AHRQ analysis finds MTM benefit lacking

January 2, 2014

A draft review sponsored by the Agency for Healthcare Research and Quality (AHRQ) found insufficient evidence for medication therapy management (MTM) effect on most outcomes.

An extensive literature search of more than 2,200 records of articles on MTM was narrowed to 36 studies in 42 articles. Of these, “only a few studies were of low risk of bias,” according to the authors of the draft review.

Among its findings, for a few outcomes there was low strength evidence for MTM resulting in improvement over usual care. Those included “medication appropriateness, the rate of hospitalization among heart failure patients with home medicines review, and the use of generic medications for patients receiving MTM from community pharmacy when compared with educational mailings.”

However, the draft also said there is sufficient evidence that there is no MTM benefit for some outcomes. That included low strength evidence in settings with a broad range of patients in which MTM does not reduce hospitalizations and does not improve most health-related measures of quality of life.

The authors of the draft were unable to include in their review a large evaluation of MTM done by Acumen LLC for the Centers for Medicare and Medicaid Services because it came out recently. That report found MTM led to improved patient adherence and quality of prescribing. In contrast, the AHRQ draft did not find enough evidence on improved adherence. But, the draft said, among other comparisons, “we did find low strength of evidence that MTM improves medication appropriateness, which is conceptually similar to ‘quality of prescribing.’”

In addition, a systematic review by M.A. Chisholm-Burns and others in Medical Care in 2010 found pharmacists’ direct patient care had favorable effects. But, according to the draft review for AHRQ, that analysis included all kinds of pharmacists’ involvement in direct care, not just MTM.

“Investment in new research should be preceded by a careful consideration of goals of research,” according to the draft review for AHRQ.  It cautioned: “Studies focusing on causal claims require a strong theoretical foundation, an a priori statement of expected direction of effect that accounts for goals of therapy for each patient, and the use of designs that avoid confounding.”

The comment period for the draft report ends January 6. To access the draft review and comment, click here.