Medication therapy management

Last updated

Medication therapy management, generally called medicine use review in the United Kingdom, is a service provided typically by pharmacists, medical affairs, and RWE scientists that aims to improve outcomes by helping people to better understand their health conditions and the medications used to manage them. [1] This includes providing education on the disease state and medications used to treat the disease state, ensuring that medicines are taken correctly, reducing waste due to unused medicines, looking for any side effects, and providing education on how to manage any side effects. [2] [3] The process that can be broken down into five steps: medication therapy review, personal medication record, medication-related action plan, intervention and or referral, and documentation and follow-up. [4] [5]

Contents

The medication therapy review has the pharmacist review all of the prescribed medications, any over the counter medications, and all dietary supplements an individual is taking. This allows the pharmacist to look for any duplications or dangerous drug interactions. [6] [7] This service can be especially valuable for people who are older, have several chronic conditions, take multiple medications, or are seen by multiple doctors. [8] [4] [5]

Effectiveness

The goal of medication review is to improve health and reduce morbidity and mortality in patients by optimizing the use of their current medications. [3] Different hospital institutions and countries have different policies or approaches to medication review for their inpatients. [3] The effectiveness of a formal medication review program in people who are hospitalized has not been well studied. [3] There is some evidence that a medication review program reduces the number of people re-admitted to hospital and also may decrease the number of times they return to the emergency department. [3] The effects on morbidity and any improvements on the quality of a person's life are not clear. [3]

United States

In 2014, the US Centers for Medicare and Medicaid Services required Part D plans to include an MTM program, [9] which led to an expansion of services offered. [10] MTM services are provided free to eligible patients enrolled in a plan. As of 2019, to be eligible a patient must have at least two (or three, for some plans) chronic conditions, take multiple drugs covered by Part D, and are predicted to exceed a preset amount in annual out of pocket costs for their covered Part D drugs (set at $3,967 in 2018 and $4,044 in 2019). [11] [12] Plans are permitted to expand MTM eligibility to patients not meeting the minimum required criteria if they so choose. [11]

Comprehensive medication review

As part of the minimum required services, plans must provide for a comprehensive medication review (CMR) once per year, usually conducted by a pharmacist. Per CMS guidance, the goal of the CMR is to "improve patients’ knowledge of their prescriptions, over-the-counter (OTC) medications, herbal therapies and dietary supplements, identify and address problems or concerns that patients may have, and empower patients to self manage their medications and their health conditions." [11] The CMR is conducted in an interactive manner either in person or through telehealth. A pharmacist or other provider conducting a CMR will use information from various sources, such as the pharmacy fill records, the patient's pill bottles, a patient interview, and/or discussion with caregivers to identify potential improvements that can be made in the patient's therapy. [13] The pharmacist will then make any appropriate recommendations to the patient's doctor, as well as document their findings in a format similar to a SOAP note. [13] The patient must be provided a medication action plan with a list of their medications, directions, and any steps they need to take to improve their therapy (such as using reminders, organizing, stopping old medications, etc). [13] Most comprehensive medication reviews result in pharmacist intervention to recommend changes to therapy to a doctor, and/or recommendations to the patient to improve adherence/efficacy of their medications. [14] [15]

Targeted medication review

A targeted medication review (TMR, also called targeted intervention program or TIP) is a required service for eligible patients that focuses on a specific medication or disease state and is conducted once every three months. [11] The goal of a TMR program is to improve adherence to medication and identify and fix drug therapy problems common in chronic diseases such as nonadherence, duplicate therapy, or sub-optimal therapy. [13] The pharmacist or provider will contact the patient to ensure adherence, identify potential problems with the therapy, and make any appropriate recommendations to the prescriber. The provision of TMR services to patients with chronic diseases has been shown to decrease the number of inpatient admissions per 1000 patients by about 50 admissions per 1000 patients. [13]

