It is no secret that in the last 2 decades, health care professions have embraced a strong shift towards personalized, collaborative care, a model that results in measured improvements in patient outcomes, institutional efficiency, and professional satisfaction. What excites me most about this development is that as a long-time pharmacist practitioner and educator, I have had a front-row seat to a corresponding shift in health care: The expanded role of pharmacists as essential components of this team-based approach. One of the most crucial ways that our profession contributes to this is through medication therapy management (MTM).
According to the model framework developed jointly by the American Pharmacists Association and the National Association of Chain Drugstores Foundation, MTM is a service model designed to achieve patient outcomes with effective and safe medication use through health care professional collaboration. MTM has 5 core elements: medication therapy review, personal medication record, medication-related action plan, intervention or referral, and documentation and follow-up.1 Pharmacists operationalize MTM by using the Pharmacists’ Patient Care Process (PPCP), which focuses on the delivery of patient-centered care through communication, collaboration, and documentation to collect, assess, plan, implement, monitor, and evaluate for the benefit of the patient.2
Irrespective of how patients obtain prescribed medications—whether it be through a community pharmacy or an order system in a health systems setting—it is essential for patients to have critical information about how the drugs are meant to be taken, what effects the drugs might have, and what risks they are to be mindful of. But oftentimes, a patient might have multiple prescribers (eg, a gastroenterologist, a nephrologist, a cardiologist), and it is vital for the pharmacist to review and evaluate all medications and how they may function in the individual patient. Additionally, when people are relatively young and healthy, they may be taking only 1 or 2 medications, which isn’t too difficult to keep track of. However, once people start getting advanced in age, or they start developing multiple chronic disease states, such as hypertension, diabetes, osteoporosis, etc, the medications they will require demand much more intensive management. Here, the pharmacist has an opportunity to be an essential part of the patient’s health care team, doing a great deal to help them maintain or improve their quality of life.
What does this look like on a practical level? Generally, many patients have very simple but important interactions with a pharmacist: They get a prescription sent to a pharmacy, wait in line, pick it up, and the pharmacist gives them basic instructions and asks them if they have any questions. But over time, as people begin to take more and more medications, there is a greater need for pharmacists to intervene beyond giving these simple directives. In my practice, I would often check in with the patient on multiple levels. I would ask about blood pressure, and how it’s being managed. I would follow up on lifestyle modifications we may have discussed, such as smoking cessation, diet and exercise, and how the patient’s stress is being managed. It is then important for the pharmacist to review the medications carefully for any drug interactions that may prove relevant, whether they be positive or negative.
When we then add to these factors the unavoidable fact that our patients are human and may not follow our directives properly—whether it’s because they forget a medication or don’t like the effect it has on them and stop taking it—we encounter the problem of nonadherence, waste, and the patient’s quality of life declining. We want to be careful, kind, and have very open communication with the patient so that if they’re experiencing adverse effects of any kind, we can suggest a change that can be made on behalf of the patient. Ultimately, MTM allows us to collaborate with the patient to allow them to be in more control of their own health care, and to assist them in a way that improves their quality of life. That is a very powerful role for a pharmacist to have.
About the Author
Gail Orum-Alexander, PharmD, BCGP, is dean of the College of Pharmacy at Marshall B Ketchum University. Before joining MBKU, Orum-Alexander served as the associate dean of experiential education, associate dean of academic affairs, associate dean of assessment and interim dean at the KGI School of Pharmacy and Health Sciences. She also held the position of dean of the College of Science and Health at Charles R. Drew University of Medicine and Science, overseeing programs in public health, physician assistant, radiologic sciences and pharmacy technology.
This extends to health systems settings as well. Increasingly, pharmacists are members of a health care team that engages in rounds serving as medication experts, with a focus on medications, interactions, or personalized feedback on individual patients and what drugs will be effective as they are treated for severe disease or injury. MTM is also useful for transitions of care, which involves a patient moving from one type or level of care to another. For example, a transition of care would occur when a patient has been discharged from the hospital after surgery to a rehabilitation facility to help them recover. One can’t always take the same medications in these different settings, so the patient can benefit from personalized care that optimizes not just the drug therapies they receive, but also aligns the appropriate medication regimen to the patient’s health care setting.
One important part of this expanded role of pharmacists in the collaborative approach to health care is the clear evidence indicating these methods benefit more than the patient themselves. Health systems and insurance companies have welcomed this development, since it leads to better patient outcomes. Effective collaboration between pharmacists, nurses, and physicians results in increased efficiency and decreased costs. And as pharmacists work directly with patients and their physicians to determine the best course of action for medication therapy, this leaves doctors with more time to spend with their patients. It is also crucial to mention that the sheer number of new drug therapies that come to market every year must be accounted for, and the expertise of the pharmacist as a resource in exploring, introducing, and managing a new medication for a patient is tremendously valuable.
Ultimately, MTM for pharmacists involves inter-professional collaboration to partner with patients and their families to make sure they have the best quality of care and the optimal quality of life. The practice demands so much more of the pharmacist than simply dispensing drugs; it takes all the pharmacist’s knowledge, clinical skills, and professionalism to provide care to help the patient. It takes communication skills, clinical skills, and a strong understanding and knowledge of medications to appropriately advise patients and give them the information they need to have a healthier life.
REFERENCES
1. Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model. 2008, Version 2.0. https://aphanet.pharmacist.com/sites/default/files/files/core_elements_of_an_mtm_practice.pdf
2. Joint Commission of Pharmacy Practitioners. Pharmacists’ Patient Care Process. May 29, 2014. https://jcpp.net/wp-content/uploads/2016/03/PatientCareProcess-with-supporting-organizations.pdf
