Medication Therapy Management in the Primary Care Setting

Objectives: To evaluate the effect of medication therapy management on chronic disease management and generic drug prescribing in the clinic setting. Methods: Private insurer initiates Pay-for-Performance (PFP) project for clinic-based pharmacists in Iowa and South Dakota (n = 9 clinics) in 2009. Each pharmacist was assigned ∽300 patients with at least 1 of 4 disease states (diabetes mellitus, hyperlipidemia, hypertension, and asthma). Pharmacists were expected to complete 2 medication reviews for each patient. The primary outcome was frequency of patients achieving goal levels: diabetes: hemoglobin A1c (A1c) <8%, low-density lipoprotein (LDL) <130 mg/dL, and blood pressure (BP) <140/80 mm Hg; hypertension: BP <140/90 mm Hg; hyperlipidemia: LDL <130 mg/dL; and asthma: percentage of persistent asthmatics on controller medication. Generic prescribing rates were evaluated for antihypertensives, cholesterol-lowering agents, proton pump inhibitors, and antidepressants. Results: A total of 827 patients at 3 clinics were included in the analysis. For diabetes, 77.1% had A1c <8%, 83.2% had LDL <130 mg/dL, and 76.3% had BP <140/80 mm Hg. For hypertension, 86.2% had BP <140/90 mm Hg. For hyperlipidemia, 80.6% had LDL <130 mg/dL. For asthma, 100% were on controller medication. One medication review was completed on 88.8% of patients. Generic prescribing rates ranged from 65.8% to 79.4%. Implications/Adaptability: A high percentage of patients achieved goal levels at clinics with clinical pharmacist services. A multidisciplinary approach to patient care may improve disease state management and medication cost savings.

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Pay-for-performance model of medication therapy management in pharmacy practice

Journal of the American Pharmacists Association ◽

10.1331/japha.2011.10031 ◽

2011 ◽

Vol 51 (3) ◽

pp. 425-431 ◽

Cited By ~ 7

Author(s):

Thomas L. Lenz ◽

Michael S. Monaghan

Keyword(s):

Pay For Performance ◽

Pharmacy Practice ◽

Medication Therapy Management ◽

Performance Model ◽

Therapy Management ◽

Medication Therapy

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Assessment of the Impact of Medication Therapy Management Delivered to Home-Based Medicare Beneficiaries

Annals of Pharmacotherapy ◽

10.1345/aph.1l524 ◽

2009 ◽

Vol 43 (4) ◽

pp. 603-610 ◽

Cited By ~ 30

Author(s):

Erin K Welch ◽

Thomas Delate ◽

Elizabeth A Chester ◽

Troy Stubbings

Keyword(s):

Chronically Ill ◽

Medication Therapy Management ◽

Baseline Risk ◽

Controlled Study ◽

Medication Cost ◽

Medicare Beneficiaries ◽

Therapy Management ◽

Medication Therapy ◽

Medication Costs ◽

The Impact

Background: Medication Therapy Management (MTM) is a voluntary patient participation program mandated for Medicare Part D sponsors by the Centers for Medicare and Medicaid Services for chronically ill beneficiaries with high medication costs/utilization. Objective: To assess the impact of an MTM program on mortality, healthcare utilization, and prescription medication costs and to quantify drug-related problems (DRPs) identified during MTM. Methods: This nonrandomized controlled study was conducted among beneficiaries who were targeted for MTM in 2006. The MTM intervention was designed to identify potential DRPs, educate the patient/caregiver about appropriate medication use, and ensure that the patient was appropriately integrated into clinical services. Data were collected from administrative databases and manual chart abstractions. Study outcomes included all-cause death (primary outcome), hospitalization, and emergency department (ED) visit rates and medication cost changes in the 180 days following MTM targeting and quantification of DRPs. Multivariate logistic regression was used to adjust the outcomes for baseline risk and other potential confounders. A mock MTM intervention was performed for beneficiaries who declined MTM and died, were hospitalized, and/or made an ED visit. Results: A total of 459 opt-in and 336 opt-out beneficiaries who agreed and declined, respectively, to receive MTM were included in the analysis. Beneficiaries who opted in were less likely to die compared with beneficiaries who opted out (adjusted OR [AOR] 0.5; 95% CI 0.3 to 0.9) but were more likely to have had a hospitalization (AOR 1.4; 95% CI 1.1 to 2.0) and an increase in medication costs (AOR 1.4; 95% CI 1.1 to 1.9) during follow-up. There was no difference in ED visit rates. At least one DRP was identified in more than 83% of beneficiaries in both groups, with the most common DRP being drug–drug interaction. Conclusions: Our investigation supports the use of MTM, with its increased coordination of information between healthcare providers and patients, since it may impact mortality positively in a population of high-risk Medicare beneficiaries.

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Potential cost savings of medication therapy management in safety-net clinics

Journal of the American Pharmacists Association ◽

10.1331/japha.2015.14062 ◽

2015 ◽

Vol 55 (3) ◽

pp. 269-272 ◽

Cited By ~ 8

Author(s):

Hoai-An Truong ◽

C. Nicole Groves ◽

Heather B. Congdon ◽

Diem-Thanh (Tanya) Dang ◽

Rosemary Botchway ◽

...

