Browsing by Subject "medication therapy management"

Now showing 1 - 6 of 6
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    Factors associated with comprehensive medication review completion rates: A national survey of community pharmacists
    (Elsevier, 2020-05) Snyder, Margie E.; Jaynes, Heather A.; Gernant, Stephanie A.; Lantaff, Wendy M.; Doucette, William R.; Hudmon, Karen Suchanek; Perkins, Susan M.; Biostatistics, School of Public Health
    Background Completion rates for medication therapy management (MTM) services have been lower than desired and the Centers for Medicare and Medicaid Services has added MTM comprehensive medication review (CMR) completion rates as a Part D plan star measure. Over half of plans utilize community pharmacists via contracts with MTM vendors. Objectives The primary objective of this survey study was to identify factors associated with the CMR completion rates of community pharmacies contracted with a national MTM vendor. Methodsl Representatives from 27,560 pharmacy locations contracted with a national MTM vendor were surveyed. The dependent variable of interest was the pharmacies' CMR completion rate. Independent variables included the pharmacy's progressiveness stratum and number of CMRs assigned by the MTM vendor during the time period, as well as self-reported data to characterize MTM facilitators, barriers, delivery strategies, staffing, selected items from a modified Assessment of Chronic Illness Care, and pharmacist/pharmacy demographics. Univariate negative binomial models were fit for each independent variable, and variables significant at p < 0.05 were entered into a multivariable model. Results Representatives from 3836 (13.9%) pharmacy locations responded; of these, 90.9% (n = 3486) responses were useable. The median CMR completion rate was 0.42. Variables remaining significant at p < 0.05 in the multivariable model included: progressiveness strata; pharmacy type; scores on the facilitators scale; responses to two potential barriers items; scores on the patient/caregiver delivery strategies sub-scale; providing MTM at multiple locations; reporting that the MTM vendor sending the survey link is the primary MTM vendor for which the respondent provides MTM; and the number of hours per week that the pharmacy is open. Conclusions Factors at the respondent (e.g., responses to facilitators scale) and pharmacy (e.g., pharmacy type) levels were associated with CMR completion rates. These findings could be used by MTM stakeholders to improve CMR completion rates.
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    Impact of passive and active promotional strategies on patient acceptance of medication therapy management services
    (Elsevier, 2015-03) Huet, Alison L.; Frail, Caitlin K.; Lake, Leslie M.; Snyder, Margie E.; Department of Medicine, IU School of Medicine
    Objectives To assess the impact of passive and active promotional strategies on patient acceptance of medication therapy management (MTM) services, and to identify reasons for patient acceptance or refusal. Methods Four promotional approaches were developed to offer MTM services to eligible patients, including letters and bag stuffers (“passive” approaches), and face-to-face offers and telephone calls (“active” approaches). Thirty pharmacies in a grocery store chain were randomized to one of the four approaches. Patient acceptance rates were compared among the four groups, and between active and passive approaches using hierarchical logistic regression techniques. Depending on their decision to accept or decline the service, patients were invited to take part in one of two brief telephone surveys. Results No significant differences were identified among the four promotional methods or between active and passive methods in the analyses. Patients’ most frequent reasons for accepting MTM services were potential cost savings, review of how the medications were working, the expert opinion of the pharmacist, and education about medications. Patients’ most frequent reasons for declining MTM services were that the participant already felt comfortable with their medications and felt their pharmacist provides these services on a regular basis. Conclusion No significant difference was found among any of the four groups or between active or passive approaches. Further research is warranted to identify strategies for improving patient engagement in MTM services.
