Telephonic Medication Therapy Management Research Articles

Qualitative analysis of telephonic comprehensive medication review content and delivery.

Comprehensive medication reviews (CMRs) are offered to eligible Medicare beneficiaries to improve patient medication knowledge, identify, and address medication concerns, and empower medication self-management. However, the specific content of real-world CMRs is unclear. To qualitatively assess CMR content and delivery among telephonic CMR providers. This qualitative thematic analysis used transcriptions of audio-recorded patient interactions during CMRs from 3 telephonic medication therapy management provider organizations. Data were qualitatively analyzed using the inductive saturation model to code emergent themes by independent reviewers who met to agree themes through consensus. Intercoder reliability was calculated using Krippendorf alpha. Overall, 32 CMR transcripts from 3 organizations were analyzed in 13 rounds of coding. Intercoder reliability was >95%. A total of 21 themes were identified across 4 stages: call opening (4 themes), medication reconciliation (5 themes), clinical assessments and guidance (8 themes), and call closing (4 themes). The call opening stage included: service explanation; insurance coverage/cost; identity/privacy/recording; and patient's medication management. Medication reconciliation included: drug name, dose, frequency, and indication; medication deletion and addition; over-the-counter and vaccination assessment; drug efficacy assessment; and prescribing provider assessment. Clinical assessments and guidance included 4 core clinical assessments: allergy assessment; drug therapy problem assessment; drug-related adverse events; and medication modification; and 4 additional assessments: clinical/therapeutic guidance; cost savings guidance; diet/exercise/lifestyle guidance; and optional clinical and behavioral assessments. Call closing included: documentation; primary care provider confirmation; patient satisfaction; and call transfer. There were variations among organizations in the depth that CMR components were covered. These findings suggest provider organizations are including components that meet Centers for Medicare and Medicaid Services goals for CMRs. Yet, variations among organizations indicate a need for standardization and patient-centered measures to ensure appropriate CMR components are covered, while maintaining flexibility for pharmacists to provide patient-oriented CMRs that meet patients' clinical needs.

Social needs of dual-enrolled Medicare-Medicaid patients with medication nonadherence in a telehealth medication therapy management program.

BACKGROUND: Telehealth services that identify and address the social needs of patients can improve access to health care and social services. The social needs of medication therapy management (MTM)-eligible Medicare-Medicaid dual-enrolled patients are unknown. OBJECTIVE: To describe the social needs of Medicare-Medicaid dual-enrolled patients participating in a telephonic MTM program. METHODS: This study evaluated the findings of a social needs survey implemented within a telehealth MTM program. Surveys were offered telephonically to eligible Medicare-Medicaid patients of one insurance plan who were identified with medication nonadherence between July 13, 2020, and December 31, 2020. This study described patients who completed the survey during provision of a comprehensive medication review (CMR). Questions screened for social needs in the following social determinant of health domains: community and social context, economic stability, and neighborhood and physical environment. Descriptive statistics were used to describe results. RESULTS: Among 461 patients who completed CMRs, 358 completed the social needs survey. The most prevalent needs and concerns identified included lacking support to perform daily activities (165 [47%]), lacking companionship (81 [23%]), feeling left out (71 [20%]), feeling isolated (81 [23%]), not having enough money to pay bills (177 [49%]), worrying about running out of food (77 [22%]), or having run out of food within the last 12 months (81 [23%]). In this sample, 54 (15%) patients reported avoiding a provider visit because of transportation barriers. Certain individuals were without a steady place to live or were worried about losing their home (40 [11%]) and 35 (10%) reported struggling to keep a job. CONCLUSIONS: The identification of social needs among patient populations is necessary to reduce barriers to medication adherence and optimize health care utilization. This study described important social needs identified during the provision of a telehealth CMR among MTM-eligible Medicare-Medicaid dual-enrolled patients. DISCLOSURES: Dr Nahata was supported in part by the Avatar Foundation. Dr Silva Almodóvar works as a research pharmacist within a medication management program, which provides medication therapy management services.

