Physician perceptions of pharmacist-provided medication therapy management: Qualitative analysis

ObjectiveTo identify physician perceptions of community pharmacist-provided medication therapy management (MTM).MethodsThree focus groups consisting of family and internal medicine physicians were conducted in Pittsburgh, York, and Philadelphia, PA, using a semistructured topic guide to facilitate discussions. Each participant completed an exit survey at session conclusion.Results23 physicians participated in one of three focus groups conducted in Pittsburgh (n = 9), York (n = 6), and Philadelphia (n = 8). Participants identified common medication issues in their practices: nonadherence, adverse effects, drug interactions, medication costs, and incomplete patient understanding of the medication regimen. Receipt of a complete patient medication list was reported as the greatest potential benefit of MTM. Participants believed that physicians would be better suited as MTM providers than pharmacists. Concerns identified were the mechanism of pharmacist payment, reimbursement of time spent by physicians to coordinate care, and the training/preparation of the pharmacist. The need for a trusting relationship between a patient's primary care physician and the pharmacists providing MTM was identified.ConclusionThis study provides information to assist pharmacists when approaching physicians to propose collaboration through MTM. Pharmacists should tell physicians that they will receive an updated patient medication list after each visit and emphasize that direct communication is essential to coordinate care.     

Evaluation of pharmacist-provided medication therapy management services in an oncology ambulatory setting

ObjectivesTo determine the effect of formal medication therapy management (MTM) services on pharmacist workload, as well as to describe the population receiving MTM, describe the services provided, and determine the reimbursement rate for billed MTM services.Data sourcesMTM Current Procedural Terminology (CPT) code claims, electronic medical records, and pharmacist MTM logs.Data synthesisA retrospective review of all MTM charges from January 1, 2010, to March 31, 2010, was performed. Data collected included location of the MTM visit, age, gender, insurance, primary malignancy, comorbidities, home medications, time to complete and document the MTM visit, and rate of reimbursement.ResultsIn the 3-month period, 239 MTM visits were completed. It took pharmacists a median of 20 minutes (range 15–127) of face-to-face time and 18 minutes (5–90) for documentation per visit. To date, no claims for MTM have been rejected, and reimbursement rates range from 47% to 79% depending on the insurance provider.ConclusionsMTM in the ambulatory clinic is feasible despite the increase in pharmacist workload from documenting and billing. The increased visibility of clinical pharmacy services justifies the extra time required for formal MTM.     

Identifying opportunities for pediatric medication therapy management in children with medical complexity

BackgroundDespite potential benefits of medication therapy management (MTM) for complex pediatric patients, implementation of pediatric MTM services is rare.ObjectivesTo describe how a standardized pediatric MTM model identifies potential interventions and their impact on medication regimen complexity index (MRCI) scores in children with medical complexity (CMC) and polypharmacy.MethodsThis retrospective proof-of-concept study included pediatric patients receiving primary care in a large outpatient primary care medical home for CMC within a tertiary freestanding children’s hospital from August 2020 to July 2021. Medication profiles of established patients aged 0-18 years with at least 5 active medications at the time of the index visit were assessed for medication-related concerns, potential interventions, and potential impact of proposed interventions on MRCI scores.ResultsAmong 100 patients, an average of 3.4 ± 2.6 medication-related concerns was identified using the pediatric MTM model. Common medication-related concerns (>25% of patients) included inappropriate or unnecessary therapy, suboptimal therapy, undertreated symptom, adverse effect, clinically impactful drug-drug interaction, or duplication of therapy. A total of 97% had opportunities for 5.0 ± 2.9 potential interventions. Most common proposed interventions included drug discontinuation trial (69%), patient or caregiver education (55%), dosage form modification (51%), dose modification (49%), and frequency modification (46%). The mean baseline MRCI score was 32.6 (95% CI 29.3–35.8) among all patients. MRCI scores decreased by a mean of 4.9 (95% CI 3.8–5.9) after application of the theoretical interventions (P < 0.001). Mean potential score reduction was not significantly affected by patient age or number of complex chronic conditions. Potential impact of the proposed interventions on MRCI score was significantly greater in patients with higher baseline medication counts (P < 0.001).ConclusionMost CMC would likely benefit from a pharmacist-guided pediatric MTM service. A standardized review of active medication regimens identified multiple medication-related concerns and potential interventions for nearly all patients. Proposed medication interventions would significantly reduce medication regimen complexity as measured by MRCI. Further prospective evaluation of a pharmacist-guided pediatric MTM service is warranted.     

