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Medication adherence and its relationship to the therapeutic alliance: Results from an innovative pilot study within a community pharmacy MTM practice  [PDF]
Janice Pringle, PhD.,Michael Melczak, PhD,Arnie Aldridge, MS,Margie Snyder, PharmD, MPH
INNOVATIONS in Pharmacy , 2011,
Abstract: Objectives: To determine whether patients who received Medication Therapy Management (MTM) from community pharmacists using a brief scale to measure Therapeutic Alliance (i.e., MTM + TA) would show better medication adherence than patients whoreceived MTM without use of the TA scale (MTM only). Design: Quasi-experimental, using a direct intervention group (MTM + TA) and a comparison group of randomly selected claims records from patients who received only the MTM service (MTM only). We used a doubly robust propensity score approach to estimate the average effect of therapeutic alliance on medication adherence. The analysis was limited to the following broad medication categories: antihypertensives, antidiabetic agents, and antihyperlipidemics. Setting: The direct intervention group included patients receiving MTM services from pharmacists in a community pharmacy chain setting. Participants: After matching with claims data, the direct intervention group was n=117, with an average age of 76.4. The comparison group was n=146, with an average age of 76.2. Intervention: Administration of two brief scales designed to measure general health outcomes and TA within the context of MTM (with focus on TA scale administration). Main Outcome MeasuresProportion of Days Covered (PDC) and PDC80. Results: Using the therapeutic alliance scales in the context of community pharmacistprovided MTM was associated with a 3.1 percentage point increase in patients’ overall PDC (p<.001) and an increase of 4.6 percentage points in PDC80 (p=.02) as compared to patients receiving MTM without use of the therapeutic alliance scales. Conclusion: Measuring therapeutic alliance in the context of MTM is associated with improved medication adherence and represents one strategy for enhancing the effectiveness of MTM encounters. Furthermore, administration of the therapeutic alliance scales used very little time; therefore it is likely feasible for pharmacists to routinely use the scales in their practice.
Older adult perceptions of a self-reported medication risk questionnaire: A focus group study.  [PDF]
Matthew J. Witry PharmD, Graduate Student,Elizabeth H. Chang PharmD, MS, Graduate Student,Megan M. Mormann PharmD Candidate,William R. Doucette PhD, Professor
INNOVATIONS in Pharmacy , 2011,
Abstract: Background: Medication therapy management (MTM) has been shown to resolve medication-related problems and decrease health care expenses. Public and private health insurers, providers, and other stakeholders are looking for ways to involve patients in the MTM process. One option is to engage patients through the use of a medication risk questionnaire. Objective: To investigate older adults’ perceptions of completing a medication risk questionnaire and receiving a rating of their risk for medication-related problems.Methods: Four, 75 to 90 minute focus groups were conducted using a semi-structured interview guide and copies of a medication risk questionnaire to collect qualitative data from 36 community dwelling older adults in Iowa, USA. Sessions were audio-recorded, transcribed, and analyzed thematically using an iterative process. Results: The thematic analysis yielded a general theme of comprehensive medication reviews, and two themes on the medication risk questionnaire: “process and items” and “risk category reactions.” Overall, participants were unfamiliar with pharmacist services beyond counseling. They were open to the questionnaire, but suggested it would be more useful as a topic for discussion with a provider than to screen patients. Despite their medication risk rating, most did not express interest in seeking a comprehensive medication review based on the result of the questionnaire as they considered themselves at low risk for problems. Conclusions: Using a medication risk questionnaire as a topic for discussion could provide health insurance plans or providers an opportunity to increase beneficiary familiarity with MTM. These beneficiary perspectives may be useful to health plan administrators and MTM providers as they pursue new ways to involve patients in the medication management process.IntroductionMedication-related problems result in significant morbidity and expense.1-5 Research shows medication therapy management (MTM) and other pharmacist-provided interactive services are effective for improving outcomes related to these problems.2,6-9 The U.S. Centers for Medicare and Medicaid Services (CMS) mandate Medicare Part D plansCorresponding Author: Matthew Witry, PharmDUniversity of Iowa College of Pharmacy, Department of Pharmacy Practice and Science, 115 S. Grand Ave. S557 PHAR, Iowa City, IA 52242, Ph: 319.330.6105, Fax: 319.353.5646, Email: matthew-witry@uiowa.eduoffer MTM to targeted beneficiaries using three claims-based eligibility criteria: number of medications, number of chronic conditions, and medication expenditures.10While