United Kingdom

A medicine use review (MUR) is an advanced service offered by pharmacies in the United Kingdom. It is part of the current contract pharmacies hold with the National Health Service (NHS). An MUR is an opportunity for patients to discuss their medicines with a qualified pharmacist. An MUR is a free NHS service that is held in a private consultation room at a local pharmacy. It is not meant to replace the role of the general practitioner but rather provide:

Pharmacies in the United kingdom are paid £28 for each Medicines Use Review undertaken, up to a maximum of 400 per pharmacy, per year. At least 70% of patients must be in one of the four target groups:

The introduction of pharmacists into GP surgeries means that the practice pharmacists can do more to ensure that reviews are carried out where necessary. [17]

Abuse of system

There have been concerns over abuse of the system, whereby multiple pharmacies are using the system to charge the £28 fee for each 10- to 15-minute MUR, and pressuring pharmacists to meet targets for the number carried out, with the review more of a tick-box exercise than a benefit for the patient. There have also been cases of falsification of figures. [18]

Research

The effectiveness of a medication review program for elderly people who require multiple medications (polypharmacy) is not clear and more research is needed to understand how to optimize medications in elderly inpatients. [19]

See also

Related Research Articles

<span class="mw-page-title-main">Pharmacist</span> Healthcare professional

A pharmacist, also known as a chemist in Commonwealth English, is a healthcare professional who is knowledgeable about preparation, mechanism of action, clinical usage and legislation of medications in order to dispense them safely to the public and to provide consultancy services. A pharmacist also often serves as a primary care provider in the community and offers services, such as health screenings and immunizations.

<span class="mw-page-title-main">Pharmacy</span> Clinical health science

Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links health sciences with pharmaceutical sciences and natural sciences. The professional practice is becoming more clinically oriented as most of the drugs are now manufactured by pharmaceutical industries. Based on the setting, pharmacy practice is either classified as community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies is considered clinical pharmacy.

<span class="mw-page-title-main">Pain management</span> Interdisciplinary approach for easing pain

Pain management is an aspect of medicine and health care involving relief of pain in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals provide some pain control in the normal course of their practice, and for the more complex instances of pain, they also call on additional help from a specific medical specialty devoted to pain, which is called pain medicine.

<span class="mw-page-title-main">Geriatrics</span> Specialty that focuses on health care of elderly people

Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of the elderly. The term geriatrics originates from the Greek γέρων geron meaning "old man", and ιατρός iatros meaning "healer". It aims to promote health by preventing, diagnosing and treating disease in older adults. There is no defined age at which patients may be under the care of a geriatrician, or geriatric physician, a physician who specializes in the care of older people. Rather, this decision is guided by individual patient need and the caregiving structures available to them. This care may benefit those who are managing multiple chronic conditions or experiencing significant age-related complications that threaten quality of daily life. Geriatric care may be indicated if caregiving responsibilities become increasingly stressful or medically complex for family and caregivers to manage independently.

<span class="mw-page-title-main">Polypharmacy</span> Use of five or more medications daily

Polypharmacy (polypragmasia) is an umbrella term to describe the simultaneous use of multiple medicines by a patient for their conditions. The term polypharmacy is often defined as regularly taking five or more medicines but there is no standard definition and the term has also been used in the context of when a person is prescribed 2 or more medications at the same time. Polypharmacy may be the consequence of having multiple long-term conditions, also known as multimorbidity and is more common in people who are older. In some cases, an excessive number of medications at the same time is worrisome, especially for people who are older with many chronic health conditions, because this increases the risk of an adverse event in that population. In many cases, polypharmacy cannot be avoided, but 'appropriate polypharmacy' practices are encouraged to decrease the risk of adverse effects. Appropriate polypharmacy is defined as the practice of prescribing for a person who has multiple conditions or complex health needs by ensuring that medications prescribed are optimized and follow 'best evidence' practices.

