions was summarized. 125 CMRs and 1,918 targeted interventions were billed in 2015, compared with 13 CMRs and 767 targeted interventions in 2014. An estimated $16,575-$49,272 of additional revenue was generated in 2015. To complete the interventions in 2015, the team engaged in 1,714 CMR opportunities and 4,686 targeted intervention opportunities. In this MTM rotation, students provided real-life care to patients, resulting in financial and clinical contributions. This model of education and care delivery can be replicated in the community pharmacy or managed care setting. APPE students are an important component of this model of care delivery, particularly when considering the level of patient engagement needed to complete MTM interventions. No outside funding supported this research. The authors have no conflicts of interest to disclose related to this work. All authors contributed to study concept and design. Rodgers collected the data, and data interpretation was performed by Vande Griend, along with Rodgers and Nuffer. The manuscript was written and revised primarily by Vande Griend, along with Nuffer and Rodgers. This project was presented at the Pharmacy Quality Alliance Annual Meeting in Arlington, Virginia, in May 2016.

Effectiveness of a Clinical Pharmacist Medication Therapy Management Program in Discontinuation of Drugs to Avoid in the Elderly.

Despite evidence of fall risk associated with some drugs to avoid in the elderly (DAEs), many aged patients continue to receive them. To assess the effectiveness of a clinical pharmacist medication therapy management program (MTM) on discontinuation of prescribed DAEs. This was a retrospective cohort study conducted at an integrated health care delivery system. Kaiser Permanente Colorado beneficiaries aged ≥65 years who were MTM-eligible and targeted for a DAE dispensing between 01/01/2015 and 09/30/2015 were included in the observation group. Medicare beneficiaries who were not eligible for MTM but had a targeted DAE dispensing during the same time period were included in the control group. The percentage of patients with another DAE dispensing of the same specified medication (no matter the strength) during the 100 days following index DAE dispensing was assessed. Univariate and multivariable logistic regression analyses were conducted. A total of 9,059 Medicare beneficiaries were included, with 226 beneficiaries in the MTM group and 8,833 beneficiaries in the non-MTM group. Beneficiaries were primarily female and white and had a high burden of chronic disease. The percentages of patients with another dispensing of the specified DAE were 7.1% (95% CI = 3.7%-10.4%) for the MTM beneficiaries and 35.3% (95% CI 34.2%-36.2%) for the non-MTM beneficiaries (P < 0.001). The OR for the MTM group to have received another dispensing of the specified DAE was 0.12 (95% CI = 0.08-0.22) with adjustment for potential confounders. A clinical pharmacist-provided MTM intervention was associated with decreased DAE dispensing in Medicare beneficiaries. Future studies should evaluate means to further decrease DAE use in the aged. This study was funded by the Kaiser Permanente Colorado Pharmacy Department. The funder had no role in the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit the manuscript for publication. Delate has received grant funding from Janssen Pharmaceutical Companies of Johnson & Johnson outside of this study. The authors report no other disclosures. Delate supervised the study and had complete access to the data and takes responsibility for the data integrity. Study concept and design were contributed by Caffiero, Delate, Ehizuelen, and Vogel. Delate collected the data, assisted by the other authors, and analysis and interpretation of the data were provided by Ehizuelen and Vogel, along with Caffiero and Delate. The manuscript was written by Caffiero and Delate, with assistance from Ehizuelen and Vogel, and revised by all the authors. Preliminary findings from this study were presented at the Mountain States Conference for Pharmacy Residents, Fellows, and Preceptors on May 13, 2016, in Salt Lake City, Utah.

Improving Chronic Disease Outcomes Through Medication Therapy Management in Federally Qualified Health Centers.

Introduction: Appropriate management of chronic diseases, including proper use of medications, can lead to better disease control, decrease disease-related complications, and improve overall health. Pharmacists have been shown to positively affect chronic disease outcomes through medication therapy management (MTM). The primary objectives of this project are to increase the number of patients with (1) A1c in control and (2) blood pressure in control; secondary objectives are to (3) describe number and type of medication-related problems identified and resolved by pharmacists providing MTM in Federally Qualified Health Centers (FQHCs), (4) identify potential (pADEs) and actual adverse drug events (ADEs), and refer patients to diabetes self-management education classes, as needed. Methods: This multisite, prospective, descriptive pilot study engaged three FQHC sites with distinct models of established pharmacist MTM services to care for patients with uncontrolled diabetes and/or hypertension. Data were reported in aggregate regarding primary and secondary outcomes. Results: As of December 2015, 706 patients were enrolled in the project. Of the 422 with uncontrolled diabetes, 52.84% (n = 223) had an A1c <9%; 72 patients (17.06%) achieved an A1c between 8% and 9%, 19.19% (n = 81) of patients achieved an A1c <8% and ≥7%, and 16.59% (n = 70) of patients achieved an A1c <7%. The percentage of patients with blood pressure <140/90 mm Hg improved to 65.21%. Conclusion: Pharmacist-provided MTM can improve chronic disease intermediate outcomes for medically underserved patients in FQHCs.

