Medication Therapy Management Interventions in Outpatient Settings

Viswanathan, Meera; Kahwati, Leila C.; Golin, Carol E.; Blalock, Susan J.; Coker-Schwimmer, Emmanuel; Posey, Rachael; Lohr, Kathleen N

doi:10.1001/jamainternmed.2014.5841

Cited by 301 publications

(269 citation statements)

References 70 publications

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“…Potential barriers to adherence among older adults can be classified into 3 categories: (1) patient‐related factors, including sociodemographics, psychosocial factors, comorbidities, cognitive ability, and health beliefs; (2) medication‐related factors, including the number of medications taken, adverse side effects, and complex medication regimens; and (3) other factors, including the patient‐prescriber relationship, access to medication and cost, and social support 6, 46. Many randomized, control trials and observational studies have evaluated interventions among patients and healthcare professionals to improve adherence 47, 48, 49, 50. Interventions range from those that are patient focused and promote behavioral and educational change, clinician‐directed strategies, to multifaceted programs combining several adherence‐enhancing strategies.…”

Section: Discussionmentioning

confidence: 99%

“…Interventions range from those that are patient focused and promote behavioral and educational change, clinician‐directed strategies, to multifaceted programs combining several adherence‐enhancing strategies. Some study suggested that pharmacist‐led hypertension management for systolic blood pressure significantly improved medication adherence and improved CVD outcome,50 and the interventions aimed at improving patients' knowledge of their health conditions, reasons for medication use, and better understanding of the long‐term risk of hypertension are of potential clinical value in improving antihypertensive adherence 47. The Million Hearts initiative brings together communities, health systems, nonprofit organizations, federal agencies, and private‐sector partners from across the country with the ambitious goal of preventing 1 million heart attacks and strokes over the course of 5 years 51.…”

Section: Discussionmentioning

confidence: 99%

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Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population‐Based Cohort Study

Yang

Chang

Ritchey

et al. 2017

JAHA

102

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BackgroundAntihypertension medication (antihypertensive) adherence lowers risk of cardiovascular disease (CVD); few studies have examined this association among older adults.Methods and ResultsWe assessed this association among Medicare fee‐for‐service beneficiaries aged 66 to 79 years who were newly diagnosed with hypertension and initiated on antihypertensives in 2008–2009 (n=155 597). We calculated proportion of days covered (PDC) during follow‐up, using proportional subdistribution hazard models, to examine association between antihypertensive adherence and a composite CVD outcomes, including first incident of fatal/nonfatal acute myocardial infarction, ischemic heart disease, stroke/transient ischemic attack, and heart failure. During follow‐up (median 5.8 years and 798 621 person‐years), we documented 47 198 CVD events. Among beneficiaries, 60.8%, 30.3%, and 8.9% had PDC ≥80%, 40% to 79%, and <40%. Crude incidence of CVD events were 40.1 (95% CI, 40.0–40.1), 93.9 (93.8–93.9), and 98.1 (98.1–98.2) per 1000 person‐years for PDC ≥80%, 40% to 79%, and <40%, respectively. Adjusted hazard ratios for CVD events were 1.0 (<40% as reference), 1.0 (0.97–1.03) for 40% to 79%, and 0.44 (0.42–0.45) for ≥80% (P<0.001). Dose‐response analysis suggested a nonlinear relationship between PDC and risk for CVD events with a protective effect of ≥80%. The pattern of associations between PDC and ischemic heart disease, stroke/transient ischemic attack, and heart failure were largely consistent as for CVD events and across different groups.ConclusionsAntihypertensive adherence was associated with a significantly lower risk of CVD events among older adults. There appeared to be a threshold effect in reducing CVD events at around PDC 80%, above which the risk for CVD reduced substantially.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population‐Based Cohort Study

Yang

Chang

Ritchey

et al. 2017

JAHA

102

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“…Peer-reviewed, published evidence demonstrates the potential clinical and economic benefits of medication optimization in primary care, but data are inconsistent and often fraught with limitations [4][5][6][7]. This is largely due to variations in study design, inconsistent definitions and delivery of the intervention, use of inconsistent outcome metrics, and lack of a sustainable Urick sidebar payment model.…”