In medicine, patient compliance describes the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to other situations such as medical device use, self care, self-directed exercises, or therapy sessions. Both patient and health-care provider affect compliance, and a positive physician-patient relationship is the most important factor in improving compliance. Access to care plays a role in patient adherence, whereby greater wait times to access care contributing to greater absenteeism. The cost of prescription medication also plays a major role.

An independent pharmacy is a retail pharmacy that is not directly affiliated with any chain of pharmacies and is not owned by a publicly traded company. Independent pharmacies are pharmacist-owned, privately held businesses in varying practice settings. They include single-store operations, pharmacist-owned multiple store locations, franchise, compounding, long-term care (LTC), specialty, and supermarket pharmacy operation. Independent pharmacy owners generally have more flexibility to build personalized customer relationships and they strive to differentiate their services from big-chain corporations.

Pharmacotherapy, also known as pharmacological therapy or drug therapy, is defined as medical treatment that utilizes one or more pharmaceutical drugs to improve ongoing symptoms, treat the underlying condition, or act as a prevention for other diseases (prophylaxis).

Academic detailing is "university or non-commercial-based educational outreach." The process involves face-to-face education of prescribers by trained health care professionals, typically pharmacists, physicians, or nurses. The goal of academic detailing is to improve prescribing of targeted drugs to be consistent with medical evidence from randomized controlled trials, which ultimately improves patient care and can reduce health care costs. A key component of non-commercial or university-based academic detailing programs is that they do not have any financial links to the pharmaceutical industry.

Overmedication describes the excessive use of over-the-counter or prescription medicines for a person. Overmedication can have harmful effects, such as non-adherence or interactions with multiple prescription drugs.

<span class="mw-page-title-main">Clinical pharmacy</span> Branch of pharmacy for direct provision

Clinical pharmacy is the branch of pharmacy in which clinical pharmacists provide direct patient care that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often work in collaboration with physicians, physician assistants, nurse practitioners, and other healthcare professionals. Clinical pharmacists can enter into a formal collaborative practice agreement with another healthcare provider, generally one or more physicians, that allows pharmacists to prescribe medications and order laboratory tests.

<span class="mw-page-title-main">Pharmacy (shop)</span> Shop that provides pharmaceutical drugs

A pharmacy is a premises which provides pharmaceutical drugs, among other products. At the pharmacy, a pharmacist oversees the fulfillment of medical prescriptions and is available to counsel patients about prescription and over-the-counter drugs or about health problems and wellness issues. A typical pharmacy would be in the commercial area of a community.

Pharmaceutical care is a pharmacy practice model developed in the 1990s that describes patient-centered medication management services performed by pharmacists.

Drug therapy problems (DTPs) represent the categorization and definition of clinical problems related to the use of medications or "drugs" in the field of pharmaceutical care. In the course of clinical practice, DTPs are often identified, prevented, and/or resolved by pharmacists in the course of medication therapy management, as experts on the safety and efficacy of medications, but other healthcare professionals may also manage DTPs.

An ambulatist is a licensed health care provider who specializes in the prevention, management, and care coordination of ambulatory patients with chronic diseases by using lifestyle medicine and drug therapy.

Psychiatric pharmacy, also known as mental health pharmacy, is the area of clinical pharmacy specializing in the treatment of people with psychiatric illnesses through the use of psychotropic medications. It is a branch of neuropsychiatric pharmacy, which includes neurologic pharmacy. Areas where psychiatric pharmacists are found most abundantly are in chemical dependency, developmental disabilities, long-term care facilities, adherence clinics, mental health clinics, and within the prison system. However, psychiatry and neurology are not the only areas where psychiatric pharmacists require comprehensive knowledge. They must also be proficient in clinical problem solving, interprofessionalism, and communication with understanding and empathy for the patient population they serve, as they are a sensitive group.

