Examination of MTM Opportunities in Pediatric Behavioral Health

Abstract

HealthWe performed a retrospective and exploratory chart review, based on a convenience sample, to assess the need for medication-related services in a primarily child and adolescent, nonMedicare population served by a private, ambulatory behavioral center providing primarily outpatient psychiatry, psychotherapy, and partial hospitalization services. We (a) collected demographic data; (b) defined eligibility for a potential MTM program for this patient population based on criteria that were derived from CMS, facility stakeholders, and pharmacist specialists; and (c) identified existing aspects of sound MTM that could potentially be applied to the sample. CMS criteria were adapted to define eligibility for MTM: (a) the presence of at least 1 psychiatric (Axis I) and 1 nonpsychiatric medical condition (Axis III) as the minimal criterion for the existence of multiple chronic conditions, and (b) multiple medications (4 or more, in this instance). Facility stakeholders had particular concern for monitoring medications consistent with Joint Commission medication management standards for behavioral health. From this position, additional criteria for patient selection were included: medications with potential for producing tardive dykinesia and high-dose psychopharmacology (above recommended dosage ranges). Pharmacist specialist criteria were based on MRPs as categorized by routine drug regimen review and services. Potential needs as documented in the records were considered as part of fulfillment of the 3 principles of sound MTM: (a) need for medication management assistance, (b) availability of health professionals who intervene with patients and physicians to improve drug regimens, and (c) established performance outcomes measures.

Establishment of Pediatric Medication Therapy Management: A Proposed Model

“…In the Medicare population, eligibility for MTM requires (at a minimum) that beneficiaries meet the following criteria: (1) the presence of multiple chronic diseases; (2) take multiple prescription medications; and (3) incur a specified dollar amount for covered Part D drugs. Since pediatric patients are not beneficiaries of Medicare, implementation of MTM for this population has been limited [6,7]. …”

The Patient Protection and Affordable Care Act: Implications for Pediatric Pharmacy Practice

“…The study highlights the opportunity for pharmacist involvement in optimizing medication use in pediatrics. 16 Medication reconciliation is required by the Joint Commission when a patient has a transition of care across the health care continuum in an effort to prevent medication errors including duplication of therapy, omission of medications, inappropriate dosing, and drug interactions. 17 One study using a pharmacist to complete medication reconciliation in an emergency department found that nearly 80% of patients' medication histories had an omission of a dose and 25% had an omission of a specific prescribed medication.…”