Class of 2009 / OBJECTIVES: To compare the attitudes of community pharmacy managers who did and did not contract with Mirixa to provide Medicare Part D medication therapy management (MTM) services in 2006. METHODS: Design: Cross-sectional descriptive study. Setting: United States in 2006. Participants: 100 pharmacy managers contracted to provide MTM services in 2006 and 100 pharmacy managers not contracted to provide MTM services in 2006. Intervention: Telephone-administered survey of independent community pharmacy managers. Main outcome measures: Pharmacist knowledge of and attitudes toward Medicare Part D MTM services. RESULTS: 200 pharmacy managers completed the study (n = 100 for each group). Pharmacists who contracted with Mirixa to provide MTM services in 2006 were more familiar with Medicare Part D MTM (80% vs. 59%, P = 0.001). Significantly more pharmacists contracted with Mirixa to provide MTM services agreed that they were qualified to provide MTM services (96% vs. 88%, P = 0.01) and strongly agreed that an annual personal medication review would benefit patient outcomes (59% vs. 45%, P = 0.04). No significant difference was found between groups with regard to other variables addressed in the survey. CONCLUSIONS: Results of this study suggest that familiarity with Medicare Part D MTM services was a key factor in whether pharmacists chose to contract to provide MTM in 2006. Additionally, significantly more pharmacists who contracted felt strongly that personal medication reviews would improve patient outcomes.

Class of 2012 Abstract / Specific Aims: To assess physician approval of the MTM services provided. Specifically, to compare cost saving, guideline adherence, and safety concern interventions. Methods: A retrospective analysis of pharmacist interventions was performed using the MMC database for 2008. Data were collected on the type of intervention and approval by physicians. Physician specialty was also collected from state medical boards. Descriptive statistics were used to generate frequencies of approvals. Chi-square tests were used to compare physician approval by intervention type. Main Results: Pharmacists initiated 1,563 interventions that were faxed to physicians for approval. Of these interventions, cost saving, guideline adherence, and safety concerns were 33.2, 58.3, and 8.5 percent, respectively. Interventions primarily targeted diabetes (38.6%), cardiovascular disease (28.8%), gastroesophageal reflux disease (13.1%), and respiratory disease (8.4%). Physician approval for cost saving, guideline adherence, and safety concerns were 58.0, 44.4, and 41.0 percent, respectively. Approval for cost saving was greater than guideline adherence (58.0% versus 41.0%, P<0.001) and safety concerns (58.0% versus 44.4%, P=0.005). Approval among primary care physicians (PCP) compared to specialty physicians was greater for both cost saving (60.6% versus 50.7%, P=0.046) and guideline adherence (43.2% versus 36.2%, P=0.045) interventions. Conclusions: Results of this investigation provide evidence that there are differences in the types of MTM interventions that physicians will approve. In an effort to improve patient outcomes, this finding suggests a potential to increase overall physician approval of pharmacist-initiated MTM interventions in the areas of guideline adherence and safety concerns. Results further suggest that lower approval by specialists compared to PCPs may call for alternative methods to better reach these providers.

Class of 2008 Abstract / Objectives: The purpose of this study was to identify how community pharmacies have integrated medication therapy management (MTM) programs into their workflow and specifically determine the changes that were made in order to deliver such services. Methods: This was a descriptive study on the implementation of MTM programs in community pharmacies. Pharmacy managers associated with Cardinal Health, Medicine Shoppe International, United Drugs, the Iowa Pharmacy Association (IPA) and 10 additional selected pharmacists were invited to take an online survey regarding MTM program implementation in their pharmacy. Exclusion criteria were those pharmacists that did not provide any MTM services from January 2006 through December 2007. The primary dependent variables included time spent training, time to complete clinical pharmacy program sessions, scheduling and implementing clinical pharmacy sessions, staffing, and cost for additional equipment. Data analysis included percents and frequencies for categorical variables addressed in the internet survey. Results: Pharmacists that participated in this survey were mostly male (82%) and had been practicing for greater than 10 years. Only 3 out of 17 participants were female and all were a part of the group practicing for less than 10 years. The majority of participants in both groups completed 0-2 MTM sessions per week (p=0.65). In order to complete these sessions, the hiring of additional staff was not required (82%) nor was the purchase of additional equipment (70%). Conclusions: The implementation of MTM programs in community pharmacies requires little to no additional time or money. With this data, more pharmacists should be inclined to provide MTM sessions.