Developing a dashboard for benchmarking the productivity of a medication therapy management program

ObjectivesTo describe a method for internal benchmarking of medication therapy management (MTM) pharmacist activities. SettingMultisite MTM pharmacist practices within an integrated health care system. Practice descriptionMTM pharmacists are located within primary care clinics and provide medication management through collaborative practice. MTM pharmacist activity is grouped into 3 categories: direct patient care, nonvisit patient care, and professional activities. Practice innovationMTM pharmacist activities were tracked with the use of the computer-based application Pharmacist Ambulatory Resource Management System (PhARMS) over a 12-month period to measure growth during a time of expansion. ResultsA total of 81% of MTM pharmacist time was recorded. A total of 1655.1 hours (41%) was nonvisit patient care, 1185.2 hours (29%) was direct patient care, and 1190.4 hours (30%) was professional activities. The number of patient visits per month increased during the study period. There were 1496 direct patient care encounters documented. Of those, 1051 (70.2%) were face-to-face visits, 257 (17.2%) were by telephone, and 188 (12.6%) were chart reviews. Nonvisit patient care and professional activities also increased during the period. ImpactPhARMS reported MTM pharmacist activities and captured nonvisit patient care work not tracked elsewhere. Internal benchmarking data proved to be useful for justifying increases in MTM pharmacist personnel resources. Reviewing data helped to identify best practices from high-performing sites. Limitations include potential for self-reporting bias and lack of patient outcomes data. ConclusionImplementing PhARMS facilitated internal benchmarking of patient care and nonpatient care activities in a regional MTM program.

Using pharmacists to improve risk stratification and management of stage 3A chronic kidney disease: a feasibility study.

BackgroundMeasurement of albuminuria to stratify risk in chronic kidney disease (CKD) is not done universally in the primary care setting despite recommendation in KDIGO (Kidney Disease Improving Global Outcomes) guidelines. Pharmacist medication therapy management (MTM) may be helpful in improving CKD risk stratification and management.MethodsWe conducted a pragmatic, cluster-randomized trial using seven primary care clinic sites in the Geisinger Health System to evaluate the feasibility of pharmacist MTM in patients with estimated glomerular filtration rate (eGFR) 45–59 ml/min/1.73 m2 and uncontrolled blood pressure (≥150/85 mmHg). In the three pharmacist MTM sites, pharmacists were instructed to follow a protocol aimed to improve adherence to KDIGO guidelines on testing for proteinuria and lipids, and statin and blood pressure medical therapy. In the four control clinics, patients received usual care. The primary outcome was proteinuria screening over a follow-up of 1 year. A telephone survey was administered to physicians, pharmacists, and patients in the pharmacist MTM arm at the end of the trial.ResultsBaseline characteristics were similar between pharmacist MTM (n = 24) and control (n = 23) patients, although pharmacist MTM patients tended to be younger (64 vs. 71 y; p = 0.06) and less likely to have diabetes (17 % vs. 35 %; p = 0.2) or baseline proteinuria screening (41.7 % vs. 60.9 %, p = 0.2). Mean eGFR was 54 ml/min/1.73 m2 in both groups. The pharmacist MTM intervention did not significantly improve total proteinuria screening at the population level (OR 2.6, 95 % CI: 0.5–14.0; p = 0.3). However, it tended to increase screening of previously unscreened patients (78.6 % in the pharmacist MTM group compared to 33.3 % in the control group; OR 7.3, 95 % CI: 0.96–56.3; p = 0.05). In general, the intervention was well-received by patients, pharmacists, and providers, who agreed that pharmacists could play an important role in CKD management. A few patients contacted the research team to express anxiety about having a CKD diagnosis without prior knowledge.ConclusionsPharmacist MTM may be useful in improving risk stratification and management of CKD in the primary care setting, although implementation requires ongoing education and multidisciplinary collaboration and careful communication regarding CKD diagnosis. Future studies are needed to establish the effectiveness of pharmacist MTM on slowing CKD progression and improvement in cardiovascular outcomes.Trial registrationClinicalTrials.gov, NCT02208674 Registered August 1, 2014, first patient enrolled September 30, 2014

