Why medication therapy management

Experts estimate that 1. Pharmacists provide medication therapy management services in all care settings in which patients take medications. While pharmacists in different settings may provide different types of medication therapy management services, the goal of all pharmacists providing medication therapy management is to make sure that the medication is right for the patient and his or her health conditions and that the best possible outcomes from treatment are achieved.

Anyone who uses prescription medications, non-prescription medications, herbals, or other dietary supplements may potentially benefit from medication therapy management services. People who may benefit the most include those who use several medications, those who have several health conditions, those who have questions or problems with their medications, those who are taking medications that require close monitoring, those who have been hospitalized, and those who obtain their medications from more than one pharmacy.

MTM is one example of a medication management service. Additional examples pharmacist-provided services that include medication management are below. The medication therapy review is a systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them. J Am Pharm Assoc.

Pharmacotherapy consults refer to services provided by pharmacists on referral from other health care providers or other pharmacists. These consult services are typically reserved for more complicated patient cases, specifically for patients who have complex medical conditions and who have either already experienced medication related problems or who are at high potential to develop them.

Patients requiring pharmacotherapy consults may have a single or multiple complex medical conditions that require medication therapy to effectively manage. Pharmacists providing these services typically have advanced expertise and training in the subject area and may be Board Certified in their specialty by the Board of Pharmaceutical Specialties.

Bluml BM. Definition of medication therapy management: development of profession wide consensus. Disease management principles involve coordinated healthcare interventions for diseases in which patients must assume some responsibility for their care.

Pharmacists providing these medication therapy management services address drug and non-drug therapy, as well as lifestyle modifications associated with these diseases integrate the patient into programs that empower them to manage their disease and medications, and thereby reduce healthcare costs and improve quality of life of patients. Comprehensive Medication Management CMM is a whole-person approach that considers more than just the medication list.

A CMM effort focuses on the patient and the clinical and personal goals of therapy, rather than relying solely on the knowledge of the currently prescribed medications as a baseline for interventions. CMM is fundamentally separate from the pharmacy dispensing role. Often the program is set up within primary care or group practice locations designated exclusively for pharmacists to assess patients and deliver medication management services.

To enable this level of patient care, successful CMM programs have established broad, collaborative practice agreements between pharmacists and physician organizations. In fact, this is the big differentiator in CMM: that the pharmacist functions as part of the care team, and interacts regularly with the primary care physician, specialists, nurses, and other clinicians. Often, the pharmacist maintains patient hours on-site in the clinic or health system, or rounds with clinicians to see patients.

Or, patient interactions may take place remotely, using a telehealth platform. Its focus is on treating the whole-patient, with the goal of optimizing outcomes not only a particular condition or disease state, but for all conditions, using the best course of medication therapy.

This requires close cooperation between the pharmacists delivering these services and the entire clinical team. Pharmacist conducts clinical assessments of patient and patient records can include labs, X-rays, tests, clinic notes.

Pharmacist is part of the patient's care team, functioning as a "provider" in various ways, pursuant to state regulations. Pharmacist assesses medications at hospital admission and discharge, as well as long term care facilities. No - CMM is used as a cost reducer for patients being managed under risk and value based care contracts.

Capps, K. Health2 Resources, May Medication Management. Included MTM studies were largely practice based; they varied substantially in usual-care comparators, specific intervention elements, and patient populations. This reality is problematic for systematic reviews because MTM effectiveness in relationship to usual care can be adequately characterized only by controlling for the variation in the active intervention components that might also be present in the usual-care group.

For MTM, this variation in practice likely reflects the evolution of the professional practice of pharmacy. Most studies were not designed to capitalize on variants in MTM program elements for a rigorous, prospective evaluation of outcomes by those variants.

In addition, most studies did not report patient characteristics beyond age and sex, thus limiting our ability to address the underlying heterogeneity in our review. Finally, most studies did not measure fidelity to intended MTM intervention elements; thus, whether studies demonstrating no effect of MTM were actually failures of implementation is difficult to determine.

Our findings emphasize several important needs for future efforts to review MTM programs systematically. The first is for researchers and program evaluators to specify and design MTM interventions based on existing definitions, taxonomies, and service models.

The second is to use the appropriate consensus guidelines for study reporting based on design, 73 - 76 giving particular attention to reporting intervention features, usual care practices, and fidelity of intervention delivery. Medication therapy management is already in widespread practice, which presents both challenges and opportunities for researchers and policy makers.

The MTM programs of the future may contribute to coordinated and improved care through delivery within accountable-care organizations or patient-centered medical homes. However, as MTM becomes more integrated into routine health care, the more difficult it is to attribute change to MTM alone. Furthermore, secular trends in related quality-improvement initiatives eg, medication adherence interventions; practice-based, medication-related patient safety initiatives or requirements; and meaningful use requirements for electronic health records might obscure the effects of MTM efforts.

Positive deviance analyses 78 with rigorous measurement of implementation features or stepped wedge trial designs 79 may be useful, since they provide rigorous approaches to evaluating real-world implementation. Finally, the population effect of MTM may depend on higher rates of patient participation; future studies and evaluations should consider including measures of reach and examine alternative ways of enrolling patients and keeping them engaged.

Because MTM services vary substantially, any constraints applied by a systematic review to establish scope necessarily limit the applicability of the review findings. Our review did not address MTM interventions conducted in inpatient settings or single-episode types of interventions eg, medication reconciliation, which some view as a specific type of MTM service. Although we tried to distinguish MTM from disease or case management interventions, making this distinction was challenging.

We allowed MTM interventions that targeted patients with a single condition, such as diabetes or hypertension, as long as the MTM services included a comprehensive review of all medications rather than just medications for the single condition.

Despite these limitations, the range of included study designs enhanced the applicability of findings for real-world settings when evidence was sufficient. We included interventions labeled pharmaceutical care or medicines management to ensure that the evidence base included studies before the Medicare Part D MTM era and non-US studies.

Although our approach made results more challenging to interpret because of the resultant heterogeneity, it ensured that we captured interventions that had MTM components but lacked the descriptor phrase medication therapy management. We attempted to stratify findings by whether the study was a Part D program, but we did not have enough studies that used the same outcomes to be able to draw conclusions.

New research should be based on national priorities. Studies designed to identify causal relationships between MTM interventions and their outcomes including cost-effectiveness analyses must control for confounding, but they may offer limited information on the elements that explain program success or failure. Studies designed to explore the reasons for program success or failure using qualitative or single-arm designs may offer hypotheses-generating rather than hypotheses-confirming insights on MTM effectiveness.

New research, regardless of specific focus, will likely continue to find inconsistent results until studies account for underlying sources of variability in populations, interventions, and outcome measures. We found a low strength of evidence of benefit for a limited number of intermediate and health care use and cost outcomes.

Evidence was insufficient for most outcomes because of inconsistency in direction and magnitude and also because of imprecision. Wide variations in populations and MTM interventions likely explain these inconsistencies. Published Online: November 17, Author Contributions: Drs Viswanathan and Kahwati had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Conflict of Interest Disclosures: None reported.

Approval from the AHRQ was required before the manuscript could be submitted for publication, but the authors are solely responsible for its content and the decision to submit it for publication. The AHRQ staff did not participate in the conduct of the review, data collection, data management, data analysis, interpretation of the data, or preparation of the manuscript. Our website uses cookies to enhance your experience.

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