Primary Care Providers’ experiences with Pharmaceutical Care-based Medication Therapy Management Services  [PDF]
Heather L. Maracle, Pharm.D.,Djenane Ramalho de Oliveira, Ph.D.,Amanda Brummel, Pharm.D
INNOVATIONS in Pharmacy , 2012,
Abstract: This study explored primary care providers’ (PCPs) experiences with the practice of pharmaceutical care-based medication therapy management (MTM). Qualitative, semi-structured interviews were conducted with six PCPs who have experiences working with MTM pharmacists for at least three years. The first author conducted the interviews that were audio-taped, transcribed, and coded independently. The codes were then harmonized via discussion and consensus with the other authors. Data were analyzed for themes using the hermeneutic-phenomenological method as proposed by Max van Manen. Three men and three women were interviewed. On average, the interviewees have worked with MTM pharmacists for seven years. The six (6) themes uncovered from the interviews included: (1) “MTM is just part of our team approach to the practice of medicine”: MTM as an integral part of PCPs’ practices; (2) “Frankly it’s education for the patient but it’s also education for me”: MTM services as a source of education; (3) “It’s not exactly just the pharmacist that passes out the medicines at the pharmacy”: The MTM practitioner is different from the dispensing pharmacist; (4) “So, less reactive, cleaning up the mess, and more proactive and catching things before they become so involved”: MTM services as preventative health care efforts; (5)“I think that time is the big thing”: MTM pharmacists spend more time with patients; (6) “There’s an access piece, there’s an availability piece, there’s a finance piece”: MTM services are underutilized at the clinics. In conclusion, PCPs value having MTM pharmacists as part of their team in ambulatory clinics. MTM pharmacists are considered an important source of education to patients as well as to providers as they are seen as having a unique body of knowledge –medication expertise. All PCPs highly treasure the time and education provided by the MTM pharmacists, their ability to manage and adjust patients’ medications, and their capability to address patients’ medication experiences. MTM pharmacists are seen as being different from dispensing pharmacists, and PCPs usually highlight that difference to patients as they refer them to MTM services. Lastly, it is apparent that MTM pharmacists struggle to explain what their role is within the healthcare team and they need to find a more effective way to explain the unique value they add to the care of patients.
A Description of Medication Therapy Management Services in Minnesota  [PDF]
Amie Jo Digatono, Pharm.D. Candidat
INNOVATIONS in Pharmacy , 2011,
Abstract: Objective: To describe Medication Therapy Management (MTM) services in Minnesota, quantifying how many patient encountersoccur per week and compiling provider and practice site characteristics.Design: Cross‐sectional study.Setting: Minnesota practice sites surveyed in June and July 2010.Participants: MTM providers in Minnesota who are registered users of the Assurance documentation system or are members of theMinnesota Pharmacists Association MTM Academy. Intervention: Self‐administered online questionnaire completed by study participants.Main Outcome Measures: The number of patient encounters per week, practice site location, practitioner length of time as a MTMservice provider, and the motivating factors for providing direct patient care services. Results: There were 56 respondents, reporting a median of 5 MTM patient encounters per week (range 0 to 35) and a median lengthof service of 4 years (range <1 to 15). Clinic‐based practices were reported by 66% of providers and community pharmacy‐basedpractices by 30%. Eighty‐five percent practice in an urban setting, 9% in a large rural town and 6% in a small rural town. Nearly half(46%) of providers are the sole practitioner at their site. The most commonly cited motivation for providing direct patient careservices was to improve patient outcomes.Conclusion: MTM service providers in Minnesota were more likely to report practicing in an urban area and in a clinic. Manypractices were low‐volume or newly established, with half of all respondents reporting 5 or fewer MTM patient encounters per weekand a length of service of four years or less.