Clinical outcomes of medication therapy management services in primary health care

This study evaluates whether the integration of pharmacists into health-care teams through the delivery of pharmaceutical care-based medication therapy management (MTM) services can improve the clinical outcomes of patients with chronic health conditions in the primary health-care setting. A retrospective descriptive study of 92 outpatients assisted by MTM pharmacists in primary health-care units was carried out over 28 months (median follow-up: 05 months). Patients were followed up by MTM pharmacists, with a total of 359 encounters and a ratio of 3.9 encounters per patient. The prevalence of hypertension, diabetes mellitus and dyslipidaemia was 29.5%, 22.0% and 19.4%, respectively. There was a high prevalence of drug-related problems with a ratio of 3.4 per patient. Pharmacists performed a total of 307 interventions to prevent or resolve drug-related problems. With regard to control of the most prevalent chronic medical conditions, a high percentage of patients reached their therapy goals by the last encounter with the pharmacist: 90.0% for hypertension, 72.3% for diabetes mellitus and 90.3% for dyslipidaemia. MTM services provided by pharmacists resolved drug therapy problems and improved patients' clinical outcomes. This study provides evidence for health-care managers of the need to expand the clinical role of pharmacists within the Brazilian public health-care system.

FDA allows omega-3 medication to be marketed off-label

In a legal settlement that’s much talked about, FDA agreed to allow the drug company Amarin to market its prescription omega-3 fatty acid product for off-label use.Amarin’s icosapent ethyl (Vascepa) is FDA approved to treat extremely high triglyceride values of 500 mg/dL or above. Although physicians commonly prescribe the medication for off-label use, the agreement would allow Amarin to market Vascepa to patients with high triglyceride levels of 200 mg/dL to 499 mg/dL.Saseen also believes the decision could open a “floodgate” for other companies that are seeking to promote their prescription medications for off-label use. Other experts agree that the decision would signal to other drug companies that they may be able to negotiate with FDA.In 2015, Amarin sued FDA for the right to market Vascepa to a larger group of patients. The court ruled in Amarin’s favor and said prohibiting Amarin from disseminating truthful information about the medication was a violation of free speech. FDA decided not to appeal the judge’s ruling.The final settlement must still be approved by a federal judge.“Based on the unusual circumstances of this case and the scientific information known to the FDA at this time, the agency does not anticipate a substantial adverse impact on public health resulting from this agreement,” said FDA in a statement.FDA is encouraging health care providers to continue to use their best clinical judgment based on all available scientific information about use of Vascepa for individual patients.Many unknownsLike other omega-3 fatty acids, Vascepa provides a dose-dependent reduction in triglyceride levels. But much is still unknown about omega-3 fatty acids, and the mortality benefit of triglyceride reduction with Vascepa is unclear for patients with triglyceride levels less than 500 mg/dL, according to Evan Sisson, PharmD, associate professor in the department of pharmacotherapy and outcomes science at Virginia Commonwealth University School of Pharmacy in Richmond.Results of two large outcome trials, REDUCE-IT and STRENGTH, will provide information on whether long-term prescription omega-3 fatty acids are beneficial in reducing cardiovascular events in patients with triglyceride values that are elevated at a level of 200 mg/dL to 499 mg/dL.Sisson said results from REDUCE-IT, which compare Vascepa plus statin to statin alone, will help determine if reducing non-HDL cholesterol by adding Vascepa to a statin further reduces residual cardiovascular risk.“Although well-designed studies may suggest off-label uses for drugs, many consumers are unable to accurately evaluate the quality of the data,” said Sisson. “In the absence of a formal FDA review, pharmacists must serve as an advocate for patient safety, critically reviewing the drug therapy literature and interpreting the information for the patient and their health care team.” (See sidebar.)Vascepa for off-label use: What do MTM pharmacists need to know?Omega-3 fatty acid products are used for many different off-label purposes, ranging from dermatologic to psychiatric.“They are used for so many ‘uses’ that it is hard to sometimes determine what they are being used for or if they are being perceived by a patient or clinician as effective,” said Saseen.Sisson added that although omega-3 fatty acids effectively lower triglyceride levels, monotherapy is appropriate only for patients with significantly elevated levels—greater than 500 mg/dL—who are at risk of pancreatitis.