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    Medication Management: The Macrocognitive Workflow of Older Adults With Heart Failure
    (JMIR Publications Inc., 2016-10-12) Mickelson, Robin S.; Unertl, Kim M.; Holden, Richard J.; Department of BioHealth Informatics, School of Informatics and Computing
    BACKGROUND: Older adults with chronic disease struggle to manage complex medication regimens. Health information technology has the potential to improve medication management, but only if it is based on a thorough understanding of the complexity of medication management workflow as it occurs in natural settings. Prior research reveals that patient work related to medication management is complex, cognitive, and collaborative. Macrocognitive processes are theorized as how people individually and collaboratively think in complex, adaptive, and messy nonlaboratory settings supported by artifacts. OBJECTIVE: The objective of this research was to describe and analyze the work of medication management by older adults with heart failure, using a macrocognitive workflow framework. METHODS: We interviewed and observed 61 older patients along with 30 informal caregivers about self-care practices including medication management. Descriptive qualitative content analysis methods were used to develop categories, subcategories, and themes about macrocognitive processes used in medication management workflow. RESULTS: We identified 5 high-level macrocognitive processes affecting medication management-sensemaking, planning, coordination, monitoring, and decision making-and 15 subprocesses. Data revealed workflow as occurring in a highly collaborative, fragile system of interacting people, artifacts, time, and space. Process breakdowns were common and patients had little support for macrocognitive workflow from current tools. CONCLUSIONS: Macrocognitive processes affected medication management performance. Describing and analyzing this performance produced recommendations for technology supporting collaboration and sensemaking, decision making and problem detection, and planning and implementation.
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    Medication Therapy Management Delivery by Community Pharmacists: Insights from a National Sample of Medicare Part D Beneficiaries
    (ACCP, 2019-08) Adeoye, Omolola A.; Farley, Joel F.; Coe, Antoinette B.; Pestka, Deborah L.; Farris, Karen B.; Zillich, Alan J.; Snyder, Margie E.; Medicine, School of Medicine
    Introduction The Medicare Part D medication therapy management (MTM) program positions pharmacists to optimize beneficiaries' medications and improve care. Little is known regarding Part D MTM delivery by community pharmacists and other pharmacist provider types. Objectives To (a) characterize Medicare Part D MTM delivery by community pharmacists, (b) compare MTM delivery by community pharmacists to other pharmacists, and (c) generate hypotheses for future research. Methods A descriptive cross‐sectional study using merged data from a 20% random sample of Medicare beneficiary enrollment data with a 100% sample of recently available 2014 Part D MTM files was conducted. Andersen's Behavioral Model was applied to describe MTM delivery across beneficiary characteristics. Descriptive and bivariate statistics were used to compare delivery of MTM between community and other pharmacist providers. Results Among beneficiaries sampled, community pharmacists provided comprehensive medication reviews (CMRs) to 22% (n = 26 337) of beneficiaries receiving at least one CMR. Almost half (49.4%) were provided face‐to‐face. Across pharmacist cohorts, median days to CMR offer of post‐MTM program enrollment were within the 60‐day policy requirement. The community pharmacist cohort had fewer days from CMR offer to receipt (median 47 days). Community pharmacists provided more medication therapy problem (MTP) recommendations (mean [SD] of 1.8 [3.5]; P < .001), but resolved less MTPs (0.2 [0.7]; P < .001), and most commonly served beneficiaries that were in the south but less in the west/northeast. Additionally, community pharmacists served a smaller proportion of black beneficiaries, yet a larger proportion of Hispanic beneficiaries (P < .001). Conclusion Community pharmacists provided approximately one in five CMRs for MTM eligible beneficiaries in 2014, with CMRs occurring more quickly, resulting in more MTP recommendations, but resolving less MTPs than those provided by noncommunity pharmacists. Future research should explore geographic/racial‐ethnic disparities in beneficiaries served and strategies to increase negligible MTP resolution by community pharmacists.
