Medication therapy problems identified by pharmacists conducting telephonic comprehensive medication management within a team‐based at‐home care program

Abstract

IntroductionComprehensive Medication Management (CMM) is a collaborative patient‐centered approach to medication optimization. We recently implemented telephonic CMM as part of a multidisciplinary team within a team‐based at‐home care program. The objective of this study was to describe the type and frequency of medication therapy problems (MTPs) identified by pharmacists delivering CMM as part of this program, as well as the acceptance rates of the recommendations made to rectify them.MethodsWe conducted a retrospective chart review of all patients receiving CMM within the program between December 12, 2018 and December 31, 2019. We identified and classified MTPs based on the framework developed by the Pharmacy Quality Alliance. Descriptive statistics were used to determine the quantity of MTPs, as well as the acceptance rates of the recommendations.ResultsWe identified 307 patients who received CMM. Of these patients, 58% were female (178/307) and 96% identified as White (296/307). Average age was 72 years old (SD 13). On average, pharmacists identified 4 MTPs/patient with a 35% acceptance rate (431/1228) for their recommendations. Of those accepted, pharmacists were able to resolve 185 (43%) of these MTPs on their own while providers resolved the remaining 246 (57%) MTPs. Acceptance of MTPs was more likely if patients were spoken to (38.4% vs 29.5%, relative risk [RR] = 1.30, 95% CI 1.10‐1.54, P = .002).ConclusionsPharmacists were able to identify several MTPs when conducting telephonic CMM within a team‐based at‐home care program. These MTPs and their associated recommendations however, often failed to be resolved. Recommendations were more likely to be resolved if patients were spoken to, highlighting the importance of engaging the patient as part of CMM. Future studies should examine ways to improve intervention acceptance as well as the clinical and economic impact of changes made as a result of telephonic CMM and MTP identification.

Comprehensive medication management services provided via telehealth or hybrid models: A scoping review

“…All studies included a pharmacist and a provider on their team conducting the interventions 23‐33 . The number of interprofessional team members delivering CMM varied from two to five members.…”

“…Pharmacists made recommended medication changes in real‐time using collaborative practice agreements in seven studies 24,27‐30,32,33 and made real‐time recommendations to the provider in four studies 23,25,26,31 . Six studies studied interventions that used telehealth to reach patients 24,26,27,31‐33 whereas five studied interventions using a hybrid model (combination of telehealth and face‐to‐face delivery) of care 23,25,28‐30 . Seven studies offered audio‐only telephone outreach, 23,24,26,28‐31,33 four used two‐way audio–video connections, 25,27,31,32 and one also used secure text messaging (Table 2).…”

“…The overall risk of bias was moderate for six of the observational studies, 26,27,29,31‐33 and low in the remaining three (Table 3). 25,28,30 The most common cause for moderate or high bias was due to the measurement of outcomes 24,29,21‐33 …”

“…One retrospective cohort study examined telephonic CMM patients compared with electronic‐only medication reviews without patient contact (not CMM) 29 . The study found no change in safety‐related MRPs via telephone (telephone = 49.5% patients vs. electronic review = 42.1% patients, p = 0.15) and more adherence‐related or cost‐related MRPs identified (7.2% vs. 3.6% patients, p = 0.015) but fewer indication MRPs identified (37.2% vs. 46.8%, p = 0.001) 29 .…”

“…One retrospective cohort study examined telephonic CMM patients compared with electronic‐only medication reviews without patient contact (not CMM) 29 . The study found no change in safety‐related MRPs via telephone (telephone = 49.5% patients vs. electronic review = 42.1% patients, p = 0.15) and more adherence‐related or cost‐related MRPs identified (7.2% vs. 3.6% patients, p = 0.015) but fewer indication MRPs identified (37.2% vs. 46.8%, p = 0.001) 29 . A descriptive report of a video CMM service in an epilepsy clinic identified drug–disease interactions in 32.7% of participants, ≥1 drug–drug interaction in 54.2%, adverse drug reactions in 36.9%, dose‐related safety concerns in 35.1%, and a therapeutic duplication in 13.9%, and all of these were addressed by the team pharmacist via recommendations to the provider, real‐time changes, or patient counseling 25 .…”