“To lower cardiovascular risk, omega-3 fatty acids should always be used in addition to background statin therapy,” said Sisson.Of course, diet, exercise, and other lifestyle changes are also key.Medication therapy management pharmacists are accustomed to off-label uses of certain medications, which is all the more reason they need to stay up to date with the literature and what’s FDA approved and not. Sites such as Micromedex and the New England Journal of Medicine’s Journal Watch can provide reliable information for pharmacists to keep up with patients’ questions. In a legal settlement that’s much talked about, FDA agreed to allow the drug company Amarin to market its prescription omega-3 fatty acid product for off-label use. Amarin’s icosapent ethyl (Vascepa) is FDA approved to treat extremely high triglyceride values of 500 mg/dL or above. Although physicians commonly prescribe the medication for off-label use, the agreement would allow Amarin to market Vascepa to patients with high triglyceride levels of 200 mg/dL to 499 mg/dL. Saseen also believes the decision could open a “floodgate” for other companies that are seeking to promote their prescription medications for off-label use. Other experts agree that the decision would signal to other drug companies that they may be able to negotiate with FDA. In 2015, Amarin sued FDA for the right to market Vascepa to a larger group of patients. The court ruled in Amarin’s favor and said prohibiting Amarin from disseminating truthful information about the medication was a violation of free speech. FDA decided not to appeal the judge’s ruling. The final settlement must still be approved by a federal judge. “Based on the unusual circumstances of this case and the scientific information known to the FDA at this time, the agency does not anticipate a substantial adverse impact on public health resulting from this agreement,” said FDA in a statement. FDA is encouraging health care providers to continue to use their best clinical judgment based on all available scientific information about use of Vascepa for individual patients. Many unknownsLike other omega-3 fatty acids, Vascepa provides a dose-dependent reduction in triglyceride levels. But much is still unknown about omega-3 fatty acids, and the mortality benefit of triglyceride reduction with Vascepa is unclear for patients with triglyceride levels less than 500 mg/dL, according to Evan Sisson, PharmD, associate professor in the department of pharmacotherapy and outcomes science at Virginia Commonwealth University School of Pharmacy in Richmond.Results of two large outcome trials, REDUCE-IT and STRENGTH, will provide information on whether long-term prescription omega-3 fatty acids are beneficial in reducing cardiovascular events in patients with triglyceride values that are elevated at a level of 200 mg/dL to 499 mg/dL.Sisson said results from REDUCE-IT, which compare Vascepa plus statin to statin alone, will help determine if reducing non-HDL cholesterol by adding Vascepa to a statin further reduces residual cardiovascular risk.“Although well-designed studies may suggest off-label uses for drugs, many consumers are unable to accurately evaluate the quality of the data,” said Sisson. “In the absence of a formal FDA review, pharmacists must serve as an advocate for patient safety, critically reviewing the drug therapy literature and interpreting the information for the patient and their health care team.” (See sidebar.)Vascepa for off-label use: What do MTM pharmacists need to know?Omega-3 fatty acid products are used for many different off-label purposes, ranging from dermatologic to psychiatric.“They are used for so many ‘uses’ that it is hard to sometimes determine what they are being used for or if they are being perceived by a patient or clinician as effective,” said Saseen.Sisson added that although omega-3 fatty acids effectively lower triglyceride levels, monotherapy is appropriate only for patients with significantly elevated levels—greater than 500 mg/dL—who are at risk of pancreatitis.“To lower cardiovascular risk, omega-3 fatty acids should always be used in addition to background statin therapy,” said Sisson.Of course, diet, exercise, and other lifestyle changes are also key.Medication therapy management pharmacists are accustomed to off-label uses of certain medications, which is all the more reason they need to stay up to date with the literature and what’s FDA approved and not. Sites such as Micromedex and the New England Journal of Medicine’s Journal Watch can provide reliable information for pharmacists to keep up with patients’ questions. Like other omega-3 fatty acids, Vascepa provides a dose-dependent reduction in triglyceride levels. But much is still unknown about omega-3 fatty acids, and the mortality benefit of triglyceride reduction with Vascepa is unclear for patients with triglyceride levels less than 500 mg/dL, according to Evan Sisson, PharmD, associate professor in the department of pharmacotherapy and outcomes science at Virginia Commonwealth University School of Pharmacy in Richmond. Results of two large outcome trials, REDUCE-IT and STRENGTH, will provide information on whether long-term prescription omega-3 fatty acids are beneficial in reducing cardiovascular events in patients with triglyceride values that are elevated at a level of 200 mg/dL to 499 