MTM - Medication Therapy Management for
Pharmacists and Their Patients
Modern drugs
empower us to manage our illnesses and prolong our lives. But like other
powerful tools, medications must be handled with care.
According to
the American Pharmacists Association’s (APhA) “What is Medication Therapy
Management” webpage, 1,500,000 preventable accidents related to medication
occur every year. These accidents result in injury and sometimes death. This
problem costs our economy $1,770,000,000 a year, and to push back against it,
pharmacists have come together around a strategy called Medication Therapy
Management, or MTM.
OutcomesMTM is one organization that connects over 65,000 pharmacists,
trained by the company. Community pharmacies, clinics and private medical
practices are linked to provide better management of medications.
According to the APhA website article OutcomesMTM: Creating an ‘Everyday, Every-hour’ Business Model, Chief
Executive Officer Tom Halterman and Chief Operating Officer Patty Kumbera began
their careers as pharmacists at two different Walgreens in Des Moines Iowa.
They found themselves putting in many extra hours talking to doctors about how
to straighten out their patients’ conflicting prescriptions.
After they created OutcomesMTM they were able to lower the costs of insurance providers and improve
the ultimate outcome for patients. They call this “MTM on an everyday,
every-hour basis,” according to Halterman.
Pharmacy Today
in a profile on OutcomesMTM states, “The impact associated with the
implementation and development of this business model includes lowered costs,
reduced medication risks, improved prescription and medication therapy
adherence, and overall health improvement.”
Sade Osotimehin, PharmD, signed up with OutcomesMTM.
She works at a Walgreens in Baltimore. For Osotimehin, “job satisfaction has
increased ‘1,000 percent’ since becoming an OutcomesMTM provider. “It’s
rewarding to utilize the knowledge from 6 or 7 years of school to help
patients,” Osotimehin said.
Students at the
College of Pharmacy at the University of Texas in Austin (UTEXAS) are learning
to use and implement the MTM model. The Pharmacy College is teaching an MTM
Services certificate training program developed by APhA. Students learn
communication skills to work with patients and customers. They are trained to
identify problems related to patients’ prescribed medication.
Students
“develop and implement interventions… self-study modules, case studies,
hands-on patient interviews, and assessment practice sessions, (to) obtain the
clinical knowledge and skills needed to establish medication therapy management
services,” according to the UTEXAS Medication Therapy Management Services
webpage.
A Pharmacy
Times website article titled “Core elements of Medication Therapy Management” notes that students at UTEXAS also internalize the five core MTM
concepts created by the APhA and the National Association of Chain Drug Stores
(NACDS) for certain patients with more than one chronic disease, who are on
multiple medications, and have high expenses for their different medications.
The concepts include:
A one-year comprehensive medication
review that includes reviewing all drugs, dietary supplements and herbal
medicines being taken by the patient.
Creating a written record including
medicines being taken, strengths and weaknesses of the patient, and likely
future issues.
Creating a medication action plan,
“strategies to maximize the benefits of his or her medication therapy,”
according to Rankin.
An
intervention strategy to prevent injuries and avoid any medication related
problems that may come up.
Documenting
services and doing follow-ups to ensure that patients get the best benefits of
the medicine they are taking.
Medication
Safety Pharmacist, Diane Schultz is with the Seattle based Group Health Central
Hospital. She had created an MTM formula: Listen, Empathize, Apologize and
Follow Up. The formula ensures that no patient feels left out or unheard,
according to Pharmacy Today. Jim Carlson, also with Group Health Central,
states, “We want pharmacists to fully engage
with (the patient) and complete the four-step process. Otherwise, we may fix a
specific problem, but leave the patient thinking that no one really cares about
them.”
The Associate
Dean of the University of Georgia’s College of Pharmacy Dr. George Francisco in
a phone interview said pharmacists should practice “due diligence” and do the
most they can to help patients before they leave the store. A pharmacists needs
to connect to the patients by talking with them and making them feel involved.
According to Dr. Francisco, a pharmacist wants to make a good connection with
the patient, so that everything runs efficiently from the doctor providing the
prescription, to the pharmacist selling the medicine, to the patient buying and
using the medicine.
OutcomesMTM’s strategy of “creating
an ‘everyday, every-hour’ business model,” pays off for patients. One patient of
Sade Osotimehin at Walgreens in Baltimore stopped taking her medication
regularly, and when Osotimehin contacted the patient, she found that the doctor
had switched the patient from a drug that cost five dollars to one that cost
$50. The patient had to choose between groceries and medication. Since
Walgreens and the patient’s insurer were both working with OutcomesMTM,
Osotimehin was able to call the doctor and reduce the cost of the drug.
A study was done at the University of North Carolina on MTM practices. The school partnered with
a regional pharmacy chain, Kerr Drug to find strategies to reduce Medicaid
costs. As a result of the study, “MTM services helped the North Carolina
Medicaid program save on average $9,444 annually – an average cost savings of
$107 per beneficiary,” according to an Industry News Release titled Study
Reveals Pharmacist-Provided MTM Services Help Improve Patient Health, Reduce
Medicaid Costs.
Managed Care
Pharmacy’s Success Stories webpage cites one patient’s
story. Daisy was seeing multiple doctors and taking multiple medications. She was
treated for heart failure, coronary artery disease, diabetes, high cholesterol,
hypertension, arthritis, chronic renal insufficiency and chronic lung disease.
Daisy’s doctor prescribed metformin, a
drug used to combat diabetes, but she learned through a pharmacist that metformin
causes respiratory and heart problems for a person with renal insufficiency.
Humana’s MTM based Rx Mentor program put
pharmacist Abby Durrett, PharmD, a Board Certified Pharmacotherapy Specialist,
in touch with Daisy, Durrett gathered information from Daisy, consulted with
her doctors and established better lines of communication. This counseling and
guidance from
Durrett made Daisy’s doctor drop
metformin from her treatment.
Technology and
better communications are changing services and taking pharmaceutical service
to a new level. MTM has proven itself as an effective tool in
delivering patient medication. When physicians and pharmacists work together
with patients, and lines of communication are clear, the medications patients
take are safer and more effective and they are delivered at a lower cost, according to the AphA website.
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