Keyword(s):

Cost Savings ◽

Safety Net ◽

Medication Therapy Management ◽

Potential Cost ◽

Therapy Management ◽

Medication Therapy ◽

Safety Net Clinics

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Factors Influencing Enrollment in the Medication Therapy Management Clinic at an Academic Ambulatory Care Clinic

Journal of Pharmacy Practice ◽

10.1177/0897190014544791 ◽

2014 ◽

Vol 29 (2) ◽

pp. 106-109 ◽

Cited By ~ 2

Author(s):

Mansi Shah ◽

Jessica Tilton ◽

Shiyun Kim

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Medication Therapy Management ◽

Care Clinic ◽

Therapy Management ◽

Medication Therapy ◽

State Management ◽

Initial Appointment ◽

Patient Enrollment

Purpose: In 2001, the University of Illinois Hospital and Health Sciences System (UI Health) established a pharmacist-run, referral-based medication therapy management clinic (MTMC). Referrals are obtained from any UI Health provider or by self-referral. Although there is a high volume of referrals, a large percentage of patients do not enroll. This study was designed to determine the various factors that influence patient enrollment in the MTMC. Methods: This study was a retrospective chart review of demographic and patient variable data during years 2010 and 2011. Disabilities, distance from MTMC, mode of transportation, past medical history, and appointment dates were extracted from the medical records. Results were analyzed using descriptive statistics and logistic regression analysis. Results: A total of 103 referrals were made; however, only 17% of patients remain enrolled in MTMC. The baseline demographics included a mean age of 63 years, 68% female, 70% African American, and 81% English speaking. Patients lived an average of 8 miles from MTMC; most utilized public or government-supplemented transport services; 24% of patients reported some type of disability, most commonly utilizing a walker or a wheelchair. On average, patients were prescribed 13 medications with hypertension (70%), diabetes (56%), and hyperlipidemia (48%) being the most common chronic disease states. The reason for referral included medication management, education, medication reconciliation, and disease state management. Five patients were unable to be contacted to schedule an initial appointment. Additionally, 18 patients failed their scheduled initial appointment and did not reschedule. Logistic regression analysis demonstrated distance traveled for clinic visit, age, and history of hypertension affected the probability of patients showing for their appointments (chi-square = 19.7, P < .001). Conclusion: This study demonstrated that distance from MTMC is the most common barrier in patient enrollment; therefore, strategies to improve patient access are necessary.

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Producing Cost Savings through an Employer Sponsored Medication Therapy Management (MTM) Program for Patients with Diabetes

Research in Social and Administrative Pharmacy ◽

10.1016/j.sapharm.2010.09.026 ◽

2011 ◽

Vol 7 (1) ◽

pp. e10

Keyword(s):

Cost Savings ◽

Medication Therapy Management ◽

Therapy Management ◽

Medication Therapy ◽

Patients With Diabetes

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Mitigation of Medication Mishaps via Medication Therapy Management

Annals of Pharmacotherapy ◽

10.1345/aph.1l591 ◽

2009 ◽

Vol 43 (4) ◽

pp. 611-620 ◽

Cited By ~ 35

Author(s):

Vanita K Pindolia ◽

Lesia Stebelsky ◽

Tanya M Romain ◽

Lori Luoma ◽

Sandra N Nowak ◽

...

Keyword(s):

Clinical Outcomes ◽

Prescription Drugs ◽

Adverse Drug Events ◽

Cost Savings ◽

Management Program ◽

Medication Therapy Management ◽

Pharmacy Cost ◽

Therapy Management ◽

Medication Therapy ◽

Therapy Goals

Background: In 2006. the Center for Medicare & Medicaid Services incorporated the requirement for a Medication Therapy Management Program (MTMP) for individuals with Part D coverage to ensure that drug regimens provide optimal therapeutic outcomes through improved medication use, thereby reducing adverse drug events. Objective: To evaluate the effectiveness of an MTMP implemented for Medicare Advantage Prescription Drug members enrolled with Health Alliance Plan (HAP) during 2006 and 2007. Methods: Patient eligibility for MTMP was searched electronically. Clinical pharmacists researched medication histories and adherence and, through telephone contact, ascertained the patients' healthcare goals and needs. A patient-centered pharmacotherapy plan was created and implemented collaboratively with the patient's physician(s). To ensure that therapy goals were met, pharmacists performed follow-up interventions. Clinical outcomes and cost savings were compared for MTMP enrollees versus those declining enrollment. Results: Average enrollment rate for the MTMP was 20% for 2006 and 2007. Nearly 60% of interventions involved changing therapy to improve efficacy and greater than 40% involved changing therapy to improve safety. Analysis of 2006 data revealed an overall improvement in electronically measurable clinical outcomes for MTMP enrollees versus individuals who declined enrollment, including a trend toward improved adherence to drug therapy for heart failure, insulin use, and a significant reduction in gastrointestinal bleeds (p = 0.001). Cost-savings analysis indicated a greater reduction in total prescription per member per month costs ($PMPM) of 17.2% for MTMP enrollees versus a 7% reduction for those who declined MTMP (p = 0.001). Patients who enrolled into the 2006 MTMP also saw a sustained positive effect in lowered $PMPM for prescription drugs in 2007. Conclusions: The HAP MTMP, conducted through telephone contacts, produced positive trends in improving clinical outcomes, reductions in pharmacy costs, and sustained pharmacy cost savings for patients who enrolled in the MTMP compared with patients who declined enrollment.

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