mg/dL. Sisson said results from REDUCE-IT, which compare Vascepa plus statin to statin alone, will help determine if reducing non-HDL cholesterol by adding Vascepa to a statin further reduces residual cardiovascular risk. “Although well-designed studies may suggest off-label uses for drugs, many consumers are unable to accurately evaluate the quality of the data,” said Sisson. “In the absence of a formal FDA review, pharmacists must serve as an advocate for patient safety, critically reviewing the drug therapy literature and interpreting the information for the patient and their health care team.” (See sidebar.)Vascepa for off-label use: What do MTM pharmacists need to know?Omega-3 fatty acid products are used for many different off-label purposes, ranging from dermatologic to psychiatric.“They are used for so many ‘uses’ that it is hard to sometimes determine what they are being used for or if they are being perceived by a patient or clinician as effective,” said Saseen.Sisson added that although omega-3 fatty acids effectively lower triglyceride levels, monotherapy is appropriate only for patients with significantly elevated levels—greater than 500 mg/dL—who are at risk of pancreatitis.“To lower cardiovascular risk, omega-3 fatty acids should always be used in addition to background statin therapy,” said Sisson.Of course, diet, exercise, and other lifestyle changes are also key.Medication therapy management pharmacists are accustomed to off-label uses of certain medications, which is all the more reason they need to stay up to date with the literature and what’s FDA approved and not. Sites such as Micromedex and the New England Journal of Medicine’s Journal Watch can provide reliable information for pharmacists to keep up with patients’ questions. Vascepa for off-label use: What do MTM pharmacists need to know?Omega-3 fatty acid products are used for many different off-label purposes, ranging from dermatologic to psychiatric.“They are used for so many ‘uses’ that it is hard to sometimes determine what they are being used for or if they are being perceived by a patient or clinician as effective,” said Saseen.Sisson added that although omega-3 fatty acids effectively lower triglyceride levels, monotherapy is appropriate only for patients with significantly elevated levels—greater than 500 mg/dL—who are at risk of pancreatitis.“To lower cardiovascular risk, omega-3 fatty acids should always be used in addition to background statin therapy,” said Sisson.Of course, diet, exercise, and other lifestyle changes are also key.Medication therapy management pharmacists are accustomed to off-label uses of certain medications, which is all the more reason they need to stay up to date with the literature and what’s FDA approved and not. Sites such as Micromedex and the New England Journal of Medicine’s Journal Watch can provide reliable information for pharmacists to keep up with patients’ questions. Vascepa for off-label use: What do MTM pharmacists need to know?Omega-3 fatty acid products are used for many different off-label purposes, ranging from dermatologic to psychiatric.“They are used for so many ‘uses’ that it is hard to sometimes determine what they are being used for or if they are being perceived by a patient or clinician as effective,” said Saseen.Sisson added that although omega-3 fatty acids effectively lower triglyceride levels, monotherapy is appropriate only for patients with significantly elevated levels—greater than 500 mg/dL—who are at risk of pancreatitis.“To lower cardiovascular risk, omega-3 fatty acids should always be used in addition to background statin therapy,” said Sisson.Of course, diet, exercise, and other lifestyle changes are also key.Medication therapy management pharmacists are accustomed to off-label uses of certain medications, which is all the more reason they need to stay up to date with the literature and what’s FDA approved and not. Sites such as Micromedex and the New England Journal of Medicine’s Journal Watch can provide reliable information for pharmacists to keep up with patients’ questions. Omega-3 fatty acid products are used for many different off-label purposes, ranging from dermatologic to psychiatric. “They are used for so many ‘uses’ that it is hard to sometimes determine what they are being used for or if they are being perceived by a patient or clinician as effective,” said Saseen. Sisson added that although omega-3 fatty acids effectively lower triglyceride levels, monotherapy is appropriate only for patients with significantly elevated levels—greater than 500 mg/dL—who are at risk of pancreatitis. “To lower cardiovascular risk, omega-3 fatty acids should always be used in addition to background statin therapy,” said Sisson. Of course, diet, exercise, and other lifestyle changes are also key. Medication therapy management pharmacists are accustomed to off-label uses of certain medications, which is all the more reason they need to stay up to date with the literature and what’s FDA approved and not. Sites such as Micromedex and the New England Journal of Medicine’s Journal Watch can provide reliable information for pharmacists to keep up with patients’ questions.

