Drug Criteria & Outcomes
MTM: Another New Pharmacy Acronym?
By Sara Webster, PharmD Candidate Auburn University Harrison School of Pharmacy
Medications taken incorrectly in the United States represent annual costs of more than $100 billion.1 One possible solution, medication therapy management (MTM), is a distinct group of services that optimizes therapeutic outcomes for individual patients.2,3 MTM services enhance patients' understanding of appropriate drug usage, increase compliance with medication therapy, and improve detection of adverse events. These services employ collaboration between the members of a multidisiplinary health team that include a physician, pharmacist, nurse practitioner, dietician, and disease-specific educator (e.g., diabetes).
MTM is expected to decrease overall medical costs by evaluating patients' current therapies, thereby reducing unexpected physician appointments, emergency department visits, and hospital stays.4 These services include, but are not limited to:
- Performing or obtaining necessary assessments of patient's health status.
- Formulating a medication treatment plan.
- Selecting, initiating, modifying, or administering medication therapy.
- Monitoring and evaluating the patient's response to therapy, including safety and efficacy.
- Performing a comprehensive medication review to identify, resolve, and prevent medication-related problems including adverse drug events.
- Documenting the care delivered and communicating essential information to patient's other primary care providers.
- Providing verbal education and training designed to enhance patient understanding and appropriate use of his or her medications
- Providing information, support services, and resources designed to enhance patient understanding and adherence with his or her therapeutic regimen.
- Coordinating and integrating medication therapy management services within the broader health care management services being provided to the patient.3,4
Focus activities may include providing education and management of drug therapy for issues such as diabetes, hypertension, smoking cessation, pain control, asthma, anticoagulation, and immunizations.3 Diabetes education classes may be offered, as well as instruction on glucose testing and insulin use. A physician's management of a patient's hypertension would benefit from regularly checking blood pressures and maintaining logs. Other possible services include assessing pain control and determining the most practical therapeutic options, educating on inhaler and peak flow meter use for asthma patients, and inoculating people with the influenza, pneumococcal, and other indicated vaccines.
In addition, monitoring could be utilized for osteoporosis, INR, cholesterol, and other medical needs.3 With osteoporosis, a screening could be conducted to judge the need for a DEXA scan. Likewise, INRs could be tested regularly to help individualize warfarin dosing. Screening of cholesterol levels could be provided to determine efficacy of cholesterol-lowering medications.
Other medication-related services include developing comprehensive patient drug therapy information, which could be achieved by completing a medication review, a personal medication profile, and a drug therapy plan. In conjunction with this, intervention and referral, which consists of recommendations for medication changes, review of abnormal laboratory values, and reports of adverse drug events, are also possible by-products of MTM. Documentation and follow-up would be necessary to receive full benefit from all of these services. MTM service providers can make recommendations to patients, physicians, and other health care providers based on analysis of the patient's current issues. The increased attention given to a patient's current therapies through this education and monitoring also might increase his or her compliance. A personal medication profile could be created and updated listing the patient's medications, doses, indications, and monitoring results to discuss and evaluate during physician and pharmacy visits.3
MTM is covered by Medicare Part D for qualified patients who may receive pharmaceutical care, cognitive services, and disease-state management.5 Patients qualify if they have at least two chronic medical conditions, take at least two medications covered by Part D, and are likely to spend greater than $4,000 on medications annually.4 MTM also is available to all interested patients, especially those who have issues with multiple and/or complicated disease states, polypharmacy issues, or have the desire to receive help in medication utilization.3
Currently, there is no specific model that defines which practitioners can provide these services or how to provide them. A good option is the team (or multidisiplinary) approach, in a "face-to-face" setting rather than by telephone or with printed materials.3,4 A collaborative practice could exist between the nurse practitioner, physician, and pharmacist to eliminate excessive visits to physicians for medication purposes. For example, a pharmacist, during an MTM visit, could observe a patient for physical signs of an adverse drug reaction, drug interaction, or inappropriate therapy. The pharmacist would then be able to alert the physician of the issue and implement therapy adjustments. Another example would be a patient having problems controlling his or her diabetes; an MTM visit might allow the pharmacist to recommend changes in current therapy, or increase compliance to the prescribed regimen. These changes would help the patient better control his or her disease, as well as provide a plan for more frequent monitoring and maintain documentation of glucose readings for future reference.3
Many patients, regardless of whether they qualify for Part D, would benefit from receiving these services, and MTM will likely elicit more insurance providers to include reimbursement for these services as their patients' request and demand it. The financial aspects of these services are important to the patient in determining whether health or finance is put first. The availability of payment for this service could increase so that payment for MTM is available to more than only those who qualify under Part D. This allows patients with a need for MTM to have the opportunity to benefit from it.2
- NexDose: A Unique Solution for Medication Therapy Management. NexDose web site. Available at: www.nexdose.com/for_hcp/MTM.htm. Accessed Nov. 6, 2006.
- DaVanzo J, Dobson A, Koenig L, et al. Medication therapy management services: A critical review. J Am Pharm Assoc 2005;45:580-587.
- Bennett M, Bertram C, Chater R, et al. Medication therapy management in community pharmacy practice: Core elements of an MTM service. American Pharmacists Association and National Association of Chain Drug Stores; Washington, DC, and Alexandria, VA; April 2005; 1-10.
- Chen DF, Thompson KK. Proposed model for assuring quality of Medicare's medication therapy management. Am J Health-System Pharm 2006;63:1,167-1,171.
- Pharmacist's Letter. October 2006; 22:1.