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    The impact of clinical pharmacist led comprehensive medication management on diabetes care at Federally Qualified Health Centers within the BD Helping Build Healthy Communities program
    (Wiley, 2022-03) Pastakia, Sonak D.; Clark , Alycia; Lewis, Katie; Taugher, Damon; Patel, Rajal; Ali, Liz; Wu, Cecilia; Butler, Racheal; Bateman, M. Thomas, Jr.; McCarthy, Caitlin; Vargas, Joanne; Poulsom, Carrie; Medicine, School of Medicine
    Introduction The BD Helping Build Healthy Communities (HBHC) program is a philanthropically funded initiative designed to provide support for comprehensive medication management (CMM) services at Federally Qualified Health Centers (FQHCs) to support care for low-income populations. Objectives The primary outcome of interest was the change in glycosylated hemoglobin (HbA1c) between baseline and 6 months with changes in systolic (SBP) and diastolic blood pressure (DBP) between baseline and 6 months being evaluated as secondary outcomes. Methods Awardees of the HBHC program who provided clinical pharmacist led CMM services in 2017, 2018, or 2019 to address the needs of people living with diabetes, were asked to complete a standardized monitoring template to evaluate their progress in serving patients receiving care at their clinic. The data from these reports was then analyzed using the paired t test to identify statistically significant changes in HbA1c, SBP, and DBP. Results A total of eight FQHCs, providing care to a total of 2502 patients, received funding within the HBHC program for their CMM activities related to diabetes. Within the primary outcome analysis of the change in HbA1c at 6 months, a statistically significant reduction in average clinic HbA1c between baseline and 6 months (9.4 vs 8.2, mean difference 1.2, 95% CI [0.45-1.97, P <.01]) was observed. Similarly, a statistically significant reduction was observed between baseline and 6 months for SBP (140.8 vs 130.2 mm Hg, mean difference 10.5, 95% CI [2.2-18.9 mm Hg, P <.05] and DBP (83.1 vs 78.9 mm Hg, mean difference 4.15, 95% CI [0.48-7.82 mm Hg, P <.05]). Conclusion The CMM activities within the HBHC program were able to demonstrate statistically significant reductions in HbA1c and blood pressure. Despite the inherent limitations associated with a retrospective analysis with diminishing patient follow-up over 24 months, this analysis shows that investment in clinical pharmacist led CMM could potentially have positive impacts on clinical outcomes for patients receiving care at FQHCs. Additional rigorous studies are needed to confirm the findings seen in this analysis.
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    Variation in Medication Therapy Management Delivery: Implications for Health Care Policy
    (AMCP, 2018-09) Snyder, Margie E.; Jaynes, Heather A.; Gernant, Stephanie A.; Lantaff, Wendy M.; Suchanek Hudmon, Karen; Doucette, William R.; Medicine, School of Medicine
    BACKGROUND: Medication therapy management (MTM) program evaluations have revealed mixed outcomes, with some studies finding favorable outcomes and others finding no differences between patients who received MTM versus those who did not. One possible reason for outcomes variability is differences in delivery of MTM programs. The Chronic Care Model (CCM) provides a framework for how health care organizations can improve care for the chronically ill through 6 elements: organization of health care, delivery system design, clinical information systems, decision support, self-management, and linkages to community resources. OBJECTIVE: To apply the CCM to understand variation in MTM delivery and formulate policy recommendations. METHODS: This study used a mixed-methods descriptive analysis of MTM delivery. Investigators conducted visits to a purposeful sample of MTM practices to observe MTM and interview participants. The pharmacists and staff of these practices completed a modified Assessment of Chronic Illness Care (ACIC). Pairs of investigators analyzed interview transcripts to identify themes. Demographics and ACIC scores were summarized using descriptive statistics. After analysis, investigators discussed overarching themes and policy implications organized by CCM elements. RESULTS: Seven practices participated, and 87 participants were interviewed. Based on ACIC scores, MTM patient volume, and payer mix, practices were categorized as Early Maturity Level or Later Maturity Level. From the model, organization of health care themes included whether MTM was the practice’s core competence, belief/confidence in the MTM process, lack of formal rewards, and the influence of organizational goals and external environment. Delivery system design themes pertained to the extent that MTM processes were formalized. Clinical information systems themes were the extent to which systems were influenced by payers, efficiency strategies, and the accuracy and availability of information. In considering clinical decision support themes, alert design limitations and variation in user approaches to alerts based on experience were noted. We observed strong support for patient self-management; when present, barriers were attributed to the patient, MTM provider, or payer. Referral to community resources was minimal. Numerous policy implications were identified. CONCLUSIONS: Our research identified numerous ways by which MTM delivery varies, particularly by MTM practice maturity level. These findings provide evidence for several policy changes that could be considered to optimize MTM delivery, encourage alignment with the CCM, and promote practice maturation.