Clinical pharmacists' scope of knowledge for medication therapy management in chronic kidney disease patients

Medication therapy management (MTM) was first implemented and introduced for chronically ill patients and those taking multiple prescription drugs. The MTM has five steps, namely medication therapy review (MTR), personal medication record (PMR), medication-related action plan (MAP), intervention or referral, and finally, documentation. After receiving MTM services, patients will gain knowledge on medicines, which may decrease non-adherence to treatment and increase its efficacy. Studies have shown the positive impact of MTM on geriatric, pediatric, and chronically ill patients and those on polypharmacy. MTM services may improve medication adherence, decrease healthcare costs, and improve the quality of life (QoL) of patients with chronic kidney disease (CKD) by addressing various issues like anaemia, metabolic acidosis, protein management, fluid management, electrolyte management, dosage adjustment based on eGFR, vaccination, and medication-related problems and intervening with the education about the disease, drugs, and lifestyle modifications.

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Potentially Inappropriately Prescribed Medications Among Medicare Medication Therapy Management Eligible Patients with Chronic Kidney Disease: an Observational Analysis

Journal of General Internal Medicine ◽

10.1007/s11606-020-06537-z ◽

2021 ◽

Author(s):

Armando Silva-Almodóvar ◽

Edward Hackim ◽

Hailey Wolk ◽

Milap C. Nahata

Keyword(s):

Chronic Kidney Disease ◽

Logistic Regression ◽

Kidney Disease ◽

Female Gender ◽

Primary Care Providers ◽

Medication Therapy Management ◽

Care Providers ◽

Therapy Management ◽

Medication Therapy ◽

Stage 4

Abstract Background Potentially inappropriately prescribed medications (PIPMs) among patients with chronic kidney disease (CKD) may vary among clinical settings. Rates of PIPM are unknown among Medicare-enrolled Medication Therapy Management (MTM) eligible patients. Objectives Determine prevalence of PIPM among patients with CKD and evaluate characteristics of patients and providers associated with PIPM. Design An observational cross-sectional investigation of a Medicare insurance plan for the year 2018. Patients Medicare-enrolled MTM eligible patients with stage 3–5 CKD. Main Measures PIPM was identified utilizing a tertiary database. Logistic regression assessed relationship between patient characteristics and PIPM. Key Results Investigation included 3624 CKD patients: 2856 (79%), 548 (15%), and 220 (6%) patients with stage 3, 4, and 5 CKD, respectively. Among patients with stage 3, stage 4, and stage 5 CKD, 618, 430, and 151 were with at least one PIPM, respectively. Logistic regression revealed patients with stage 4 or 5 CKD had 7–14 times the odds of having a PIPM in comparison to patients with stage 3 disease (p < 0.001). Regression also found PIPM was associated with increasing number of years qualified for MTM (odds ratio (OR) 1.46–1.74, p ≤ 0.005), female gender (OR 1.25, p = 0.008), and increasing polypharmacy (OR 1.30–1.57, p ≤ 0.01). Approximately 14% of all medications (2879/21093) were considered PIPM. Majority of PIPMs (62%) were prescribed by physician primary care providers (PCPs). Medications with the greatest percentage of PIPM were spironolactone, canagliflozin, sitagliptin, levetiracetam, alendronate, pregabalin, pravastatin, fenofibrate, metformin, gabapentin, famotidine, celecoxib, naproxen, meloxicam, rosuvastatin, diclofenac, and ibuprofen. Conclusion Over one-third of Medicare MTM eligible patients with CKD presented with at least one PIPM. Worsening renal function, length of MTM eligibility, female gender, and polypharmacy were associated with having PIPM. Majority of PIPMs were prescribed by PCPs. Clinical decision support tools may be considered to potentially reduce PIPM among Medicare MTM–enrolled patients with CKD.

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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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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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The effectiveness of an independent anti-neoplastic medication therapy management system

10.21203/rs.2.18221/v1 ◽

2019 ◽

Author(s):

Jianping Zhang ◽

Rong Xu ◽

Xincai Zhao ◽

Yonggang Wang ◽

Wanhu Zhu ◽

...

Keyword(s):

Management System ◽

Population Aging ◽

Action Plan ◽

Medication Therapy Management ◽

Tumor Patients ◽

Therapy Management ◽

Clinical Pharmacists ◽

Medication Therapy ◽

Intervention Plan ◽

Reaction Potential

Abstract Background: Cancer has been a serious health threat for human especially in developing countries. As the tumor patients are largely in elderly population, the ongoing trend of population aging and increased long-term cancer survivors will add complexity to tumor patients management. However, the tumor patients, aged and with multiple therapeutics, are largely under-served in medication service in China. The aim of this study was to evaluated the effectiveness of an independent anti-neoplastic medication therapy management system for tumor patients management.Methods: An independent, anti-neoplastic medication therapy management (MTM) system, in Shanghai Jiao Tong University affiliated sixth People's Hospital, was established in 2018 as a result of collaboration of onco-chemotherapy, clinical pharmacy and software engineers. The system consists of an independent clinic of pharmacy and MTM software. The software consisted of six modules to enable clinical pharmacists to serve the patients. The six modules are medication therapy review, intervention plan, personal medication record, medication-related action plan, intervention and/or referral, and documentation and follow-up.Results: In a year, 173 tumor patients visited the pharmacy clinic and the averaged clinic visiting count was 2.4 for the all tumor patients. Two thirds patients (117/173) were with one or more identified drug-related problems (DRPs) in medication therapy review. Three leading DRPs are adverse drug reaction, potential drug-drug interaction and non-adherence. Seventy percent of DRPs could be resolved (cure or improved) in four weeks; the medication adherence reached 84%-100% following three or four round of review and intervention.Conclusions: The involvement of clinical pharmacists in polypharmacy tumor patients management increased the communication with oncologists, and could ultimately enhance the effectiveness, safety and rational use of medication.

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