Leticia R. Moczygemba

Integration of collaborative medication therapy management in a safety net patient-centered medical home.

OBJECTIVE To describe the integration of collaborative medication therapy management (CMTM) into a safety net patient-centered medical home (PCMH). SETTING Federally qualified Health Care for the Homeless clinic in Richmond, VA, from October 2008 to June 2010. PRACTICE DESCRIPTION A CMTM model was developed by pharmacists, physicians, nurse practitioners, and social workers and integrated with a PCMH. CMTM, as delivered, consisted of (1) medication assessment, (2) development of care plan, and (3) follow-up. PRACTICE INNOVATION CMTM is integrated with the medical and mental health clinics of PCMH in a safety net setting that serves homeless individuals. MAIN OUTCOME MEASURES Number of patients having a CMTM encounter, number and type of medication-related problems identified for a subset of patients in the mental health and medical clinics, pharmacist recommendations, and acceptance rate of pharmacist recommendations. RESULTS Since October 2008, 695 patients have had a CMTM encounter. An analysis of 209 patients in the mental health clinic indicated that 425 medication-related problems were identified (2.0/patient). Pharmacists made 452 recommendations to resolve problems, and 384 (85%) pharmacist recommendations were accepted by providers and/or patients. For 40 patients in the medical clinic, 205 medication-related problems were identified (5.1/patient). Pharmacists made 217 recommendations to resolve the problems, and 194 (89%) recommendations were accepted. CONCLUSION Integrating CMTM with a safety net PCMH was a valuable patient-centered strategy for addressing medication-related problems among homeless individuals. The high acceptance rate of pharmacist recommendations demonstrates the successful integration of pharmacist services.

Impact of telephone medication therapy management on medication and health-related problems, medication adherence, and medicare part D drug costs: A 6-month follow up

BACKGROUND The Medicare Modernization Act of 2003 mandated the provision of medication therapy management (MTM) to eligible Part D beneficiaries to improve medication-related outcomes. As MTM programs evolve, evaluation is necessary to help inform MTM best practices. OBJECTIVE The objective of this study was to determine the impact of pharmacist-provided telephone MTM on: (1) medication and health-related problems (MHRPs); (2) medication adherence; and (3) Part D drug costs. METHODS This quasi-experimental study included Part D beneficiaries from a Texas health plan. Andersens Behavioral Model of Health Services Use served as the study framework. MTM utilization was the health behavior. Age, gender, and race were predisposing factors, and number of medications, chronic diseases, and medication regimen complexity were need factors. Outcomes were pre-to-post changes in: (1) MHRPs; (2) medication adherence, using the medication possession ratio (MPR); and (3) total drug costs. Multiple regression was used to analyze group differences while controlling for predisposing and need factors. RESULTS At baseline, the intervention (n = 60) and control (n = 60) groups were not statistically different regarding predisposing and need factors, with the exception of gender. The intervention group had significantly (P = 0.009) more men compared with the control group (51.7% vs 28.3%). There were 4.8 (2.7) and 9.2 (2.9) MHRPs identified at baseline and 2.5 (2.0) and 7.9 (3.0) MHRPs remained at the 6-month follow up in the intervention and control groups, respectively. The intervention group (vs control) had significantly more MHRPs resolved (P = 0.0003). There were no significant predictors of change in MPR or total drug costs from baseline to follow up, although total drug costs decreased by

Texas pharmacists' opinions about and plans for provision of medication therapy management services

158 in the intervention group compared with a

Facilitators and barriers to implementing antimicrobial stewardship strategies: Results from a qualitative study

118 increase in the control group. CONCLUSIONS A telephone MTM program resolved significantly more MHRPs compared with a control group, but there were no significant changes in adherence and total drug costs.

Development and implementation of a telephone medication therapy management program for Medicare beneficiaries

OBJECTIVES To determine pharmacist awareness of medication therapy management (MTM), confidence in and intentions to provide MTM, related training needs, and barriers to MTM provision; and to assess pharmacist and practice site characteristics that are related to confidence in providing MTM. DESIGN Nonexperimental cross-sectional study. SETTING May 2006 in Texas. PARTICIPANTS 1,833 Texas community pharmacists who were affiliated with the Texas Pharmacy Association. INTERVENTION an anonymous, self-administered online survey was e-mailed to participants. MAIN OUTCOME MEASURES Awareness of MTM legislation, confidence in providing MTM, intentions to provide MTM, and barriers to MTM provision. Pharmacist and practice site characteristics were also collected. RESULTS The response rate was 11.8% (n = 157). Overall, pharmacists (>75%) were aware of the three criteria for targeted beneficiaries. They were confident in providing medication therapy review (MTR), creating a personal medication record (PMR), and performing intervention and referral but were only somewhat confident in creating a medication action plan. Pharmacists disagreed or were neutral about having adequate documentation systems for MTM. The majority of respondents intend to become MTM providers (74%) and were interested in additional training (78%). Independent pharmacists, those with adequate documentation systems, and those who had previously provided patient care services were more confident regarding MTM provision. CONCLUSION Pharmacist intentions to provide MTM indicate that they are eager to expand their roles as patient care providers. Pharmacist confidence in providing MTR, creating a PMR, and performing the intervention and referral suggest that pharmacists already have many of the skills necessary to provide MTM; however, more education about creating action plans and using documentation systems may help pharmacists become successful MTM providers.