Evaluating satisfaction with pharmacist-provided MTM services in a Medicaid population.

Optimizing patient outcomes is a goal for medication therapy management (MTM) programs, with patient satisfaction representing a valuable measure to provide information about pharmacist-delivered services and the overall effectiveness of the program. The objective of this study was to assess patient satisfaction after engaging in a telephonic comprehensive medication review (CMR) with a pharmacist in a Medicaid population. This was a retrospective cohort study. A quality assurance component of the MTM program was incorporated as a survey evaluating patient satisfaction. Three questions were administered at the conclusion of the CMR, with 2 questions conducted during a follow-up review. Of the 5 total questions, 2 were open response, 1 used a 5-point Likert scale, and 2 were yes/no questions. Response rates of 93.0% and 53.5% for the first and second halves of the survey, respectively, were achieved. Seventy-eight percent of patients indicated satisfaction with the MTM program, 63.5% reported that the medication review was helpful, and 80% reported experiencing a very good level of care. In addition, 59% found the patient takeaway documents received after the CMR to be helpful and 81% felt they had a better understanding of their medications. A subgroup analysis found that of the patients who reported feeling that the CMR was helpful, 66% were taking 7 or more medications. Overall, Medicaid patients in this study were very satisfied with the telephonic MTM services provided and found the information relayed during the conversation with the pharmacist to be helpful. Further studies are recommended to confirm these findings.

Evaluation of a Pharmacist-Led Telephonic Medication Therapy Management Program in Rural Arizona: Implications for Community Health Practice

This study evaluated a pharmacist-led telephonic Medication Therapy Management (MTM) program for rural patients in Arizona with poor access to healthcare services. A pharmacist provided telephonic MTM services to eligible adult patients living in rural Arizona communities with a diagnosis of diabetes and/or hypertension. Data were collected and summarized descriptively for demographic and health conditions, clinical values, and medication-related problems (MRPs) at the initial consultation, and follow-up data collected at 1 and 3 months. A total of 33 patients had baseline and one-month follow-up data, while 15 patients also had three-month follow-up data. At the initial consultation, the following MRPs were identified: medication adherence issues, dose-related concerns, adverse drug events (ADE), high-risk medications, and therapeutic duplications. Recommendations were made for patients to have the influenza, herpes zoster, and pneumonia vaccines; and to initiate a statin, angiotensin converting enzyme inhibitor, angiotensin receptor blocker, beta-blocker, and/or rescue inhaler. In conclusion, this study demonstrated that while pharmacists can identify and make clinical recommendations to patients, the value of these interventions is not fully realized due to recommendations not being implemented and difficulties with patient follow-up, which may have been due to the COVID-19 pandemic. Additional efforts to address these shortcomings are therefore required.

POSB10 Identification of Medication-Related Problems Among RURAL Community-Dwelling Patients Receiving Telephonic Medication Therapy Management Services

Rural community-dwelling patients often have difficulty accessing healthcare services and experience poorer health outcomes. The objective of this study was to evaluate medication-related problems identified through a novel, collaborative medication therapy management (MTM) program for underserved patients in Arizona.

Perceptions and experiences of promotoras and pharmacists in an academic-community partnership providing telephonic MTM services to a Spanish-speaking, rural population: a focus group study.

