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。     

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。     

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.     

药物治疗管理在结直肠肿瘤病人围手术期营养支持治疗中的实践

目的评价临床药师运用药物治疗管理参与结直肠肿瘤病人围手术期营养支持治疗的效果,探索临床药师如何运用药物治疗管理为结直肠肿瘤病人围手术期提供更满意的药学服务。方法选取 2019年 1月至 2020年 3月黄山市人民医院收治的 100例行结直肠癌根治术的病人,采用随机数字表法分为对照组和试验组,各 50例。对照组由临床医师和护士负责病人的围手术期营养治疗管理,试验组由临床药师应用药物治疗管理对病人围手术期营养治疗进行干预。比较两组病人术后营养状况,临床疗效,治疗依从性和不良反应发生率。结果与对照组相比,试验组病人术后第 7天营养指标血红蛋白,白蛋白、黄醇结合蛋白水平提高,炎症指标 C反应蛋白水平降低( P<0.05);术后 7d营养风险发生率试验组( 8/50,16%)低于对照组( 18/视50,36%)(P<0.05);试验组术后出现并发症发生率( 7/50,14%)和药物不良反应发生率(4/50,8%)低于对照组( 22/50,44%)(15/ 50,30%)(P<0.05);治疗依从性良好率试验组( 42/50,84%)优于对照组( 18/50,36%)(P<0.05);住院天数试验组( 18.22±4.71)d少于对照组( 22.58±8.45)d(P<0.05)。结论药物治疗管理在围手术期病人营养支持治疗中的应用,可以有效改善病人围手术期营养情况,提高用药依从性,降低药物不良反应发生率,促进病人术后早期康复。     

Virtual medication therapy management: The cornerstone to a pharmacy renaissance

ObjectivesTo introduce an innovative clinical service that can be used to reduce medication errors and improve quality of care in the rural environment, in order to assist in eliminating or alleviating disparities in health based on geographical location.SummaryVirtual medication therapy management (MTM) will be a tool to assist underserved populations, specifically residents of rural communities. It will use videoconferencing software to provide MTM services to populations that lack access to care. For virtual MTM to be effective, specific measures must be implemented to comply with the Health Insurance Portability and Accountability Act, and state regulations must be established to standardize the practice.ConclusionThe virtual MTM model is a feasible and promising model for advancing MTM services. With commitment and cooperation from various health care fields, virtual MTM could be the cornerstone of a health care renaissance.     

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

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

药物治疗管理教学模式的探讨

药物治疗管理（medication therapy management，MTM）作为新兴的药学服务体系，国外已经形成了成熟的教学模式，在我国还处于探索阶段，未形成完善的教学模式，而通过MTM教学对于提高药师以患者为中心的服务信念和自我效能具有重要意义。因此，本文主要对国外的MTM教学模式以及MTM的实践教学研究进行探讨，为国内建立完善的MTM教学体系提供理论依据，以促进我国药学服务事业的发展。     

Generating demand for pharmacist-provided medication therapy management: Identifying patient-preferred marketing strategies

ObjectiveTo identify effective strategies for marketing pharmacist-provided medication therapy management (MTM) services to patients in a self-insured employer setting.DesignQualitative study.SettingUniversity of Pittsburgh during March through May 2008.Participants26 university employees taking at least one chronic medication.InterventionThree focus group sessions were conducted using a semistructured topic guide to facilitate the discussion.Main outcome measuresEmployees’ perceived medication-related needs, perceived benefits of pharmacist-provided MTM, potential barriers for employee participation in MTM, and effective strategies for marketing MTM.ResultsParticipants reported concerns with timing of doses, medication costs, access, and ensuring adherence. Participants generally felt positively toward pharmacists; however, the level of reported patient contact with pharmacists varied among participants. Some participants questioned pharmacists’ education and qualifications for this enhanced role in patient care. Perceived benefits of MTM noted by participants included the opportunity to obtain personalized information about their medications and the potential for improved communication among their health providers. Barriers to patient participation were out-of-pocket costs and lack of time for MTM visits. Participants suggested use of alternative words to describe MTM and marketing approaches that involve personal contact.ConclusionPharmacists should emphasize parts of MTM that patients feel are most beneficial (i.e., provision of a personal medication record) and use patient-friendly language to describe MTM when marketing their practice. Patients will need greater exposure to the concept of MTM and the pharmacists’ role in order to correctly describe and assign value to this type of pharmacist patient care practice.