Community pharmacy-based medication therapy management services: financial impact for patients
Dodson SE,Ruisinger JF,Howard PA,Hare SE
Pharmacy Practice (Granada) , 2012,
Abstract: Objective: To determine the direct financial impact for patients resulting from Medication Therapy Management (MTM) interventions made by community pharmacists. Secondary objectives include evaluating the patient and physician acceptance rates of the community pharmacists’ recommended MTM interventions.Methods: This was a retrospective observational study conducted at 20 Price Chopper and Hen House grocery store chain pharmacies in the Kansas City metro area from January 1, 2010 to December 31, 2010. Study patients were Medicare Part D beneficiaries eligible for MTM services. The primary outcome was the change in patient out-of-pocket prescription medication expense as a result of MTM services.Results: Of 128 patients included in this study, 68% experienced no out-of-pocket financial impact on their medication expenses as a result of MTM services. A total of 27% of the patients realized a cost-savings (USD440.50 per year, (SD=289.69)) while another 5% of patients saw a cost increase in out-of-pocket expense (USD255.66 per year, (SD=324.48)). The net financial impact for all 128 patients who participated in MTM services was an average savings of USD102.83 per patient per year (SD=269.18, p<0.0001). Pharmacists attempted a total of 732 recommendations; 391 (53%) were accepted by both the patient and their prescriber. A total of 341 (47%) recommendations were not accepted because of patient refusal (290, 85%) or prescriber refusal (51, 15%).Conclusions: Patient participation in MTM services reduces patient out-of-pocket medication expense. However, this savings is driven by only 32% of subjects who are experiencing a financial impact on out-of-pocket medication expense. Additionally, the majority of the pharmacists’ recommended interventions (53%) were accepted by patients and prescribers.
Retrospective Analysis of Medication Adherence and Cost Following Medication Therapy Management  [PDF]
Ashley Branham, PharmD,Joseph Moose, PharmD,Stefanie Ferreri, PharmD, CDE
INNOVATIONS in Pharmacy , 2010,
Abstract: Objective: To determine if pharmacist-provided medication therapy management (MTM) improves medication adherence in Medicare patients. A secondary objective is to compare the total monthly cost of a patient’s prescription medication regimen 6 months before and 6 months following a comprehensive medication review (CMR). Design: Retrospective analysis of medication adherence, pre-post comparison. Setting: Three independent pharmacies in North Carolina. Patients: 97 Medicare Part D beneficiaries with one or more chronic disease states who participated in a comprehensive medication review (CMR). Intervention: MTM services provided by community pharmacists. Main outcome measure: Change in adherence as measured by the proportion of days covered (PDC) and change in medication costs for patients and third party payers. Results: Patients were adherent to chronic disease-state medications before and after MTM (PDC≥ 0.8). Overall, change in mean adherence before and after MTM did not change significantly (0.87 and 0.88, respectively; p = 0.43). However, patients taking medications for cholesterol management, GERD, thyroid and BPH demonstrated improved adherence following a CMR. No change in adherence was noted for patients using antihypertensives and antidiabetic agents. Average total chronic disease-state medication costs for participants were reduced from $210.74 to $193.63 (p=0.08) following the comprehensive medication review. Total costs for patient and third party payers decreased from patients prescribed antilipemics, antihypertensives, GERD and thyroid disorders following a CMR. Conclusions: Pharmacist-provided MTM services were effective at improving medication adherence for some patients managed with chronic medications. Pharmacist-provided MTM services also were effective in decreasing total medication costs.
Medication adherence issues in patients: focus on cost
Matsui D
Clinical Audit , 2013, DOI: http://dx.doi.org/10.2147/CA.S30125
Abstract: ication adherence issues in patients: focus on cost Review (490) Total Article Views Authors: Matsui D Published Date March 2013 Volume 2013:5 Pages 33 - 42 DOI: http://dx.doi.org/10.2147/CA.S30125 Received: 09 November 2012 Accepted: 11 January 2013 Published: 11 March 2013 Doreen Matsui Department of Pediatrics and Medicine, University of Western Ontario, London, Ontario, Canada; Children's Hospital, London Health Sciences Centre, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada Abstract: Advances in drug therapy have resulted in efficacious treatments being available; however, the benefit may be lost if prescribed medications are not taken properly. Unfortunately, poor medication adherence is common and widespread, affecting all age groups and disease conditions. Adherence is a factor in health outcomes of pharmacotherapy with possible failure to achieve therapeutic goals and worsening of illness. Higher health care costs may result from more frequent physician and emergency department visits and increased hospitalization rates. The cost of medications may play a role in whether patients do or do not take their medication with increased cost sharing leading to poorer adherence with prescription drugs. Given the possible adverse consequences of nonadherence, interventions to improve medication-taking behavior are encouraged although not consistently successful. Surprisingly, there is relatively little information on the cost-effectiveness of these interventions and more methodologically sound research is needed in this area. Alternative strategies that have been proposed are value-based insurance design and the use of financial incentives, although the former has not been widely accepted, and the latter is ethically controversial. This article reviews some of the main issues with regards to adherence with drug therapy including some of the cost implications of less than optimal medication adherence.