BACKGROUND: The literature is limited concerning the collaboration between pharmacists and promotoras in the delivery of medication therapy management (MTM) services. Yet, this information could help address a practice gap while improving MTM collaborative care approaches. OBJECTIVE: To identify the knowledge, attitudes, and barriers of clinical call center health professionals (pharmacists, nurses, pharmacy interns) and promotoras towards MTM collaborative care in implementing the Rural Arizona Medication Therapy Management (RAzMTM) program. METHODS: A descriptive, qualitative study using semistructured focus groups was conducted with call center health professionals and promotoras who participated in the RAzMTM program to improve pharmaceutical care for patients with diabetes and/or hypertension in rural Arizona. Recruitment and consent letters, a demographic questionnaire, and a focus group guide were designed specifically for this project. Three facilitators participated in each focus group-one guided the discussion while the others took notes. Focus groups were audio recorded to verify all responses and transcribed verbatim with omission of participant identifiers. Thematic analysis was conducted by 2 independent researchers who reviewed the transcripts to identify codes, seek consensus, and agree on themes, with negotiation from a third independent researcher. RESULTS: Nine participants took part in 2 focus groups. Participants were predominantly female (89%), college graduates and/or had postgraduate/professional degrees (78%), and were Hispanic or Latino (89%). Five themes were identified: (1) roles and responsibilities of RAzMTM participants; (2) benefits unique to the RAzMTM program; (3) interprofessional experience of RAzMTM participants; (4) professional growth for RAzMTM participants; and (5) opportunities for future improvement. Perceptions of the participants in the RAzMTM program were consistent-experiences of health professionals and promotoras were positive; they recognized the benefit of each other's involvement in the program; and they learned how to work together to improve patient care. Future recommended program improvements include improving ease of scheduling (e.g., extending pharmacist availability to provide MTM services). CONCLUSIONS: These focus group results suggest that provision of telephonic MTM services, using an academic-community partnership, was positively received by participating pharmacists and promotoras. However, future work is needed for continued improvement of strategies to enhance interprofessional relationships in patient chronic disease management. DISCLOSURES: This project was supported by the Grant or Cooperative Agreement Number DP004793, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. This work also was supported, in part, by SinfoniaRx. Axon, Taylor, and Warholak received funding from SinfoniaRx. Axon reports grants from Tabula Rasa Op-Co, Merck & Co, Pharmacy Quality Alliance, Arizona Department of Health, and American Association of Colleges of Pharmacy, outside the submitted work. Warholak and Taylor received funding from Arizona Department of Health Services as part of a contract, outside the submitted work. Vaffis reports funding from Merck and Pharmacy Quality Alliance. This study was presented as a poster at the American Society of Health-System Pharmacists Summer Meetings & Exhibition (June 10-12, 2019, Boston, MA) and as a podium presentation at the Arizona Pharmacy Association Southwestern States Residency Conference (June 14, 2019, Phoenix, AZ).

Exploring performance predictors among employees in a pharmacist-led medication management center

ObjectiveHealth care companies are increasingly interested in developing and maintaining employee motivation. However, this can be challenging with different professions working together in delivering telephonic medication therapy management services. The purpose of the study is to assess employees’ perceptions of performance metrics, strategies to achieve those metrics, motivational work factors, and barriers to achievement at a medication management center (MMC). DesignFocus group using purposive sampling. SettingSix in-person focus groups were conducted with the MMC employees. ParticipantsSeparate focus groups were conducted for pharmacists, student pharmacist interns, and pharmacy technicians. Each group consisted of approximately 5 participants, lasted roughly 1 hour, and was facilitated by trained qualitative researchers. Outcome measuresThe semistructured sessions involved participants responding to open-ended, predetermined questions introduced by a facilitator. The sessions were audio-recorded and transcribed for analysis. Two independent reviewers analyzed the transcripts; a third independent reviewer facilitated a consensus to resolve discrepancies. ResultsThirty MMC employees, with an average age of 32.1 ± 10.5 years, participated; most of them (73.3%) were women and had worked at the MMC for an average of 2.8 ± 2.2 years. Six themes were identified: (1) awareness and understanding of performance measures; (2) perceptions of performance measures; (3) suggested changes to make the performance measures more reflective of their roles; (4) motivating factors to improve performance; (5) performance barriers; and (6) strategies to achieve performance goals. The intrinsic motivational factors included providing patient care, helping change patients’ lives, and meeting work goals. The extrinsic motivational factors included remuneration, management, teamwork, work environment, and feedback. The performance barriers were unrealistic goals, lack of feedback, ineffective communication, and inconsistent operational procedures. ConclusionsThese study findings contribute to a growing body of research surrounding employee motivation within organizations with diverse workforces. Future work is warranted to investigate employee motivation in similar pharmacy-related settings.