Integrating home-based medication therapy management (MTM) services in a health system

ObjectivesTo describe the integration of home-based Medication Therapy Management (MTM) into the ambulatory care infrastructure of a large urban health system and to discuss the outcomes of this service. SettingMinnesota from September 2012 to December 2013. The health system has more than 50 primary care and specialty clinics. Eighteen credentialed MTM pharmacists are located in 16 different primary care and specialty settings, with the greatest number of pharmacists providing services in the internal medicine clinic. Practice innovationHome-based MTM was promoted throughout the clinics within the health system. Physicians, advanced practice providers, nurses, and pharmacists could refer patients to receive MTM in their homes. A home visit had the components of a clinic-based visit and was documented in the electronic health record (EHR); however, providing the service in the home allowed for a more direct assessment of environmental factors affecting medication use. EvaluationNumber of home MTM referrals, reason for referral and type of referring provider, number and type of medication-related problems (MRPs). ResultsIn the first 15 months, 74 home visits were provided to 53 patients. Sixty-six percent of the patients were referred from the Internal Medicine Clinic. Referrals were also received from the senior care, coordinated care, and psychiatry clinics. Approximately 50% of referrals were made by physicians. More referrals (23%) were made by pharmacists compared with advanced practice providers, who made 21% of referrals. The top 3 reasons for referral were: nonadherence, transportation barriers, and the need for medication reconciliation with a home care nurse. Patients had a median of 3 MRPs with the most common (40%) MRP related to compliance. ConclusionHome-based MTM is feasibly delivered within the ambulatory care infrastructure of a health system with sufficient provider engagement as demonstrated by referrals to the service.

