MTM Reduces Hospitalizations for Some Home Health Patients

Medication therapy management by phone reduced hospitalizations in home health care patients with the lowest baseline risk of hospitalization but not overall, according to the results of a new study.

Medication therapy management (MTM) conducted by phone may help home health care patients with a low baseline risk for hospitalization stay out of the hospital, according to the results of a new study. The intervention did not reduce overall hospitalizations, however, suggesting that MTM by phone may not be effective for patients with more severe conditions requiring more intensive care.

A number of studies have evaluated the effectiveness of pharmacist-led MTM, but their conclusions have varied, raising questions as to how the service should be provided to ensure the maximum benefit for patients. As stakeholders are placing increased emphasis on improving quality of care while reducing costs, the current study, published online on April 9, 2014, in Health Services Research, assessed the efficacy of pharmacist-led telephone MTM at reducing hospitalizations in Medicare patients entering home health care.

Patients newly admitted to a random sample of 40 home health care centers were randomly enrolled in the trial and were assigned to receive either MTM or usual care. Pharmacists called patients in the MTM group and completed a medication therapy review that involved identifying medication-related problems, creating a written personal medication record for the patient and providers, and developing a medication action plan. Seven days after the initial phone call, patients received a follow-up call from the pharmacist. Additional follow-up via telephone was provided as needed during the first 30 days of the 60-day home health care program.

In the MTM sessions, pharmacists identified 460 medication-related problems, 414 (90%) of which were resolved. Despite the high percentage of medication corrections, the MTM intervention did not reduce 60-day all cause hospitalizations compared with the control group. However, among patients with the lowest baseline risk for hospitalization, those who received the MTM intervention had just a third the hospitalization rate at 60 days.

Similar results were observed for hospitalizations at 30 days. No significant difference in 30-day all-cause hospitalizations was found between the intervention and control groups among all patients. But patients in the MTM group who were also in the quartile with the lowest risk were 6 times less likely to be hospitalized at 30 days than were those in the control group. The results also indicated that time to first hospitalization was not significantly different in the MTM group compared with those in the control group, overall, but was longer for patients in the quartile with the lowest risk who received MTM.

The study authors suggest that the telephone MTM intervention may only be effective in patients with the ability to manage their medications somewhat independently.

“In contrast, for those patients who require more intensive assistance to take medication, this telephonic MTM program may not be sufficient to overcome the needs of these patients,” they write.