Comprehensive and Targeted Reviews Are Essential

Medication therapy management (mtm) is especially important during the coronavirus disease 2019 (COVID-19) pandemic.

As social distancing practices will be encouraged for some time, it is important for pharmacists to follow up with patients to identify medication-related problems (MRPs) and help resolve them. One study assessed MRPs in Medicare beneficiaries, and MTM services were provided to 910 patients by trained pharmacy students under the supervision of pharmacists.¹ The study results showed that 633 (69.6%) of the patients had at least one MRP, with the most common being severe drug-drug interaction (33.4%) and untreated conditions (14.7%).¹ Also, patients with MRPs were taking significantly more OTC and prescription medications.¹ This study emphasizes the importance of MTM services, especially for high-risk patients aged 65 years and older. Pharmacists can play an integral role in providing these services and communicating with the health care team.

KEY COMPONENTS

Comprehensive medication reviews (CMRs) are required annually by the Centers for Medicare & Medicaid Services (CMS) for every MTM-eligible patient, which involves reviewing all medications and identifying and resolving MRPs (see FIGURE²). Evidence shows that community pharmacists can lower health care costs and prevent adverse outcomes by addressing MRPs.³ As part of the review, a personal medication record (PMR) is also created and includes all the patient’s medications with the following details: allergies, indication, instructions, pharmacy and physician contact information, special instructions, and the start and stop dates.² After the record is created, pharmacists can provide the document to the patient and other members of the health care team for continuous communication regarding the drug regimen. The medication-related action plan includes a list of actions tailored for each patient to use as a guide for self-management.²

Target medication reviews (TMRs) are required at least quarterly to monitor the patient’s drug therapy and identify and resolve actual or potential MRPs, which may include adverse drug interactions, drug interactions, duplication of therapy, and medication nonadherence.^2,4 If a pharmacist identifies an MRP during the TMR, then the prescriber can be contacted for follow-up to help resolve any drug-related issues. Pharmacists can also play an important role in recommending medication alternatives that are more cost effective for patients with adherence issues due to drug costs.

One retrospective cohort study conducted by Humana compared acute inpatient admissions and emergency department (ED) visits between patients participating in MTM services involving CMRs, TMRs, or both.⁴ The study also examined TMR services and medication adherence rates. Study participants eligible to receive MTM services in 2014 or 2015 were included in the study. The CMS requirements for eligibility included the following criteria: patients with at least 3 of the 5 core chronic conditions (diabetes, heart failure, hypertension, hyperlipidemia, and osteoporosis) who were prescribed at least 8 chronic medications and met the minimum medication spend set for Medicare Part D each year.⁴ The study results showed that TMR interventions were associated with a statistically significant reduction in acute inpatient admissions in 2014 and 2015. In 2015, there were significant reductions in ED visits for patients receiving TMR-only interventions or a combination of TMR and CMR services.⁴

One limitation is that retrospective studies can only provide associations and do not demonstrate causality. However, the results of this study showed important information regarding the potential benefits of frequent monitoring using TMRs. Pharmacists can play an important role in MTM services by using TMRs to focus on specific problems arising from medication to improve health outcomes.

PERFORMING MTM SERVICES DURING COVID-19

In an interview with Pharmacy Times®, Callie Pray, PharmD, an MTM pharmacist for the independent pharmacy Holder Drug in Alva, Oklahoma, discussed how she has conducted consults during the COVID-19 pandemic. She now often performs CMRs and TMRs at patients’ homes via telephone.

“Practically all of those [patients who] qualify for CMRs have multiple disease states and/or are over 60 years, so are [at] high risk of developing COVID-19,” Pray said.

Phone consults are the perfect way to help keep patients safe and provide MTM services. They provide an opportunity for Pray to chat with patients and do mental health checks, as some feel isolated because of social distancing.

“It is a good opportunity to see if there is anything they need delivered,” she said.

Evidence shows that MTM programs offering CMRs via telephone may significantly reduce health care costs, hospitalizations, and mortality, but further studies are needed to compare with faceto- face consults.⁵

Jennifer Gershman, PharmD, CPh, is a drug information pharmacist and Pharmacy Times® contributor who resides in South Florida.

REFERENCES

• Rogan EL, Ranson CA, Valle-Oseguera CS, et al. Factors associated with medication- related problems in an ambulatory Medicare population and the case for medication therapy management. Res Social Adm Pharm. 2020;16(6):783-786. doi:10.1016/j. sapharm.2019.08.033
• Medication therapy management in pharmacy practice. American Pharmacists Association. March 2008. Accessed June 15, 2020. https://www.pharmacist.com/sites/ default/files/files/core_elements_of_an_mtm_practice.pdf
• Took RL, Liu Y, Kuehl PG. A study to identify medication-related problems and associated cost avoidance by community pharmacists during a comprehensive medication review in patients one week post hospitalization. Pharmacy (Basel). 2019;7(2):51. doi:10.3390/pharmacy7020051
• Ferries E, Dye JT, Hall B, Ndehi L, Schwab P, Vaccaro J. Comparison of medication therapy management services and their effects on health care utilization and medication adherence. J Manag Care Spec Pharm. 2019;25(6):688-695. doi:10.18553/ jmcp.2019.25.6.688
• DeZeeuw EA, Coleman AM, Nahata MC. Impact of telephonic comprehensive medication reviews on patient outcomes. Am J Manag Care. 2018;24(2):e54-e58.