Community pharmacists' interventions and documentation during medication therapy management encounters delivered face-to-face versus via telephone: The devil is in the details.

To date, no studies are available comparing in-person versus telephone-administered medication therapy management (MTM) encounters in a community pharmacy setting with respect to medication-related problems, interventions and documentation. The objective of this study was to evaluate types of medication-related problems, interventions, and documentation among patients receiving MTM face-to-face versus over the telephone. A retrospective analysis was performed on all completed comprehensive medication reviews (CMR) between 2011 and 2017 in 14 community pharmacies in Western Massachusetts, USA that belong to one district of a national chain. Medication-related problems were classified as: Beers criteria medications, untreated condition, dose too high or low, medication omission, duplicate therapy, drug-drug interaction, non-adherence, complicated dosing. Pharmacist's interventions were classified as education, medication reconciliation, and vaccination. Documentation of assessment, plan, discussion notes, and recommendations were evaluated as being present or absent. In total, 297 encounters (56.5% were over the telephone) were included in the analysis. There was no significant differences between clinical and demographic characteristics and types of medication-related problems and pharmacist interventions among patients who received face-to-face versus telephone MTM service. Assessment was documented among 28% of face-to-face and 42% of telephone CMR encounters (p<0.05). Plan was documented among 27% of face-to-face and 40% of telephone CMR encounters (p<0.05). Discussion notes were documented among 97% of face-to-face and 98% of telephone CMR encounters (p>0.05). Pharmacist recommendations were documented among 92% of face-to-face and 95% of telephone CMR encounters (p>0.05). Pharmacists identify medication-related problems and provide education and medication reconciliation interventions independent of the mode of delivery. The overall low frequency of assessment and plan documentation raises concerns. It is imperative for pharmacists to document both instances of provider outreach and follow-up to ascertain resolutions of patients' medication-related problems.

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.

PMU72 EVALUATION OF MEDICATION-RELATED PROBLEMS AMONG RURAL COMMUNITY-DWELLING PATIENTS RECEIVING MEDICATION THERAPY MANAGEMENT FOR DIABETES AND/OR HYPERTENSION

To assess whether differences exist in medication-related problems (MRPs) between urban, micropolitan, and small town patients receiving medication therapy management (MTM) services for diabetes and/or hypertension. Participants were aged 18 years and older, residing in rural Arizona counties (per Arizona statute), diagnosed with diabetes and/or hypertension, and receiving pharmacist-delivered, telephonic MTM from an academic-based center. Data on MRPs were collected for: drug-disease and drug-drug interactions; therapy duplications; dose-related safety concerns: adverse drug reactions (ADRs); and high-risk medications. The pharmacist made recommendations to address problems identified and determined, during a follow-up consultation, whether prescribers resolved recommendations. For this descriptive analysis, subjects were categorized using Rural-Urban Commuting Area (RUCA) codes (1-3=urban; 4-6=micropolitan; 7-10=small town). A total of 384 patients were included in this study. Participants were predominantly female (66%), white (73%), and non-Hispanic (52%); one-third were older (65-74 years, 33%). Twenty-three patients had a therapy duplication; 19 of these were resolved during the initial consultation. Fifteen patients had drug-disease interactions; fewer of these individuals resided in small towns (n=3) versus micropolitan areas (n=7, p=0.02). Three of the six drug-disease interactions referred to the prescriber were resolved. Drug-drug interactions were identified for 31 patients while 33 had dose-related safety concerns. Of these, 10 drug-drug interactions and 28 dose-related safety concerns referred to the prescriber, were resolved. Fifty-one patients had ADRs that were resolved during the initial consultation. Thirty-nine patients with high-risk medications were identified among older adults (>65 years); 30 were referred to the provider and of these, nine were resolved. Pharmacists identified over 200 MRPs among this sample of rural-residing patients with diabetes and/or hypertension. While variation existed in the number of pharmacists’ recommendations resolved by prescribers, these differences were less apparent between RUCA areas. Further work is needed to increase prescribers’ acceptance of national guideline recommendations.