No description available.

Class of 2015 Abstract / Objectives: Quantify how many interventions were made during a pilot MTM program at a Costco pharmacy and assess patients’ attitudes towards MTM services offered at their local pharmacy. Methods: Contacted patients by phone and offered MTM services over 10 weeks. The patients are insured patients referred by Outcomes MTM and filled at least 50% of medications at Costco. Successful interventions were tallied and questionnaires administered to collect data on patients’ background knowledge of MTM, rating of how helpful and beneficial MTM services conducted by local pharmacy were, how frequent patients would like such services, how much they were willing to pay for such services, and demographic information. Results: Due to low response rate no meaningful statistical differences were able to be observed. However interesting trends started to emerge; more adherence related interventions, adequate compensation for a dedicated MTM pharmacist, and that MTM is unknown to most patients but do find it useful. Additionally we were able to observe challenges and difficulties with implementing MTM services at a store level. Conclusions: The original aim of the study was not able to be adequately achieved due to low response rate. However the trends that emerged let us make some subjective conclusions; adherence related interventions were fairly common, a dedicated MTM pharmacist may be a feasible in a community setting, most patients are unaware of what MTM is but do find it useful after the service, and challenges to implementing an MTM service from the store level.

Class of 2015 Abstract / Objectives: To compare provider acceptance rates of medication therapy management (MTM) interventions initiated by a MTM center for potential drug-related problems in 2012. Interventions included cost-savings to patients, adherence to clinical guidelines, medication adherence, and safety initiatives. Methods: This retrospective cross-sectional project measured the provider acceptance rates of MTM interventions for Medicare Part D beneficiaries. Intervention count and acceptance rates were analyzed from the center’s MTM software and database that utilizes prescription claims analysis post-intervention to determine intervention success. A chi-square test was used to assess the statistical significance between the interventions. An alpha level of 0.5 was determined a-priori. This was a quality improvement project, and Institutional Review Board approved this project as exempt status. Results: The total percent of recommendations accepted was 35% (159,795 out of 455,898). The rate of acceptance was highest for safety interventions (51%), followed by cost (35%), adherence (12%), and guidelines (8%). The acceptance rates for the four intervention types were statistically different from each other (p-value <0.0001). Within each intervention type, the most frequently accepted interventions were: removal of medications from the Beer’s Criteria (8% of safety related changes); changes from a brand name, non-oral medication like eye drops and nasal sprays, to a generic within the same class (15% of cost-saving related changes); improved adherence to hypertension and diabetic medications (29% of adherence related changes); and adding an antihypertensive agent to diabetic patients (62% of clinical guideline related changes). Conclusions: Safety initiatives had the highest acceptance percentage of all four intervention types. Approving more safety interventions with medication use may reduce the risk of morbidity and mortality. Pharmacists providing MTM services may want to increase focus on drug safety as providers are accepting more safety interventions. More research is needed to determine why providers approve the other recommendations at lower rates.

Objective: This study was designed to better understand perceived barriers and facilitators to providing medication therapy management (MTM) services by pharmacists who recently provided telephonic MTM services to home health care patients. These services were provided as part of a randomized, controlled trial (RCT) to develop suggested quality improvement strategies for future service design. Design: This was a qualitative study. A semi-structured individual interview format was used to elicit responses. Setting: Interviews were conducted by phone with participants. Participants: All pharmacists who recently provided telephonic MTM services as a part of an RCT participated in this study. Interventions: Pharmacists were asked questions regarding their perceptions of the services, training opportunities, patient perceptions of the services, interactions with physicians, and suggestions for improvement. General demographic information was collected for each pharmacist and summarized using descriptive statistics. Interview data were analyzed using inductive qualitative methods to reveal key themes related to facilitators and barriers of MTM services in home health care patients. Main Outcome Measures: The main outcome measures were major themes identified from pharmacist interviews pertaining to barriers, facilitators, and quality improvement strategies for telephonic MTM delivery. Results: A total of four pharmacists (i.e., 100% of those who participated in the prior RCT) were interviewed. Several themes emerged from the analysis, including: communication and relationships, coordinating care and patient self-management, logistics, professional fulfillment, service delivery and content, and training opportunities. Conclusions: This study provides possible strategies to overcome barriers and facilitate service provision for future telephonic MTM services.

No description available.