药物治疗管理研究进展

药物治疗管理(medication therapy management,MTM)是药学实践中形成的一种服务模式.MTM能有效地帮助患者正确认识及配合药物治疗,增强用药依从性,减少不良反应事件和不合理用药等相关问题,帮助患者获得最佳的治疗受益.本文通过介绍MTM的核心要素、运行模式、国内外实践及发展的研究情况,结合当前...     

高血压病药物治疗管理实践综述

世界卫生组织认为,高血压是患者致残和死亡的重要的危险因素,每年影响超过10亿人,造成近940万人死亡。高血压患者常因衰老、合并症和多种药物而出现各种药物相关问题,已有强有力的证据证明以团队为基础的药物治疗管理(MTM)可以有效地治疗高血压等慢性疾病,尤其是当临床药师加入初级保健团队并能够做出独立的医疗药物管理决策时。临床药师是一种未充分利用的资源,显示出扩大初级保健在MTM方面的能力。药师通过MTM工作模式,可以有效解决高血压患者药物相关问题(DRPs),最终达到与患者共同管理疾病的目的。本文利用Strand分类系统,从适应证、有效性、安全性和依从性四个方面对高血压的DRPs进行分类分析,并从MTM五个核心因素出发,对临床药师利用高血压MTM解决DRPs的情况进行归纳,以期帮助临床药师在高血压MTM的临床实践,为我国的药学服务实践提供策略。     

Outcomes of pharmacist-provided medication review in collaborative care for adult Singaporeans receiving hemodialysis

Background Patients receiving hemodialysis are predisposed to drug related problems (DRPs). While collaborative care (CC) models with pharmacist involvement can reduce DRP occurrence, few have examined its impact on clinical and economic outcomes. Objective To determine whether a CC model with pharmacist-provided medication review can reduce unplanned admissions and healthcare utilization in patients receiving hemodialysis, compared to usual care (UC). Setting Outpatient nephrology clinic of a tertiary hospital in Singapore. Method In this retrospective observational study, patients who were taking more than 10 medications or had prior unplanned admissions were included. Patients were identified as being managed under CC (n = 134) if they received comprehensive pharmacist-provided review, or under the UC (n = 190) if they did not. Those perceived to be at greater risk were given priority for receiving CC. All outcomes analyses were adjusted for covariates. Main outcome measure The primary outcome was incidence of unplanned admissions within 6 months post index visit. Secondary outcomes included length of stay (LOS), mortality and healthcare utilization cost. Results CC reduced unplanned admissions by 27% (IRR 0.73, 95% CI 0.54–0.99, p = 0.047) and shortened mean LOS by 1.3 days [6.7 (2.6) vs. 8.0 (3.2), p < 0.001] compared to UC. There were no significant differences in mortality (p = 0.189) or mean healthcare utilization cost (p = 0.165) between groups. Pharmacists identified 515 DRPs with 429 (83.3%) resolved after review. Conclusion The CC model with pharmacist-provided medication review reduced unplanned admissions and LOS in patients receiving hemodialysis. Further studies are warranted to confirm reductions in mortality and healthcare utilization.     