Outcomes of a Medicare Part D telephone medication therapy management program

BACKGROUND Many hospitals have implemented antimicrobial stewardship programs (ASPs) and have included in their programs strategies such as prior authorization and audit and feedback. However there are few data concerning the facilitators and barriers that ASPs face when implementing their strategies. We conducted a qualitative study to discern factors that lead to successful uptake of ASP strategies. METHODS Semistructured telephone interviews were conducted from June-July 2013 with 15 ASP member pharmacists and 6 physicians representing 21 unique academic medical centers. RESULTS Successful implementation of ASP strategies was found to be related to communication style, types of relationships formed between the ASP and non-ASP personnel, and conflict management. Success was also influenced by the availability of resources in the form of adequate personnel, health information technology personnel and infrastructure, and the ability to generate and analyze ASP-specific data. Types of effective strategies commonly cited included audit and feedback; prior authorization, especially with an educative component; and use of real-time alert technology and guidelines. CONCLUSIONS Several factors may influence ASP success in the implementation of their strategies. ASP members may use these findings to improve upon the success of their programs.

Preparation of Faculty Members and Students to Be Citizen Leaders and Pharmacy Advocates

PURPOSE A pharmacist-provided telephone medication therapy management (MTM) program for Medicare beneficiaries is discussed. SUMMARY The Medicare Modernization Act of 2003 requires the provision of MTM to eligible beneficiaries. Using an MTM framework as a guide, Scott & White Health Plan (SWHP), a regional Medicare Part D plan, developed and implemented a pharmacist-provided telephone MTM service for Medicare beneficiaries. A clinical pharmacist, practicing pharmacists, and physicians at SWHP were responsible for developing the MTM program. The MTM coordinator, who was also a pharmacist, worked with an information systems programmer to develop a custom-built database to support the documentation needs. Patients who were identified by SWHP as eligible to receive MTM services were mailed an MTM program information brochure each quarter. The brochure, which was sent out in two-week increments to manage the call volume, described the program and invited patients to participate. Interested patients were instructed to call SWHP to enroll in the MTM program. The medication therapy review, a core component of MTM, consisted of two steps: preassessment and assessment. Problems identified during the preassessment were confirmed or disproved, and during the assessment, medication-related problems were assessed. After the consultation, patients were mailed a portable personal medication record to use to fill out their medication lists. They also received a medication action plan that was tailored to each individual patient. The pharmacist provided consulting services and intervened to address medication- and health-related problems and to refer the patient to other health care providers if needed. CONCLUSION A regional health plan successfully developed and implemented a telephone MTM service for Medicare beneficiaries provided and managed by pharmacists.

Educating Pharmacy Students to Improve Quality (EPIQ) in colleges and schools of pharmacy.

OBJECTIVE To determine the impact of telephone medication therapy management (MTM) on medication- and health-related problems (MHRPs), medication adherence, and total drug costs for Medicare Part D participants. DESIGN Quasiexperimental. SETTING Regional Medicare Part D plan in Texas in 2007. PARTICIPANTS Medicare Part D beneficiaries who were MTM eligible. INTERVENTION Pharmacist-provided telephone MTM consultation. MAIN OUTCOME MEASURES Change in MHRPs, medication adherence, and total drug costs from baseline to 12-month follow-up. RESULTS The intervention (n = 60) and control (n = 60) groups were similar in age (71.2 ± 7.5 years and 73.9 ± 8.0 years [mean ± SD], respectively), number of medications (13.0 ± 3.2 and 13.2 ± 3.4), chronic diseases (6.5 ± 2.3 and 7.0 ± 2.1), and medication regimen complexity index (21.5 ± 7.8 and 22.8 ± 6.9). Men made up 51% of the intervention group and 28% of the control group ( P = 0.009). MHRPs at baseline were 4.8 ± 2.7 in the intervention group and 9.2 ± 2.9 in the control group, with 2.2 ± 2.0 and 7.3 ± 3.0 at the 12-month follow-up. MHRPs decreased ( P = 0.01) in the intervention group. We found no predictors of change in medication adherence. Drug costs decreased by

Fecal microbiota transplantation for recurrent Clostridium difficile infection: The patient experience

682 ± 2,141 in the intervention group and increased by

Pharmacy Practice in Virginia in 2011

119 ± 1,763 in the control group. A t test indicated that the cost difference was significant ( P = 0.03), but the adjusted regression analysis did not identify any significant predictors. CONCLUSION A telephone MTM program reduced MHRPs. Unadjusted cost comparisons showed cost savings in the intervention group. Future research should focus on understanding how telephone MTM affects medication adherence.