This retrospective study was conducted to examine the impact of third-year pharmacy students’ provision of medication therapy management (MTM) on medication and health-related outcomes of patients in community pharmacies. The study objectives were as follows: 1) describe patients’ socio-demographic and clinical characteristics; 2) describe the number and types of medication and health-related problems (MHRPs) identified by students, as well as students’ MTM interventions and recommendations; 3) describe medical provider/patient MTM recommendation acceptance rates; and 4) determine which factors (i.e., baseline MHRPs, medical conditions, prescription medications, over-the-counter (OTC) medications and herbal supplements, number of medical prescribers, MTM interventions, and MTM recommendations) were related to the number of MHRPs resolved. The study used data (MTM cases) from a required MTM course, taught at The University of Texas at Austin College of Pharmacy. The study included MTM cases provided by third-year pharmacy students enrolled in the Fall 2011 semester. MTM cases that were complete, unduplicated, and had patients aged ≥ 18 years were included the study. Descriptive statistics were used to address the first three study objectives. Multivariate linear regression was used to determine which factors were related to the number of MHRPs resolved. Out of the total number of MTM cases, 274 met the study inclusion criteria and served as the study’s final sample. The patients’ average age was 63.8 (±14.5), and the majority were female (60.4%) and Caucasian (53.2%). Almost one-third of the patients (30.7%) drank alcohol. The mean number of medical conditions and prescription medications was 6.0 (±2.7) and 9.0 (±4.0), respectively. Pharmacy students identified 1,370 MHRPs [935 medication-related problems (MRPs) and 435 health-related problems (HRPs)] and recommended 1,004 medication and health-related recommendations (MHRRs) [542 medication-related recommendations and 462 health- related recommendations]. Medical providers and/or patients accepted recommendations regarding drug discontinuation (34.8%) and OTC and herbal supplements (28.9%) at higher rates than other recommendations. Regarding the regression, the overall model was statistically significant, F=76.88, df=7, 240, p<0.001, and baseline MHRPs (β=0.127, t=2.09, p=0.04) and MTM recommendations (β =0.715, t=11.37, p<0.0001) were significantly related to MHRPs resolved. In conclusion, pharmacy students had a positive impact on patients’ medication and health-related outcomes through identifying MHRPs and providing MTM recommendations. The significant positive relationship between the number of MTM recommendations and MHRPs resolved should encourage pharmacists and pharmacy students to be more eager to provide MTM recommendations, given the evidence that they will lead to improving patients’ medication and health-related outcomes. / text

Class of 2015 Abstract / Objectives: To determine whether comprehensive medication reviews (CMRs) or non-CMR interventions following targeted medication reviews (TMRs) resulted in more positive medication changes. A CMR is a structured medication management session that includes a full review of an individual’s medical and medication records. Non-CMR interventions are more targeted problem-based interventions that include shorter medication management sessions, written patient outreach, and direct to provider interventions. Methods: This cross-sectional quality improvement project compared the number of individuals with positive medication changes who received a CMR to those with positive medication changes who did not receive a CMR (non-CMR). Individuals were included in this project if they qualified for the Medication Management Center’s (MMC) pharmacist-driven medication therapy management (MTM) program and received their medication review(s) in 2012 or 2013. The addition of an appropriate medication or the removal of an inappropriate medication was considered a positive medication change within 120 days of intervention. Odds ratios were calculated using Wilcoxon Rank Sum. Results: A total of 418,649 participants in 2012 and 370,107 in 2013 had their medications reviewed as part of the MTM program. The non-CMR group accounted for the majority of the interventions (375,159 for non-CMR versus 43,490 for CMR in 2012 and 332,006 versus 38,101 for 2013). Significantly more positive medication changes were achieved in the non-CMR group (n=88,467 for 2012 and n=54,971 for 2013) following the medication review compared to the CMR group (n=9,796 for 2012 and n=7,034 for 2013). CMR recipients were more likely to receive a recommendation (odds ratio 0.70, 95% confidence interval 0.69-0.72 for 2012 and odds ratio 0.62, 95% confidence interval 0.60-0.63 for 2013). Non-CMR recipients were more likely to have a recommendation result in a medication change (odds ratio 1.24, 95% confidence interval 1.21-1.28 for 2012 and 1.26, 95% confidence interval 1.22-1.30 for 2013). Conclusions: While the percentage of participants who received a recommendation in the non-CMR group was lower, a greater percentage of these participants received a medication change. This indicates that non-CMR interventions following TMRs may be more effective in producing a positive medication change compared to CMRs.