Implementing Services into Community Pharmacy Workflow Presents Challenges

The Medicare Prescription, Drug, Improvement, and Modernixzation Act of 2003 established requirements under Part D to provide medication therapy management (MTM) services to eligible Medicare beneficiaries.¹

This set the stage for an expansion of pharmacists’ roles in patient care. In 2018, approximately 65% of plans reported using community pharmacists through vendor contracts.^2,3 However, challenges exist with implementing MTM services into the community pharmacy workflow.

Overcoming Obstacles

The results of one cross-sectional study from a random sample of Medicare beneficiary enrollment data evaluating 2014 Part D MTM files showed that community pharmacists provided more medication therapy problem (MTP) recommendations (P<.001) but resolved fewer MTPs than those provided by non-community pharmacists (eg, MTM vendor in-house pharmacists, Medicare Part D plan pharmacists)². Evidence shows that the following are challenges to implementing MTM services in the community practice setting: business model obstacles, incorporating programs within the health care team, integration into the pharmacy workflow, lack of patient engagement, and technology adaptation struggles (Figure^2-5).

Challenges to incorporating MTM services into the pharmacy workflow include difficulty training personnel, inadequate dedicated physical space to perform consults, and lack of time.^2,3 Busy chain pharmacies can have difficulty incorporating MTM services because of the many pharmacist responsibilities that include administering immunizations and dispensing medications. Evidence shows that access to technology is critical for MTM services, especially to review electronic medical records.^3,4 Typically, MTM vendors use web-based software for documentation and billing, so incorporating trained pharmacy technicians into this task is critical. The results of another study identified barriers and implementation strategies for integrating a web-based medication management application in community pharmacies.⁴ Additionally, the study results showed that clinical training, computer literacy, and leadership training facilitated implementation of a web-based program into the practice setting.⁴ However, staff opposition to change and provider reluctance to share data were considered barriers to implementing the technology.⁴

Lack of patient interest in MTM services is also an obstacle.³ Additionally, many patients are unaware that pharmacists’ clinical training goes beyond dispensing medications.³ Pharmacists can develop a standardized approach to delivering MTM services and explain their roles to patients. Pharmacists and physicians can also successfully work together through collaborative drug therapy management to improve communication and patient care services.³ The results of a third study showed there was an increase in MTM completion rates after an educational intervention was implemented at community pharmacies (P<.001).⁵

More than 600 pharmacist practitioners and program directors who provided survey responses thought that comprehensive medication management (CMM) services allow health care organizations to achieve clinician satisfaction, cost savings, improved outcomes, and patient satisfaction, according to the results of a report from Health2 Resources.⁶

The CMM approach focuses on clinical, patient, and personal goals to improve health outcomes.⁶ Goodrich Pharmacy, an independent pharmacy in Anoka, Minnesota, and HealthPartners have successfully performed CMM.⁶ HealthPartners started paying for CMM services in 2006.6 At press time, Goodrich Pharmacy employed 18 pharmacists at 7 sites and they used CMM with approximately 900 patients.⁶

About The Author

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

References

1. Medicare Prescription Drug, Improvement, and Modernization Act of 2003, HR 1, 108th Cong (2003). Accessed April 7, 2022. https://www.congress.gov/bill/108th-congress/ house-bill/1

2. Adeoye OA, Farley JF, Coe AB, et al. Medication therapy management delivery by community pharmacists: insights from a national sample of Medicare Part D beneficiaries. J Am Coll Clin Pharm. 2019;2(4):373-382. doi:10.1002/jac5.1160

3. Ferreri SP, Hughes TD, Snyder ME. Medication therapy management: current challenges. Integr Pharm Res Pract. 2020;9:71-81. doi:10.2147/IPRP.S179628

4. Turner K, Renfro C, Ferreri S, Roberts K, Pfeiffenberger T, Shea CM. Supporting community pharmacies with implementation of a web-based medication management application. Appl Clin Inform. 2018;9(2):391-402. doi:10.1055/s-0038-1651488

5. Hohmeier KC, Wheeler JS, Brookhart A, et al. Targeting adaptability to improve medication therapy management (MTM) implementation in community pharmacy. Implement Sci. 2019;14(1):99. doi:10.1186/s13012-019-0946-7

6. GTMRx Institute. The Get the Medications iight Report: a Nationwide Snapshot of Expert Practices–Comprehensive Medication Management in Ambulatory/Community Pharmacy. May 2016. Accessed April 8, 2022. https://gtmr.org/the-gtmr-report/