Medication adherence issues in patients: focus on cost  [cached]
Matsui D
Clinical Audit , 2013,
Abstract: Doreen Matsui Department of Pediatrics and Medicine, University of Western Ontario, London, Ontario, Canada; Children's Hospital, London Health Sciences Centre, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada Abstract: Advances in drug therapy have resulted in efficacious treatments being available; however, the benefit may be lost if prescribed medications are not taken properly. Unfortunately, poor medication adherence is common and widespread, affecting all age groups and disease conditions. Adherence is a factor in health outcomes of pharmacotherapy with possible failure to achieve therapeutic goals and worsening of illness. Higher health care costs may result from more frequent physician and emergency department visits and increased hospitalization rates. The cost of medications may play a role in whether patients do or do not take their medication with increased cost sharing leading to poorer adherence with prescription drugs. Given the possible adverse consequences of nonadherence, interventions to improve medication-taking behavior are encouraged although not consistently successful. Surprisingly, there is relatively little information on the cost-effectiveness of these interventions and more methodologically sound research is needed in this area. Alternative strategies that have been proposed are value-based insurance design and the use of financial incentives, although the former has not been widely accepted, and the latter is ethically controversial. This article reviews some of the main issues with regards to adherence with drug therapy including some of the cost implications of less than optimal medication adherence. Keywords: adherence, medication, cost
Perceived value creation process: focus on the company offer
Irena Pand?a Bajs
Tr?i?te/Market , 2012,
Abstract: In the competitive business environment, as the number of rational consumers faced with many choices increases, companies can achieve their dominance best by applying the business concepts oriented to consumers in order to deliver a value which is different and better than that of their competitors. Among the various products on the market, an educated consumer chooses the offer that provides the greatest value for him/her. Therefore, it is essential for each company to determine how consumers perceive the value of its offer, and which factors determine the high level of perceived value for current and potential consumers. An analysis of these factors provides guidance on how to improve the existing offer and what the offer to be delivered in the future should be like. That could increase the perceived value of the company offer and result in a positive impact on consumer satisfaction and on establishing a stronger, longterm relationship with consumers. The process of defining the perceived value of a particular market offer is affected by the factors of the respective company’s offer as well as by competition factors, consumer factors and buying process factors. The aim of this paper is to analyze the relevant knowledge about the process of creating the perceived value of the company’s market offer and the factors that influence this process. The paper presents a conceptual model of the perceived value creation process in consumers’ mind.
Evaluation of a Consumer-Generated Marketing Plan for Medication Therapy Management Services  [PDF]
Brian J. Isetts, Ph.D.,Jon C. Schommer, Ph.D.,Sarah M. Westberg, Pharm.D.,Julie K. Johnson, Pharm.D.
INNOVATIONS in Pharmacy , 2012,
Abstract: The purpose of this project was to utilize a consumer-directed, care model redesign methodology to develop and evaluate a marketing plan for medication therapy management services (MTMS) provided in community pharmacies. This was accomplished through a six-step process: (1) application of “design thinking” for eliciting consumer input on redesigning MTMS and marketing approaches, (2) exploratory research, (3) focus group analysis, (4) marketing plan development, (5) marketing plan implementation, and (6) marketing plan evaluation.The findings showed that the application of “design thinking” and focus group analysis was useful for creating a consumer-directed marketing plan for medication therapy management services (MTMS). Implementation and evaluation of the MTMS Marketing Plan revealed that the most successful pharmacies were those that had established business associate agreements with the medical clinics closest to their site of practice, including access to electronic health records. This “virtual electronic presence” of pharmacists in the medical care system was highly consistent with the consumer demand we uncovered for a visible relationship between pharmacists, physicians and other health care providers.
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