Physicians refer patients to MTM pharmacists at Fairview

Molly Ekstrand, BSPharm, counseled several patients who were referred to her through the primary care clinic at Fairview Health Services in Minneapolis, where she worked as a medication therapy management (MTM) pharmacist.She remembers one instance in particular. The patient was in her late 40s and on a complex medication regimen, mainly due to pyelonephritis. She didn’t want to take her medications because of the adverse effects. The regimen was also complex and hard to follow because of dosing.Ekstrand had some suggestions for optimizing the patient’s drug therapy that could be helpful for the patient’s nephrologist, Rajiv Shah, MD, to know about.“I faxed the letter to the clinic, and that started my working relationship with Dr. Shah,” Ekstrand, who now works as an MTM pharmacist at Park Nicollet Health Services, told Pharmacy Today.‘Support system for patients’Shah was grateful Ekstrand could help his patient better understand her medications and the value of them.“When physicians have experience with MTM pharmacists, they realize it’s not about us being the prescriber police,” said Ekstrand. “It’s really a support system for patients. And if you can help patients manage their medications, we are giving patients the confidence to manage their health and overall well-being.”Although Shah has always been an advocate for pharmacists—especially as a nephrologist who deals with complex medication dosing and intensive regimens for kidney disease and transplant patients—he hadn’t realized until Ekstrand faxed the letter over that an MTM service existed in the outpatient setting.“When you think about what patients can do to impact their care, it’s a healthy lifestyle but also taking the medications they are prescribed,” Shah told Today. “No one can force patients to take their pills, but if you empower them and educate them about why it’s important, that’s huge.”Shah and Ekstrand first made contact more than 5 years ago. Now Shah regularly refers his patients to the MTM pharmacists at Fairview.Integrated health systemFairview is an integrated health system with MTM pharmacists embedded in 30 primary health care clinics through-out Minnesota. Many specialists they work with, like Shah, are outside of the system. Shah is technically affiliated with Fairview, however, and the primary care clinic where Ekstrand worked was in close proximity to Shah’s nephrology practice.Ekstrand did not have a collaborative practice agreement with Shah, but she did with the primary care providers in the clinic at Fairview.Referrals to Fairview’s pharmacy MTM services don’t always come through a patient’s primary care provider, however.“We have worked with specialists’ patients in cases where we haven’t worked with their primary care physician,” Amanda Brummel, PharmD, director of clinical ambulatory pharmacy services at Fairview Pharmacy Services, told Today.She said they work with many cardiologists as well who refer their patients.MORE ONLINE•Tedx talk by Rajiv Shah, MD: www.youtube.com/watch? v=ajmT93H2RpA&safe=activeThe handoffShah refers patients to MTM pharmacists directly or through the patient’s primary care provider.“I might talk to the primary care provider or the patient and say there’s this service—and they will spend an hour with you initially to go over everything. And it’s something that we as physicians can’t do,” said Shah, who has also advocated publicly for the profession of pharmacy and recently spoke about pharmacists as the new “disrupters” in health care during a Tedx talk.Shah refers patients to MTM pharmacists directly or through the patient’s primary care provider.Fairview MTM pharmacists see patients in an exam room, just like any other clinic appointment.“It’s a little abstract at first for patients, so that’s where the trust and warm transfer can help,” said Brummel.After Shah makes the referral and the patient sees the pharmacist, the MTM pharmacist faxes over a copy of the notes from the visit, and they communicate any questions by phone. Shah cannot access Fairview’s electronic medical record system since he is not directly part of the system.Brummel said the positive experiences and the difference that physicians see in their patients makes them want to continue referring patients to MTM services.“I truly believe the main driver to this is the success that the pharmacist has had as part of the team and helping the patient,” she said. Molly Ekstrand, BSPharm, counseled several patients who were referred to her through the primary care clinic at Fairview Health Services in Minneapolis, where she worked as a medication therapy management (MTM) pharmacist. She remembers one instance in particular. The patient was in her late 40s and on a complex medication regimen, mainly due to pyelonephritis. She didn’t want to take her medications because of the adverse effects. The regimen was also complex and hard to follow because of dosing. Ekstrand had some suggestions for optimizing the patient’s drug therapy that could be helpful for the patient’s nephrologist, Rajiv Shah, MD, to know about. “I faxed the letter to the clinic, and that started my working relationship with Dr. Shah,” Ekstrand, who now works as an MTM pharmacist at Park Nicollet Health Services, told Pharmacy Today. ‘Support system for patients’Shah was grateful Ekstrand could help his patient better understand her medications and the value of them.“When physicians have experience with MTM pharmacists, they realize it’s not about us being the prescriber police,” said Ekstrand. “It’s really a support system for patients. And if you can help patients manage their medications, we are giving patients the confidence to manage their health and overall well-being.”Although Shah has always been an advocate for pharmacists—especially as a nephrologist who deals with complex medication dosing and intensive regimens for kidney disease and transplant patients—he hadn’t realized until Ekstrand faxed the letter over that an MTM service existed in the outpatient setting.