MTM-Focused Residencies Can Enhance Pharmacists’ Skill Set

Postgraduate training can enhance pharmacists’ skills for providing medication therapy management (MTM) services. There are a variety of residency opportunities that focus on MTM as part of their curriculum, such as ambulatory care, managed care, and community residencies.¹

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Attending conferences, such as the American Society of Health-System Pharmacists Midyear Clinical Meeting, can provide opportunities to interview with MTM-focused programs at the residency showcase. Networking at conferences and through social media platforms, such as LinkedIn, may also open the door to MTM residency opportunities.

Residencies and MTM

The 2019 National Pharmacist Workforce Study found that approximately 41% of pharmacists practicing in the ambulatory care setting completed postgraduate year 1 (PGY1) residencies.² Additionally, 14% completed PGY2 residency programs.² The most common specialties reported in ambulatory care were anticoagulation, endocrinology, hematology/oncology, and primary care.² These results showcase the important role residencies play in enhancing clinical skills.

Johns Hopkins Medicine (JHM) offers a PGY1 community pharmacy residency program that includes MTM throughout the year, along with a focused elective opportunity.³ Other rotations include pharmacy practice, transitions of care, medication safety, residency project, leadership, community involvement and education, and internal medicine ambulatory care.³

Residents at JHM provide comprehensive medication reviews (CMRs) in patients’ homes, through pillbox clinic, and via telephone.³ Additionally, residents have more opportunities such as earning a teaching certificate, collaborating with local pharmacy schools, and participating in a pharmacy service committee.³ The community pharmacy practice sites are located in the hospital, and residents play an important role in the patient discharge process.

During the first months of the COVID-19 pandemic in 2020, the JHM residency adjusted the MTM program to shift toward telephone consults to protect patients and pharmacy staff.⁴ Pharmacy residents also hand-delivered pillboxes to patients’ residences. The residents were able to quickly adjust to the switch from in-person to telephone-based MTM services because they had already developed strong patient interviewing skills during the previous 9 months of their residency experience.⁴ Residency preceptors supervised residents’ CMRs and provided comprehensive feedback. This experience demonstrated that MTM services can still be successfully provided virtually. One of the challenges identified during the switch to virtual care was difficulty finding complex patient cases to enhance pharmacy residents’ skills.⁴

One study evaluated MTM consults provided by PGY2 ambulatory care pharmacy residents to selfinsured employer health plan patients.⁵ Residents submitted notes to the patients’ providers for any medication-related problems (MRPs) that were identified. Residents identified 68 MRPs, and 40 (58.8%) of the clinical recommendations were accepted by the providers.⁵

The economic impact of PGY1 pharmacy residents performing MTM consults in an assisted living facility was evaluated in a 184-day prospective study.⁶ There were 53 patients with an average age of 85 years enrolled in the study.6 Patients were taking an average of 12 medications, including both prescription and OTC medications. Primary care providers accepted approximately 90% of all addressed clinical recommendations from pharmacy residents.⁶ The net cost-benefit was $1550 by incorporating pharmacy residents as part of the health care team.⁶

REFERENCES

1. Thomas DJ, Tran J. Information on MTM concentrated residencies. In: Thomas DJ, Tran J, eds. The Medication Therapy Management Pharmacist Reference Book. The National Board of Medication Therapy Management; 2020. Accessed May 28, 2024. https://www.nbmtm.org/mtm-reference/information-mtm-concentratedresidencies/

2. Bakken BK, Bozymski KM, Foster B, et al. Ambulatory care pharmacy practice: findings from the 2019 National Pharmacist Workforce Survey. Am J Health Syst Pharm. 2023;80(5):284-295.doi:10.1093/ajhp.zxac352

3. PGY1 Community-Based Pharmacy Residency Program. Johns Hopkins Care at Home. Accessed May 28, 2024. https://www.hopkinsmedicine.org/care-at-home/community-pharmacy/residency/pgy1-community-based-pharmacy-residency-program

4. Pennock D, Barbour L, Green R, Fu D. A medication therapy management residency rotation adjusts to coronavirus disease 2019 constraints. J Am Pharm Assoc (2003). 2021;61(4S):S7-S11.doi:10.1016/j.japh.2021.01.024

5. Vande Griend J, Fixen DR, Fixen CW, Zupec J, Saseen JJ. Cliniclevel population health intervention by PGY2 ambulatory care pharmacy residents to optimize medication management in a self-insured employer health plan population. J Pharm Pract. 2018;31(1):52-57. doi:10.1177/0897190017698057

6. Maack B, Miller DR, Johnson T, Dewey M. Economic impact of a pharmacy resident in an assisted living facility–based medication therapy management program. Ann Pharmacother. 2008;42(11):1613-1620. doi:10.1345/aph.1L191