Effect of home-based asthma medication therapy management program on pediatric African Americans with uncontrolled asthma

ObjectivesTo determine the impact of a pharmacist home-based and telephonic medication therapy management (MTM) program for African American children enrolled in a state Medicaid plan with asthma exacerbations. Caregivers’ knowledge of asthma is described. DesignThis study was a quasi-experimental, pre-post prospective study with 2 phases: a pre-phase followed by a 12-month intervention post-phase in which each patient served as their own control. Pharmacists were sent to the patients’ homes to provide MTM at weeks 1, 24, and 48 while pharmacy students provided telephonic outreach at weeks 4, 8, 12, and 36. SettingA local Medicaid managed care organization. ParticipantsPediatric African American patients (4-17 years old) with uncontrolled asthma. Main outcome measuresOutcomes included emergency department (ED) visits, change in pharmacist assessment of asthma control, change in asthma knowledge test, change in Asthma Control Test, and change in medication adherence score. ResultsOverall, 366 pediatric patients (4-17 years old) were enrolled in this program over a 1-year period. Among the patients who were enrolled in the program, there were 122 asthma-related ED visits in the year preceding enrollment compared to 57 ED visits after their first home-based visit (P < 0.001). Although only 102 patients completed the study, more patients were assessed by the pharmacists as having well-controlled asthma at the final visit (76.8%) than at baseline (58.7%). Based on the Asthma Control Test, more patients reported uncontrolled asthma at baseline (47.5%) than at the final visit (39%). There was a statistically significant increase in the Asthma Knowledge Test (P < 0.05) and the Medication Adherence Assessment (P = 0.035) among patients compared with baseline. ConclusionRates of asthma exacerbations requiring an ED visit were substantially lower in the year after the initial pharmacist visit compared with the year preceding enrollment in the medication therapy management program.

PHP95 - Evaluation of National Clinical Guideline Adherence Among Rural Community-Dwelling Patients Receiving Medication Therapy Management for Diabetes and/or Hypertension

To assess whether differences exist in adherence to national consensus guidelines, between urban and rural patients receiving medication therapy management (MTM) for diabetes and/or hypertension. Patients participating in Year 1 of this study included those: 18 years and older, diagnosed with diabetes mellitus and/or hypertension, and living in rural Arizona communities (per Arizona statute) who received pharmacist-delivered, telephonic MTM services and a comprehensive medication review (CMR) from an academic-based MTM provider. Gaps in care were assessed according to national consensus guidelines for statins, beta-blockers, rescue inhalers, and inhaled corticosteroids, as part of the CMR. The pharmacist made recommendations for appropriate medication additions. Patient follow up consultations were conducted to determine whether prescribers acted on these recommendations. For this descriptive analysis, patients were categorized by Rural-Urban Commuting Area (RUCA) codes; RUCA codes 1-3=urban; 4-6=micropolitan; 7-10=small town). A total of 384 patients received a CMR and follow-up consultation. Participants were predominantly female (urban=70.9%, micropolitan=64.9%, small town=61.5%), white (urban=75.2%, micropolitan=78.4%, small town=68.6%), non-Hispanic (urban=17.0%, micropolitan=83.8%, small town=68.0%%) and older (65-74 years, urban=34.8%, micropolitan=18.9%, small town=37.9%). Pharmacists recommended prescribers add a statin for 57 (n=262, 21.8%) patients and 19 (33.3%) additions were identified at follow-up (urban=8, micropolitan=3, small town=8). Adding a beta-blocker was recommended for 13 (n=63, 20.6%) patients; two additions (15.4%) were present at follow-up (small town=2). Recommendations were made for adding a rescue inhaler for seven (n=89, 7.9%) patients; three additions (42.9%) were identified at follow-up (urban=2, small town=1). None of the 13 inhaled corticosteroid recommendations were present at follow-up. Differences were observed in the pharmacist’s clinical guideline recommendations accepted by prescribers, between urban- and rural-dwelling patients. More concentrated efforts are warranted to increase prescribers’ acceptance of guideline recommendations, for rural-residing patients with diabetes and/or hypertension.

