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.

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.

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.