The Tennessee medication therapy management program: A hybrid type 2 effectiveness-implementation trial study protocol |
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| Institution: | 1. TennCare Pharmacy Division, Nashville, TN, USA;2. University of Tennessee College of Pharmacy, Memphis, TN, USA;3. University of Florida College of Public Health & Health Professions, Gainesville, FL, USA;1. The University of British Columbia, Centre for Health Services and Policy Research, School of Population and Public Health, 2206, E Mall, Vancouver, BC, V6T1Z3, Canada;2. The University of Sydney, Faculty of Medicine and Health, Menzies Centre for Health Policy. Camperdown, Sydney, NSW, Australia, 2006;3. The George Institute for Global Health. Level 5, 1 King Street Newtown NSW Australia;1. Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA;2. Familial Hypercholesterolemia Foundation, Pasadena, CA, USA;3. St. Louis College of Pharmacy, St. Louis, MO, USA;4. Mercy Clinic—East Communities, St. Louis, MO, USA;5. Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA;6. Genomic Medicine Institute, Geisinger, Danville, PA, USA;7. Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA;8. Department of Surgery (Division of Public Health Sciences), Alvin J. Siteman Cancer Center, Washington University School of Medicine; Washington University in St. Louis, St. Louis, MO, USA;1. Department of Public Health, University of Otago, Wellington, 23a Mein St, Wellington, New Zealand;2. Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, PO Box 56, Dunedin, New Zealand;3. School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand;4. School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand;5. CBG Health Research Ltd, PO Box 45173, Te Atatu Peninsula, Auckland, 0651, New Zealand;1. Pharmacy Services, Alberta Health Services, Foothills Medical Centre, 1403 29 St NW, Calgary, Alberta, Canada, T2N 2T9;2. Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, Canada, T2N 4N1;3. Pharmacy Services, Alberta Health Services, Seventh Street Plaza, 10030 107 St, Suite 500, Edmonton, Alberta, T5J 3E4, Canada |
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| Abstract: | 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. |
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| Keywords: | Medication therapy management Medicaid Pharmacy reimbursement Chronic disease management Pharmacy quality Adherence Hybrid type 2 trial Mixed methods CFIR |
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