CMM alphabet soup: Making sense of our ABCs

Abstract

In many respects, the most troublesome problems of any science center around its most basic terms and fundamental concepts, and not around its more sophisticated concerns. Indeed to the extent that everything either follows from or is based on a discipline s most basic terms and fundamental concepts, problems at a higher level can always be traced back to problems at a more fundamental level. Comprehensive Medication Management (CMM) is garnering increasing attention as a whole-person model of care delivery for optimizing medication use for patients and improving outcomes across all aspects of the quadruple aim of healthcare. Recent research by Blanchard and colleagues, included in this issue of the journal, has shed light on the importance of a well-defined intervention, and, specifically, the significance of explicitly defining the essential functions and operational definitions of an evidence-based intervention to ensure consistent application and replication of the intervention in real-world practice, and, importantly, impact on patient health outcomes. CMM is a patient-centered approach to optimizing medication use and improving patient health outcomes that is delivered by a clinical pharmacist working in collaboration with the patient and other health care providers. See Table 1 for the full definition. CMM has been defined as having five essential functions consistent with the Pharmacist s Patient Care Process. These define the role of practitioners and inform activities within each phase of work. Each of these five essential functions is further described through a series of operational definitions, which explicitly define the steps involved to ensure that CMM is implemented and delivered with fidelity, can be taught, and is assessable. CMM is not a one-time intervention, but rather occurs longitudinally over time with the frequency of visits dependent on the needs of the patient. CMM is appropriate for any individual taking medications, but is ideally suited for patients with multiple chronic conditions using multiple medications who are at high risk for adverse drug effects, chronic disease morbidity and mortality and those who are high utilizers of the health care system. Even with a well-defined term and explicit definitions for operationalizing and applying CMM, confusion often exists among a number of terms used to describe pharmacists services. These terms are often used interchangeably with CMM or discussed in the context of CMM. As a profession, we often use terms such as CMM, disease state management, medication therapy management (MTM), chronic care management (CMM), care transitions, and the patient care process interchangeably, or we use them without explanation or an explicit understanding of how each intervention is operationalized and applied in practice or how the terms relate to one another. We further complicate matters when we create new meanings or alter the definitions of the terms themselves. This inconsistency in terminology may lead to confusion and misconceptions around the pharmacist s contributions and value to interprofessional healthcare teams, which further contributes to the profession s challenges around scope of practice, payment, and sustainability of services. The lack of a clear and well-defined service or intervention and its associated terms makes it difficult to assess impact of the service on important outcomes. This has contributed to the significant heterogeneity seen in studies examining the impact of pharmacist outpatient services on patient care, resulting in inconclusive findings. Finally, without clear definition and consistent use of terms and a common language to describe pharmacist services, we have no consistent approach to the education and training of students and residents. A standardized and consistent use of terminology in pharmacy is essential to ensure that patients, pharmacists and other health care professionals, the public, students and trainees, and others—internal and external to the profession—understand and are speaking a common language. In the July and September issues of the journal, two articles focus on CMM as the intervention delivered by pharmacists to improve patient care. Both articles do a great job of defining CMM, utilizing recent research to guide CMM implementation and delivery, and discussing the relationship between fidelity to the CMM patient care process and their study findings. In addition, both articles reference other terms in the context of CMM delivery, including medication therapy problems (MTPs), disease state management, collaborative practice agreement (CPA), comprehensive medication review (CMR), pharmacist s patient care process (PPCP), and the Pharmacists Achieve Results with Medications Documentation (PharmD) tool. The use of multiple terms (some with multiple meanings) may lead to confusion if not defined or fully explained in the context of the study or intervention. Using the two articles discussed here, this commentary will expand upon the terminologies used within each article to illustrate the importance of clear terminology. It is important to not only understand what CMM is and what it is not, but how it relates to other commonly used terms. The first is an article by Graybill and colleagues published in the July issue of the journal that examines MTPs identified by pharmacist s providing CMM telephonically within a team-based At-Home Care program. The objective of the study was to describe the frequency and type of MTPs identified by pharmacists delivering CMM via telephone. In the context of describing the methodology and presenting the results, the authors do a nice job defining the CMM intervention (often an oversight in many manuscripts) and highlighting Received: 26 July 2021 Revised: 2 August 2021 Accepted: 3 August 2021