Tip of the Week: Predicting MTM Completion Rates With Planned Behavior Variables

Medication therapy management (MTM) is a health care service provided by pharmacists to help patients manage their chronic diseases by managing their drug therapies, identify medication-related errors, and improve patients’ health outcomes. It has been estimated that approximately 1.5 million preventable adverse events occur each year, resulting in $177 billion in death and injury in the United States. Despite the benefits of these services, their practice is not yet commonplace. The top 6 barriers to their performance have been reported as: insufficient time, insufficiently trained staff, difficulty in billing, challenges in documentation, and organizational focus on high-volume dispensing.¹

Investigators recently examined MTM completion rates under the lens of the theory of planned behavior, which posits that a behavior—performance of MTM, for example—can be explained or perhaps predicted by intention to engage in that behavior, self-efficacy for doing so, subjective norms, and other variables. Study results published in the Journal of the American Pharmacists Association (JAPhA) showed among other things that pharmacy technician involvement can increase MTM completion rates and minimize pharmacists’ barriers in completing medication reviews for their patients. The results also suggest that pharmacy technicians are willing to help with MTM services if they receive proper training and are provided more time and support during work hours. Investigators also found that pharmacies with full-time pharmacists who had more positive attitudes towards MTM delivery significantly outperformed pharmacies with pharmacists who had negative attitudes and less involvement with MTM.²

Pharmacy is making strides toward delivering upon its promise of a more patient-centric practice. The landscape, mechanisms of reimbursement, the general design of pharmacy practice, and inertia all have been countering forces in delivering on this promise. However, changes have been afoot, and pharmacy must seize impending opportunities. Moreover, even against prevailing winds that have slowed the evolution of consistent MTM practice, there has been variability, meaning that providing MTM services is more common among some pharmacies and some pharmacists than in others.

The study found that self-efficacy (somewhat akin to confidence) and attitudes about MTM make a considerable difference in MTM practice even in the face of those prevailing winds. Therefore, recognizing the need and value in MTM can facilitate its conduct.² Managers, through direct 1-on-1 supervision, and through the support of additional continuing education and training of pharmacy personnel, can encourage the attitudes and skills necessary to deliver MTM services. Proper deployment of personnel and a consistent message to them that their doing so is of value to the pharmacy organization and will be rewarded all will go a long way into transforming practice.

Support from pharmacy management and increased job satisfaction for pharmacy technicians can improve MTM programs. This can come in the form of career laddering and slight bumps in salary, more for its intrinsic than its extrinsic benefit.

Additional information about Operations Management and Pharmacy Technicians can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.

Ashley Saclolo-Torres is a PharmD candidate at Touro University California College of Pharmacy in Vallejo.

Shane Desselle, RPh, PhD, FAPhA, is a professor of social and behavioral pharmacy at Touro University California College of Pharmacy.

REFERENCES

1. Medication therapy management (MTM) Services. Retrieved March 09, 2021, from https://www.pharmacist.com/medication-therapy-management-services.
2. Adeoye OA, Lake LM, Lourens SG, Morris RE, Snyder ME. What predicts medication therapy management completion rates? The role of community pharmacy staff characteristics and beliefs about medication therapy management. J Am Pharm Assoc. 2018. 15(4):S7-S15.