<span class="mw-page-title-main">Telepharmacy</span> Pharmacy care by telecommunication

Telepharmacy is the delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with a pharmacist. It is an instance of the wider phenomenon of telemedicine, as implemented in the field of pharmacy. Telepharmacy services include drug therapy monitoring, patient counseling, prior authorization and refill authorization for prescription drugs, and monitoring of formulary compliance with the aid of teleconferencing or videoconferencing. Remote dispensing of medications by automated packaging and labeling systems can also be thought of as an instance of telepharmacy. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities.

Specialty pharmacy refers to distribution channels designed to handle specialty drugs — pharmaceutical therapies that are either high cost, high complexity and/or high touch. High touch refers to higher degree of complexity in terms of distribution, administration, or patient management which drives up the cost of the drugs. In the early years specialty pharmacy providers attached "high-touch services to their overall price tags" arguing that patients who receive specialty pharmaceuticals "need high levels of ancillary and follow-up care to ensure that the drug spend is not wasted on them." An example of a specialty drug that would only be available through specialty pharmacy is interferon beta-1a (Avonex), a treatment for MS that requires a refrigerated chain of distribution and costs $17,000 a year. Some specialty pharmacies deal in pharmaceuticals that treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, H.I.V. psoriasis, inflammatory bowel disease (IBD) or Hepatitis C. "Specialty pharmacies are seen as a reliable distribution channel for expensive drugs, offering patients convenience and lower costs while maximizing insurance reimbursements from those companies that cover the drug. Patients typically pay the same co-payments whether or not their insurers cover the drug." As the market demanded specialization in drug distribution and clinical management of complex therapies, specialized pharma (SP) evolved.„ Specialty pharmacies may handle therapies that are biologics, and are injectable or infused. By 2008 the pharmacy benefit management dominated the specialty pharmacies market having acquired smaller specialty pharmacies. PBMs administer specialty pharmacies in their network and can "negotiate better prices and frequently offer a complete menu of specialty pharmaceuticals and related services to serve as an attractive 'one-stop shop' for health plans and employers."

<span class="mw-page-title-main">Collaborative practice agreement</span> Egal relationship between clinical pharmacists and collaborating physicians

A collaborative practice agreement (CPA) is a legal document in the United States that establishes a legal relationship between clinical pharmacists and collaborating physicians that allows for pharmacists to participate in collaborative drug therapy management (CDTM).

Comprehensive medication management (CMM) is the process of delivering clinical services aimed at ensuring a patient's medications (including prescribed, over-the-counter, vitamins, supplements and alternative) are individually assessed to determine that they have an appropriate reason for use, are efficacious for treating their respective medical condition or helping meet defined patient or clinical goals, are safe considering comorbidities and other medications being taken, and are able to be taken by the patient as intended without difficulty.

