Clinical pharmacists' scope of knowledge for medication therapy management in chronic kidney disease patients

Medication therapy management (MTM) was first implemented and introduced for chronically ill patients and those taking multiple prescription drugs. The MTM has five steps, namely medication therapy review (MTR), personal medication record (PMR), medication-related action plan (MAP), intervention or referral, and finally, documentation. After receiving MTM services, patients will gain knowledge on medicines, which may decrease non-adherence to treatment and increase its efficacy. Studies have shown the positive impact of MTM on geriatric, pediatric, and chronically ill patients and those on polypharmacy. MTM services may improve medication adherence, decrease healthcare costs, and improve the quality of life (QoL) of patients with chronic kidney disease (CKD) by addressing various issues like anaemia, metabolic acidosis, protein management, fluid management, electrolyte management, dosage adjustment based on eGFR, vaccination, and medication-related problems and intervening with the education about the disease, drugs, and lifestyle modifications.

The Tennessee Medicaid medication therapy management program: early stage contextual factors and implementation outcomes

Background First investigated in the 1990s, medication therapy management (MTM) is an evidence-based practice offered by pharmacists to ensure a patient’s medication regimen is individualized to include the safest and most effective medications. MTM has been shown to a) improve quality of patient care, b) reduces health care costs, and c) lead to fewer medication-related adverse effects. However, there has been limited testing of evidence-based, a-priori implementation strategies that support MTM implementation on a large scale. Methods The study has two objectives assessed at the organizational and individual level: 1) to determine the adoption, feasibility, acceptability and appropriateness of a multi-faceted implementation strategy to support the MTM pilot program in Tennessee; and 2) to report on the contextual factors associated with program implementation based on the Consolidated Framework for Implementation Research (CFIR). The overall design of the study was a hybrid type 2 effectiveness-implementation study reporting outcomes of Tennessee state Medicaid’s (TennCare) MTM Pilot program. This paper presents early stage implementation outcomes (e.g., adoption, feasibility, acceptability, appropriateness) and explores implementation barriers and facilitators using the CFIR. The study was assessed at the (a) organizational and (b) individual level. A mixed-methods approach was used including surveys, claims data, and semi-structured interviews. Interview data underwent initial, rapid qualitative analysis to provide real time feedback to TennCare leadership on project barriers and facilitators. Results The total reach of the program from July 2018 through June 2020 was 2033 MTM sessions provided by 17 Medicaid credentialed pharmacists. Preliminary findings suggest participants agreed that MTM was acceptable (μ = 16.22, SD = 0.28), appropriate (μ = 15.33, SD = 0.03), and feasible (μ = 14.72, SD = 0.46). Each of the scales had an excellent level of internal (> 0.70) consistency (feasibility, α = 0.91; acceptability, α = 0.96; appropriateness, α = 0.98;). Eight program participants were interviewed and were mapped to the following CFIR constructs: Process, Characteristics of Individuals, Intervention Characteristics, and Inner Setting. Rapid data analysis of the contextual inquiry allowed TennCare to alter initial implementation strategies during project rollout. Conclusion The early stage implementation of a multi-faceted implementation strategy to support delivery of Tennessee Medicaid’s MTM program was found to be well accepted and appropriate across multiple stakeholders including providers, administrators, and pharmacists. However, as the early stage of implementation progressed, barriers related to relative priority, characteristics of the intervention (e.g., complexity), and workflow impeded adoption. Programmatic changes to the MTM Pilot based on early stage contextual analysis and implementation outcomes had a positive impact on adoption.

The Establishment and Practice of Pharmacy Care Service Based on Internet Social Media: Telemedicine in Response to the COVID-19 Pandemic

Objective: For patients with chronic diseases requiring long-term use of medications who are quarantined at home, the management of medication therapy during the COVID-19 pandemic is a problem that pharmacists urgently need to discuss and solve. The study aims to establish and launch a telepharmacy framework to implement pharmaceutical care during the COVID-19 pandemic.Methods: To establish a remote pharmacy service model based on a medication consultation service platform under the official account of the “Beijing Pharmacists Association” on the social software WeChat app, obtain the medication consultation records from February 28 to April 27, 2020, during the worst period of the epidemic in China, and to perform a statistical analysis of the information about the patients seeking consultation, consultation process, content and follow-up results.Results: The medication consultation service system and telepharmacy service model based on social software were established in February 2020. The “Cloud Pharmacy Care” platform had 1,432 views and 66 followers and completed 39 counseling cases in 2 months. Counseling was available for patients of all ages. Of the 39 cases, 82.05% of patients were young and middle-aged. During the COVID-19 pandemic, the long-term medication usage problems of patients with chronic disease were effectively addressed using “Cloud Pharmacy Care”. In the consultation, 35 cases (89.7%) were related to the use of medicines or health products, and 4 cases (10.3%) involved disease state management and the use of supplements. The top five drug-related issues included the selection of medications, the dosage and usage of drugs, medications for special populations, medication therapy management of chronic diseases, and adverse drug reactions. All consultations were completed within 4 h, with a positive review rate of 97.4%.Conclusion: During the COVID-19 pandemic, a remote pharmacy service “Cloud Pharmacy Care” based on the social software WeChat app was quickly constructed and applied to solve the medication-related problems of patients and the public during home quarantining. The significance of the study lies in the timely and interactive consultation model helps to carry out medication therapy management for chronically ill patients and improves patients’ medication compliance, improves medical quality, and plays a positive role in promoting the popularization of safe medication knowledge.

Evaluation of outcomes of medication therapy management (MTM) services for patients with chronic obstructive pulmonary disease (COPD)

Objectives: To evaluate the outcomes of clinical pharmacist-led medication therapy management (MTM) services for patients with chronic obstructive pulmonary disease (COPD). Methods: Two hundred COPD patients admitted by the Department of Respiratory and Critical Care Medicine of Baoding No.1 Central Hospital during January 2019 and December 2020 were randomly assigned to a control group (n =100) and an experimental group (n =100). Patients in the control group received conventional treatment, while those in the experimental group were provided with MTM services based on the conventional treatment for comparative analysis of outcome measures, including use of antibacterials during hospital stay, length of stay (LoS), costs of hospitalization (CoH), cases of adverse drug reactions (ADRs), and medication adherence (MA) and COPD assessment test (CAT) score one and six months after discharge. Results: Compared with the control group, the experimental group had reduced use of antibacterials during hospital stay, LoS, CoH, and ADR rate (P <0.05). After discharge, patients in both groups showed remarkable improvements in MA and CAT scores in comparison with their performances upon admission, and the experimental group exhibited better MA and higher CAT score than the control group, with the differences indicating statistical significance (P <0.05). Conclusion: MTM designed for COPD patients can improve pharmacist-led service quality and clinical outcomes of COPD. doi: https://doi.org/10.12669/pjms.37.7.4518 How to cite this:Liu M, Liu J, Geng Z, Bai S. Evaluation of outcomes of medication therapy management (MTM) services for patients with chronic obstructive pulmonary disease (COPD). Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4518 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.