Section: Optimizing Medication Use In Primary Carementioning

confidence: 99%

“…Pharmacists have taken on greater responsibilities in both inpatient and outpatient settings, and the value of their contributions to the health care team has increasingly been recognized and documented [4][5][6][7]. The scope of services delivered by pharmacists and the settings in which this care is delivered are projected to increase as the health care system shifts toward the delivery of value-based models of health care.…”

mentioning

confidence: 99%

The North Carolina Experiment

Farley

Ferreri

Easter

et al. 2017

North Carolina Medical Journal

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Improving the quality of health care requires innovative approaches to addressing the misuse, overuse, and underuse of medication in the United States. Strategies must be patient-centered, collaborative, and aligned with the move toward value-based care. We highlight research in North Carolina aimed at achieving these goals. One of the greatest barriers to improving the quality of health care in the United States is the misuse, underuse, and overuse of medications. According to the most recent National Health Expenditure Data, prescription drug spending accounts for 10% of total health care expenditures, with medication spending comprising $325 billion of the $3.2 trillion spent on overall US health care in 2015 [1]. Most surprising is that health care costs attributed to the improper and unnecessary use of medicines approach nearly $300 billion, suggesting that for every dollar spent on drugs, nearly an additional dollar is spent addressing a medication misadventure [2,3].Given the burden of inappropriate medication use, there is no question that optimizing medication use is a critical component of care that must be addressed in order to improve national health care. The Center for Medication Optimization through Practice and Policy at the UNC Eshelman School of Pharmacy defines medication optimization as a patient-centered, collaborative approach to managing medication therapy that is applied consistently and holistically across care settings to improve patient care and reduce overall health care costs. Medication optimization may be addressed in different pharmacy settings. This includes the community pharmacy setting, where patients obtain their medications from pharmacies, as well as the ambulatory setting, where patients see providers who may dispense medications. Differences in the care settings in which medication optimization is addressed are important to consider when implementing programs to improve medication use in patients.With specialized education and experiential training in the pharmaceutical sciences and in evidence-based pharmacotherapy, pharmacists are well-positioned to serve as integral members of the health care team, assuming responsibility for the optimal use of medications. Pharmacists have taken on greater responsibilities in both inpatient and outpatient settings, and the value of their contributions to the health care team has increasingly been recognized and documented [4][5][6][7]. The scope of services delivered by pharmacists and the settings in which this care is delivered are projected to increase as the health care system shifts toward the delivery of value-based models of health care. Given the importance of optimal medication use as an essential component of quality health care, the need to proactively access and manage medication use, especially for patients with multiple chronic conditions, becomes important. Increasingly, value-based contracts in both public (Medicare and Medicaid) and commercially-based health plans utilize measures of appropriate medication use in thei...

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“…1 The largest national reimbursable, economically viable and scalable MTM program in the US has been administered by the Centers for Medicare and Medicaid Services (CMS) under the prescription drug benefit (Part D). Both privately administered prescription drug plans (PDPs) and Medicare Advantage plans (MA-PDs) are required by CMS to offer two levels of MTM referred to as comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) to certain beneficiaries at high risk for medication-related problems.…”

Section: Introductionmentioning

confidence: 99%

Student Perceptions of the Pharmacist’s Approach Across the Varying Levels of Medication Therapy Management Services

Spivey

Collier

Chisholm-Burns

2018

American Journal of Pharmaceutical Education

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Objective. To explore third-year pharmacy (P3) student perceptions of medication therapy management (MTM) after an introduction to the various levels of MTM services within an MTM course. Methods. A qualitative survey was conducted of 158 P3 students. Open-ended questions were used to explore students' thoughts, feelings, and perceptions related to the pharmacist's approach in MTM following a lecture establishing differences in roles and responsibilities between the varying levels of MTM. Emphasis was placed on the pharmacist's role when providing comprehensive medication management (CMM). CMM is a higher-level direct patient care service with a whole-patient focus that goes beyond medication or disease specific focuses of either a comprehensive medication review (CMR) or targeted medication review (TMR). Thematic analysis was performed and an inductive approach to data analysis was used. Results. The following five themes were identified: misperceptions entering the course, efficient delivery of MTM depends on understanding the differences between services, doctor of pharmacy education is a factor in confused MTM role expectations, role limitations exist and referrals to other providers, and the CMR meets unmet needs. Conclusion. Students noted initial confusion between their roles and responsibilities during a CMM versus a CMR. Pharmacy educators should address the varying roles and responsibility differences across MTM services within their curriculum.

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Medication Therapy Management Interventions in Outpatient Settings

Abstract: IMPORTANCE Medication therapy management (MTM) services (also called clinical pharmacy services) aim to reduce medication-related problems and their downstream outcomes.OBJECTIVE To assess the effect of MTM interventions among outpatients with chronic illnesses.

Cited by 301 publications

References 70 publications

Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population‐Based Cohort Study

Antihypertensive Medication Adherence and Risk of Cardiovascular Disease Among Older Adults: A Population‐Based Cohort Study

The North Carolina Experiment

Student Perceptions of the Pharmacist’s Approach Across the Varying Levels of Medication Therapy Management Services

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