References

  1. ↑ "Pharmacist-Led Medication Therapy Management Innovations". AHRQ Health Care Innovations Exchange. September 9, 2016.
  2. ↑ Pellegrino, AN; Martin, MT; Tilton, JJ; Touchette, DR (2009). "Medication therapy management services: definitions and outcomes". Drugs. 69 (4): 393–406. doi:10.2165/00003495-200969040-00001. PMID   19323584. S2CID   9433253.
  3. 1 2 3 4 5 6 Bülow, Cille; Clausen, Stine Søndersted; Lundh, Andreas; Christensen, Mikkel (2023-01-23). Cochrane Effective Practice and Organisation of Care Group (ed.). "Medication review in hospitalised patients to reduce morbidity and mortality". Cochrane Database of Systematic Reviews. 2023 (1): CD008986. doi:10.1002/14651858.CD008986.pub4. PMC   9869657 . PMID   36688482.
  4. 1 2 "Medication Therapy Management in Pharmacy Practice Version 2.0" (PDF). American Pharmacists Association and National Association of Chain Drug Stores Foundation. March 2008.
  5. 1 2 "Community Pharmacists and Medication Therapy Management". Centers for Disease Control and Prevention. 18 January 2018. Retrieved 21 July 2018.
  6. ↑ "Leadership for Medication Therapy Management Version 2.0" (PDF). The American Pharmacists Association and The National Association of Chain Drug Stores Foundation. March 2008.
  7. ↑ "Medication Therapy Management Services". American Pharmacists Association. Retrieved November 20, 2018.
  8. ↑ Greer, N; Bolduc, J; Geurkink, E; Koeller, E; Rector, T; Olson, K; MacDonald, R; Wilt, TJ (October 2015). "Pharmacist-Led Chronic Disease Management: A Systematic Review of Effectiveness and Harms Compared to Usual Care [Internet]". VA Evidence-based Synthesis Program Reports. PMID   27252999.
  9. ↑ "CMS proposes requiring expansion of Part D MTM benefits". www.pharmacist.com. Retrieved 2018-11-21.
  10. ↑ Viswanathan, Meera; Kahwati, Leila C.; Golin, Carol E.; Blalock, Susan; Coker-Schwimmer, Emmanuel; Posey, Rachael; Lohr, Kathleen N. (2014). "Executive Summary". Medication Therapy Management Interventions in Outpatient Settings. Agency for Healthcare Research and Quality (US).
  11. 1 2 3 4 "Fact Sheet Summary of 2019 MTM Programs" (PDF). Center for Medicare and Medicaid Services.
  12. ↑ "Part D: Getting to Know Medication Therapy Management (MTM)" (PDF). National Council on Aging.
  13. 1 2 3 4 5 Ferries, Erin; Dye, Joseph T.; Hall, Benjamin; Ndehi, Lilian; Schwab, Phil; Vaccaro, Jamieson (June 2019). "Comparison of Medication Therapy Management Services and Their Effects on Health Care Utilization and Medication Adherence". Journal of Managed Care & Specialty Pharmacy. 25 (6): 688–695. doi: 10.18553/jmcp.2019.25.6.688 . PMC   10397886 . PMID   31134865.
  14. ↑ Rivera, Jasmine; Shcherbakova, Natalia; Vala, Christine; Capoccia, Kam (December 2019). "Community pharmacists' interventions and documentation during medication therapy management encounters delivered face-to-face versus via telephone: The devil is in the details". Research in Social and Administrative Pharmacy. 16 (10): 1447–1451. doi:10.1016/j.sapharm.2019.12.020. PMID   31889640. S2CID   209519586.
  15. ↑ Pestka, Deborah L.; Zillich, Alan J.; Coe, Antoinette B.; Farris, Karen B.; Adeoye, Omolola A.; Snyder, Margie E.; Farley, Joel F. (May 2020). "Nationwide estimates of medication therapy management delivery under the Medicare prescription drug benefit". Journal of the American Pharmacists Association. 60 (3): 456–461. doi:10.1016/j.japh.2019.12.002. PMC   10478169 . PMID   31926872. S2CID   210166800.
  16. ↑ "Medicines Use Reviews (MURs)". NHS Employers. Retrieved 7 May 2019.
  17. ↑ "Pilot sees pharmacists play greater clinical role at GP practices in Norwich". Eastern Daily Press. 6 January 2017. Retrieved 16 January 2017.
  18. ↑ "Have medicines use reviews come to represent profit over patient care?". The Pharmaceutical Journal. 2013. doi:10.1211/PJ.2013.11124150. ISSN   2053-6186.
  19. ↑ Bülow, Cille; Clausen, Stine Søndersted; Lundh, Andreas; Christensen, Mikkel (2023-01-23). Cochrane Effective Practice and Organisation of Care Group (ed.). "Medication review in hospitalised patients to reduce morbidity and mortality". Cochrane Database of Systematic Reviews. 2023 (1): CD008986. doi:10.1002/14651858.CD008986.pub4. PMC   9869657 . PMID   36688482.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.