Use of the Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ) 2.0 in a telephonic medication therapy management center

Chromosome 22q11.2 deletion syndrome (22q11DS) is a neurodevelopmental disorder associated with a broad phenotype of clinical, cognitive and psychiatric features. Due to the very high prevalence of schizophrenia (30–40%), the investigation of psychotic symptoms in the syndrome is promising to reveal biomarkers for the development of psychosis, also in the general population. Since schizophrenia is seen as a disorder of the dynamic interactions between brain networks, we here investigated brain dynamics, assessed by the variability of blood oxygenation level dependent (BOLD) signals, in patients with psychotic symptoms. We included 28 patients with 22q11DS presenting higher positive psychotic symptoms, 29 patients with lower positive psychotic symptoms and 69 healthy controls between 10 and 30 years old. To overcome limitations of mass-univariate approaches, we employed multivariate analysis, namely partial least squares correlation, combined with proper statistical testing, to analyze resting-state BOLD signal variability and its age-relationship in patients with positive psychotic symptoms. Our results revealed a missing positive age-relationship in the dorsal anterior cingulate cortex (dACC) in patients with higher positive psychotic symptoms, leading to globally lower variability in the dACC in those patients. Patients without positive psychotic symptoms and healthy controls had the same developmental trajectory in this region. Alterations of brain structure and function in the ACC have been previously reported in 22q11DS and linked to psychotic symptoms. The present results support the implication of this region in the development of psychotic symptoms and suggest aberrant BOLD signal variability development as a potential biomarker for psychosis.

Reduction of 30-Day Hospital Readmissions After Patient-centric Telephonic Medication Therapy Management Services.

Background: Transitional care programs are a growing topic in health care systems across the country, with a focus on achieving a reduction in hospital readmissions and improving patient and medication safety. Numerous strategies have been employed and studied to determine successful approaches to patient transition from the hospital setting to the home setting. Pharmacist-mediated postdischarge telephonic outreach has demonstrated decreased hospital readmission rates in multiple hospital systems. Objective: To evaluate the effectiveness of pharmacist-facilitated telephonic medication therapy management (MTM) services on reducing hospital readmissions. Methods: A retrospective chart analysis (n = 314) was performed for patients who received MTM services following hospital discharge between February 23, 2014 and July 4, 2014. The primary outcome was 30-day all-cause readmission. The secondary outcomes were identification of pharmacist interventions for and recommendations about medication-related problems and discrepancies found between the patients' reported medication list and the hospital discharge medication list. Results: The data revealed no statistically significant difference in hospital readmission rates between the intervention and control groups (odds ratio,1.04; 95% CI, 0.68-1.60). Pharmacists intervened on 189 medication-related problems via facsimile to the prescriber (35.7% of charts), contacted prescribers by phone for 23 medication-related or health-related issues, and identified 823 medication list discrepancies (78.34% of charts). Conclusion: Although the provision of telephonic MTM services by pharmacists did not result in an improvement in the readmission rate during this study period, pharmacists were able to intervene on numerous medication-related problems and medication list discrepancies.

The Effectiveness of Pharmacist-Provided Telephonic Medication Therapy Management on Emergency Department Utilization in Home Health Patients.