“When you think about what patients can do to impact their care, it’s a healthy lifestyle but also taking the medications they are prescribed,” Shah told Today. “No one can force patients to take their pills, but if you empower them and educate them about why it’s important, that’s huge.”Shah and Ekstrand first made contact more than 5 years ago. Now Shah regularly refers his patients to the MTM pharmacists at Fairview. Shah was grateful Ekstrand could help his patient better understand her medications and the value of them. “When physicians have experience with MTM pharmacists, they realize it’s not about us being the prescriber police,” said Ekstrand. “It’s really a support system for patients. And if you can help patients manage their medications, we are giving patients the confidence to manage their health and overall well-being.” Although Shah has always been an advocate for pharmacists—especially as a nephrologist who deals with complex medication dosing and intensive regimens for kidney disease and transplant patients—he hadn’t realized until Ekstrand faxed the letter over that an MTM service existed in the outpatient setting. “When you think about what patients can do to impact their care, it’s a healthy lifestyle but also taking the medications they are prescribed,” Shah told Today. “No one can force patients to take their pills, but if you empower them and educate them about why it’s important, that’s huge.” Shah and Ekstrand first made contact more than 5 years ago. Now Shah regularly refers his patients to the MTM pharmacists at Fairview. Integrated health systemFairview is an integrated health system with MTM pharmacists embedded in 30 primary health care clinics through-out Minnesota. Many specialists they work with, like Shah, are outside of the system. Shah is technically affiliated with Fairview, however, and the primary care clinic where Ekstrand worked was in close proximity to Shah’s nephrology practice.Ekstrand did not have a collaborative practice agreement with Shah, but she did with the primary care providers in the clinic at Fairview.Referrals to Fairview’s pharmacy MTM services don’t always come through a patient’s primary care provider, however.“We have worked with specialists’ patients in cases where we haven’t worked with their primary care physician,” Amanda Brummel, PharmD, director of clinical ambulatory pharmacy services at Fairview Pharmacy Services, told Today.She said they work with many cardiologists as well who refer their patients.MORE ONLINE•Tedx talk by Rajiv Shah, MD: www.youtube.com/watch? v=ajmT93H2RpA&safe=active Fairview is an integrated health system with MTM pharmacists embedded in 30 primary health care clinics through-out Minnesota. Many specialists they work with, like Shah, are outside of the system. Shah is technically affiliated with Fairview, however, and the primary care clinic where Ekstrand worked was in close proximity to Shah’s nephrology practice. Ekstrand did not have a collaborative practice agreement with Shah, but she did with the primary care providers in the clinic at Fairview. Referrals to Fairview’s pharmacy MTM services don’t always come through a patient’s primary care provider, however. “We have worked with specialists’ patients in cases where we haven’t worked with their primary care physician,” Amanda Brummel, PharmD, director of clinical ambulatory pharmacy services at Fairview Pharmacy Services, told Today. She said they work with many cardiologists as well who refer their patients. MORE ONLINE•Tedx talk by Rajiv Shah, MD: www.youtube.com/watch? v=ajmT93H2RpA&safe=active MORE ONLINE•Tedx talk by Rajiv Shah, MD: www.youtube.com/watch? v=ajmT93H2RpA&safe=active MORE ONLINE•Tedx talk by Rajiv Shah, MD: www.youtube.com/watch? v=ajmT93H2RpA&safe=active •Tedx talk by Rajiv Shah, MD: www.youtube.com/watch? v=ajmT93H2RpA&safe=active The handoffShah refers patients to MTM pharmacists directly or through the patient’s primary care provider.“I might talk to the primary care provider or the patient and say there’s this service—and they will spend an hour with you initially to go over everything. And it’s something that we as physicians can’t do,” said Shah, who has also advocated publicly for the profession of pharmacy and recently spoke about pharmacists as the new “disrupters” in health care during a Tedx talk.Shah refers patients to MTM pharmacists directly or through the patient’s primary care provider.Fairview MTM pharmacists see patients in an exam room, just like any other clinic appointment.“It’s a little abstract at first for patients, so that’s where the trust and warm transfer can help,” said Brummel.After Shah makes the referral and the patient sees the pharmacist, the MTM pharmacist faxes over a copy of the notes from the visit, and they communicate any questions by phone. Shah cannot access Fairview’s electronic medical record system since he is not directly part of the system.Brummel said the positive experiences and the difference that physicians see in their patients makes them want to continue referring patients to MTM services.“I truly believe the main driver to this is the success that the pharmacist has had as part of the team and helping the patient,” she said. Shah refers patients to MTM pharmacists directly or through the patient’s primary care provider. “I might talk to the primary care provider or the patient and say there’s this service—and they will spend an hour with you initially to go over everything. And it’s something that we as physicians can’t do,” said Shah, who has also advocated publicly for the profession of pharmacy and recently spoke about pharmacists as the new “disrupters” in health care during a Tedx talk.Shah refers patients to MTM pharmacists directly or through the patient’s primary care provider. Fairview MTM pharmacists see patients in an exam room, just like any other clinic appointment. “It’s a little abstract at first for patients, so that’s where the trust and warm transfer can help,” said Brummel. After Shah makes the referral and the patient sees the pharmacist, the MTM pharmacist faxes over a copy of the notes from the visit, and they communicate any questions by phone. Shah cannot access Fairview’s electronic medical record system since he is not directly part of the system. Brummel said the positive experiences and the difference that physicians see in their patients makes them want to continue referring patients to MTM services. “I truly believe the main driver to this is the success that the pharmacist has had as part of the team and helping the patient,” she said.

Creation of a Bariatric Surgery Medication Therapy Management Model.

To describe how pharmacist-provided medication therapy management (MTM) services can be applied to bariatric surgery. A pharmacy MTM consult service located in a multispecialty medical clinic with a bariatric department attached to a hospital where bariatric surgeries are performed. MTM bariatric surgery office practice where patients are seen before surgery by a pharmacist to identify medication problems and determine how best to administer alternative dosage forms post-operatively to patients. Practice innovations are a creation of a specialized service and accompanying specialized medication database within a pharmacotherapy practice. Outcome measures are number of patients referred per month and polypharmacy consults scheduled downstream from the bariatric surgery. Improved patient outcomes and prescribing efficiency from usage of the newly developed database of drugs that can be crushed. All bariatric patients are now referred to the pharmacist MTM pharmacotherapy service for medication review before bariatric surgery. Bariatric surgery is a source of another useful MTM practice model. Utilizing MTM pharmacists to consult with bariatric patients presurgery helps ease the physician burden of writing alternative dose prescriptions and helps identify medication problems with patients before their surgery.