Treatment strategies and pharmacist-led medication management for Helicobacter pylori infection

Half of the world's population is Helicobacter pylori carrier. Updated guidelines and consensus have been issued across regions with the main aim of reducing social transmission and increasing H. pylori eradication rate. Although alternative therapies including traditional Chinese medicine and probiotics have also been used to improve H. pylori eradication rate in clinical practice, current mainstream treatment is still dependent on triple and quadruple therapies that includes antibacterial agents (e.g., amoxicillin and furazolidone) and proton pump inhibitor. Researches also assessed the eradication rate of optimized high-dose dual therapy in treating H. pylori infection. With the increase of antibiotic resistance rate, the treatment strategies for H. pylori infection are constantly adjusted and improved. Besides, low medication compliance is another key influencing factor for H. pylori treatment failure. Emerging studies indicate that pharmacists' intervention and new pharmaceutical care methods can enhance patient medication compliance, reduce adverse drug reactions, and improve H. pylori eradication rate. The purpose of this review is to summarize the advances in treating H. pylori infection and highlight the necessity of developing novel strategies to cope with the increasing challenges and to achieve personalized medication. Also, this review attaches great importance to pharmacists in optimizing H. pylori treatment outcomes as a routine part of therapy.     

A motivational factors assessment instrument for medication management center employees providing medication therapy management services: A Rasch analysis

BackgroundTelephonic medication management centers (MMCs) provide medication therapy management services to help alleviate medication-related issues and improve health outcomes. Motivation factors driving the performance of MMC personnel are key components in achieving these goals. Yet, published literature is limited on how motivation affects MMC personnel performance.ObjectiveTo assess validity and reliability of the employee motivation questionnaire (EMQ), a 19-item measure of barriers and facilitators to motivation associated with MMC employees’ work performance.MethodsPharmacist, nurse, pharmacy technician, and intern employees (N = 534) from 5 telephonic-based U.S. MMCs were invited to complete the electronic EMQ. Rasch analysis was conducted in Winsteps software using a rating scale model. Construct and content validity and reliability were analyzed with employee and item separation index (SI) and reliability coefficient (RC). Linear regression was conducted to test the association of employee characteristics with individual work performance motivation.ResultsA total of 319 employees completed the EMQ, 59.7% response rate. Principal components analysis suggested a unidimensional construct. Employee and item infit and outfit mean squared values met recommended fit criteria (0.5–1.5), suggesting that the data fit the model. An item-person map identified items that were easiest (joy of helping patients) and most difficult (motivated to work harder if incentives were tied to goal achievements) to agree with. Mismatch of employee motivation and item difficulty level on the measurement continuum (?1 to 0.92 logits) indicated a need for additional items that employees perceive as more difficult to agree with. The employee RC was 0.81 and the SI was 2.04; whereas, the item RC was 0.97 and the SI was 5.94. None of the variables tested illustrated statistically significant associations with the person motivation measure.ConclusionsThe EMQ illustrated reasonable content validity, good construct validity, and reliability evidence when used to measure motivation factors among MMC employees. Consideration of employee motivation factors may help to better meet MMC program goals and improve patient outcomes.     

三例精准用药门诊药物治疗管理案例分析

药物重整是药物治疗管理的一个重要部分,也是精准用药门诊的工作重点。专业药师运用专业知识为患者重整并优化药物治疗方案,开展用药教育并进行随访。本文主要分析3例在精准用药门诊实践中临床药师开展以药物重整为重点的药物治疗管理的案例。     

药师进行儿童哮喘药物治疗管理的实践与思考

目的探讨药师进行儿童哮喘药物治疗管理(MTM)的内容和要点,为进一步提升药学服务质量提供参考。方法根据儿童哮喘临床用药的特点,结合药师进行 MTM服务的工作实践,就药师开展哮喘儿童 MTM服务的工作流程、工作内容、工作重点等进行归纳总结。结果接受哮喘 MTM服务的病儿为医生转诊, MTM服务应分信息收集、分析评估、计划制定、计划执行、跟踪随访五步开展。信息收集中应收集哮喘相关的特异性信息;从适应证、有效性、安全性和依从性四个方面评估病儿的药物治疗情况;计划制定可能涉及哮喘急性发作的预防与处理、哮喘控制治疗、用药技术,以及运动诱发哮喘的预防与处理、抗菌药应用、过敏性哮喘季节性治疗、合并呼吸道感染时哮喘用药、过敏原的环境控制、特异性免疫治疗九方面相关内容。结论药师应结合儿童哮喘疾病及病儿自身特点,开展有针对性的 MTM服务。