Preventable emergency department (ED) use may be targeted with interventions for improving the medication use process, as medication misadventures and non-adherence frequently cause preventable ED utilization. One intervention that could prevent ED visits is Medication Therapy Management (MTM). To evaluate the effectiveness of a telephonic medication therapy management (MTM) service on reducing emergency department utilization within a Medicare insured home health population. This was a secondary analysis of data from a cluster-randomized controlled trial examining re-hospitalizations among Medicare insured patients within forty randomly selected, geographically diverse, home-health centers. The intervention consisted of an initial telephonic medication reconciliation with a pharmacy technician, a telephonic pharmacist-provided medication review, and follow-up pharmacist phone calls. The primary outcome of this analysis was 60-day all-cause emergency department utilization. Patients' baseline risk of ED utilization was calculated, and patients were stratified into quartiles based on their risk of ED utilization. Adjusted odd ratios of ED utilization were calculated. Data from 656 patients (intervention n=297, usual care n=359) were available for this study. Overall, the MTM intervention was not associated with 60-day ED use, as 24.4% of intervention patients and 25.1% of usual care patients utilized the ED (Adjusted Odds Ratio=1.11; 95% CI: 0.79-1.57). However, there was lower ED utilization among patients in the lowest risk-quartile (Adjusted Odds Ratio=2.52; 95% CI: 1.15-5.49; p= 0.02). This pharmacist-delivered telephonic medication therapy management program did not decrease ED utilization overall in a Medicare insured home health population, but may further reduce the risk of ED utilization among patients who are at lower risk of utilization.

Pharmacist extenders: An emerging way to deliver care

Five months into 2016 and already there are 5 publications on pharmacist-related telephone medication therapy management, whereas only 9 articles appeared in all of 2015. As this mechanism to influence patient outcomes appears to be taking further hold and gaining popularity, reflecting on lessons learned by others seemed an appropriate focus for this month's column. Patrick G. Clay, PharmD, AAHIVP, CPI, FCCP, APhA Science Officer and Professor of Pharmacotherapy, College of Pharmacy, University of North Texas System, Fort Worth, TX

Pharmacists' experiences with a telephonic medication therapy management program for home health care patients.

This study was designed to better understand perceived barriers and facilitators to providing medication therapy management (MTM) services by pharmacists who recently provided telephonic MTM services to home health care patients. These services were provided as part of a randomized, controlled trial (RCT) to develop suggested quality improvement strategies for future service design. This was a qualitative study. A semi-structured individual interview format was used to elicit responses. Interviews were conducted by phone with participants. All pharmacists who recently provided telephonic MTM services as a part of an RCT participated in this study. Pharmacists were asked questions regarding their perceptions of the services, training opportunities, patient perceptions of the services, interactions with physicians, and suggestions for improvement. General demographic information was collected for each pharmacist and summarized using descriptive statistics. Interview data were analyzed using inductive qualitative methods to reveal key themes related to facilitators and barriers of MTM services in home health care patients. The main outcome measures were major themes identified from pharmacist interviews pertaining to barriers, facilitators, and quality improvement strategies for telephonic MTM delivery. A total of four pharmacists (i.e., 100% of those who participated in the prior RCT) were interviewed. Several themes emerged from the analysis, including: communication and relationships, coordinating care and patient self-management, logistics, professional fulfillment, service delivery and content, and training opportunities. This study provides possible strategies to overcome barriers and facilitate service provision for future telephonic MTM services.

Effect of telephone MTM on hospitalization rates: Q&amp;A with study authors

A research team led by Alan J. Zillich, PharmD, Associate Professor of Pharmacy Practice at the Purdue University College of Pharmacy, recently released the results of a randomized, controlled pragmatic trial on the effect of pharmacists' telephonic medication therapy management (MTM) on hospitalization rates among a sample of home health care patients. The study was published in the journal Health Services Research (HSR). In this condensed and edited version of an interview with Pharmacy Today , Zillich and a coauthor, Margie E. Snyder, PharmD, MPH, Assistant Professor of Pharmacy Practice at Purdue, discuss the findings—including some unexpected ones—and how the results might help inform future MTM research and clinical practice initiatives .

