Live MTM Outperforms Chart Review on Reducing Cholesterol

Among patients with cardiovascular disease (CVD), live medication therapy management (MTM) reduces low-density-lipoprotein (LDL) cholesterol significantly more than standard, chart-review MTM, according to a study published in the September-October 2014 issue of the Journal of the American Pharmacists Association.

Researchers from the University of Boston observed CVD patients with LDL >120 mg/dL who were included in an electronic medical record (EMR) accessed by Harvard Vanguard Medical Associates and Atrius Health across multiple centers. Patients were examined in the study if a clinical pharmacist had not addressed their lipid pharmacotherapy, and patients were excluded if no LDL value had been reported within 6 months of their next appointment, no treatment plan had been documented in the EMR, nonadherence had been previously documented, and/or triglyceride levels were ≥400 mg/dL.

Prior to the study, the clinical pharmacists would receive monthly reports on the patients and then perform chart review. Following appointments with the physician, the pharmacists would typically review the EMR once again to determine whether or not their recommendations were acknowledged.

“The chart-review protocol placed a noticeable burden on the clinical pharmacists, particularly surrounding some of the subjective drawbacks of the protocol,” corresponding author Ricky Thumar, PharmD, RPh, told Pharmacy Times in an exclusive interview. “The pilot live MTM program came about not only to address the subjective drawbacks of the existing chart-review process, but also to contribute to the growing body of literature for clinical pharmacist services through an innovative approach.”

Over a 6-month period, the study authors examined mean LDL reduction from baseline between and within each MTM service, as well as the number of CVD patients who achieved their LDL goals, and the percentage of implemented recommendations from clinical pharmacists. Similar studies have shown a mean LDL reduction of 40 mg/dL or more for chart-review MTM and 60 mg/dL or more for live MTM.

The results of the current study demonstrated mean LDL reductions of 36 mg/dL ± 23.2 mg/dL in the chart-review MTM group and 62 mg/dL ±28.3 mg/dL in the live MTM group. The researchers inferred from the data that both services provided reductions in LDL in CVD patients.

“I was pleasantly surprised to see the incredibly positive impact pharmacists were having, as displayed by LDL reduction and lipid goal attainment,” Dr. Thumar noted. “I am not surprised, however, that live MTM had more favorable results than chart MTM.”

The researchers said their results suggest that implementing live MTM across multidimensional treatment plans is greatly beneficial for CVD patients.

“One of the many desires that this study aims to address is promoting clinical pharmacist services in the outpatient ambulatory and/or managed care setting through innovative practices,” Dr. Thumar concluded. “Our need and impact have long been well-established, but have historically been somewhat difficult to quantify objectively. I hope that…physicians will not only encourage their patients to utilize their pharmacists more—as the ‘drug experts’–but also…appreciate the utility (pharmacists) can provide as medical professionals.”