Predictors of medication-related problems among medicaid patients participating in a pharmacist-provided telephonic medication therapy management program.

To identify predictors of medication-related problems (MRPs) among Medicaid patients participating in a telephonic medication therapy management (MTM) program. Retrospective analysis of data from patients enrolled in a previously published study. Two Medicaid administrative claims file databases (for health care utilization and prescription dispensing information) and one pharmacy organization file for MTM program information. Seven hundred twelve adult Medicaid patients who participated in a statewide pharmacist-provided telephone-based MTM program and who received an initial medication therapy review. The primary dependent variable was the number of MRPs detected during the initial medication therapy review. Secondary dependent variables were the detection of one or more MRPs related to indication, effectiveness, safety, and adherence. Predictor variables were selected a priori that, from the literature and our own practice experiences, were hypothesized as being potentially associated with MRPs: demographics, comorbidities, medication use, and health care utilization. Bivariate analyses were performed, and multivariable models were constructed. All predictor variables with significant associations (defined a priori as p<0.1) with the median number of MRPs detected were then entered into a three-block multiple linear regression model. The overall model was significant (p<0.001, R(2) =0.064). Significant predictors of any MRPs (p<0.05) were total number of medications, obesity, dyslipidemia, and one or more emergency department visits in the past 3months. For indication-related MRPs, the model was significant (p<0.001, R(2) =0.049), and predictors included female sex, obesity, dyslipidemia, and total number of medications (p<0.05). For effectiveness-related MRPs, the model was significant (p<0.001, R(2) =0.054), and predictors included bone disease and dyslipidemia (p<0.05). For safety-related MRPs, the model was significant (p<0.001, R(2) =0.046), and dyslipidemia was a predictor (p<0.05). No significant predictors of adherence-related MRPs were identified. This analysis supports the relative importance of number of medications as a predictor of MRPs in the Medicaid population and identifies other predictors. However, given the models' low R(2) values, these findings indicate that other unknown factors are clearly important and that criteria commonly used for determining MTM eligibility may be inadequate in identifying appropriate patients for MTM in a Medicaid population.

A randomized, controlled pragmatic trial of telephonic medication therapy management to reduce hospitalization in home health patients.

To evaluate the effectiveness of a telephonic medication therapy management (MTM) service on reducing hospitalizations among home health patients. Forty randomly selected, geographically diverse home health care centers in the United States. Two-stage, randomized, controlled trial with 60-day follow-up. All Medicare- insured home health care patients were eligible to participate. Twenty-eight consecutive patients within each care center were recruited and randomized to usual care or MTM intervention. The MTM intervention consisted of the following: (1) initial phone call by a pharmacy technician to verify active medications; (2) pharmacist-provided medication regimen review by telephone; and (3) follow-up pharmacist phone calls at day seven and as needed for 30 days. The primary outcome was 60-day all-cause hospitalization. Data were collected from in-home nursing assessments using the OASIS-C. Multivariate logistic regression modeled the effect of the MTM intervention on the probability of hospitalization while adjusting for patients' baseline risk of hospitalization, number of medications taken daily, and other OASIS-C data elements. A total of 895 patients (intervention n = 415, control n = 480) were block-randomized to the intervention or usual care. There was no significant difference in the 60-day probability of hospitalization between the MTM intervention and control groups (Adjusted OR: 1.26, 95 percent CI: 0.89-1.77, p = .19). For patients within the lowest baseline risk quartile (n = 232), the intervention group was three times more likely to remain out of the hospital at 60 days (Adjusted OR: 3.79, 95 percent CI: 1.35-10.57, p = .01) compared to the usual care group. This MTM intervention may not be effective for all home health patients; however, for those patients with the lowest-risk profile, the MTM intervention prevented patients from being hospitalized at 60 days.