Skilled pharmacists lead state MTM programs to better patient care

May 1, 2009

When state medication therapy management programs (MTMs) tap into pharmacists' clinical skills, patient outcomes improve and drug therapy errors decline significantly.

Key Points

A pharmacist-led medication therapy management (MTM) program in Minnesota resolved almost 800 drug-therapy problems in the first year it was implemented, and pharmacists were paid $39,866 to provide these MTM services.

Called the Medication Therapy Management Care Program, the initiative serves recipients of Medicaid and General Assistance Medical Care, a state program for low-income adults 21 to 64 years of age, who have no dependent children under the age of 18 and do not qualify for federal healthcare programs.

According to Lisa Diagle, policy analyst for the American Society of Health-System Pharmacists (ASHP), state health programs like the one run by pharmacists in Minnesota have several advantages.

ASHP reviewed 11 programs in 9 states (Florida, Iowa, Minnesota, Mississippi, Montana, North Carolina, Ohio, Vermont, and Wyoming), all centered on ways state MTM programs tap into pharmacists' clinical skills to improve patient outcomes. Through these programs, pharmacists have demonstrated their ability to deliver MTM services. Although these programs took various approaches to management, billing, and eligibility, they shared some key characteristics:

"State health programs that utilize pharmacists to provide MTM services are key to resolving patients' drug-therapy problems and reducing healthcare expenditures," ASHP's Diagle said.

"For example, in the first year of Minnesota's Medication Therapy Management Care program, 34 pharmacists provided MTM services to 259 patients and resolved 789 drug therapy problems, 3.1 per patient. Many of the programs ASHP identified were using pharmacists to help manage drug therapy for patients with multiple chronic conditions who take multiple medications."

She added, "As the medication experts, pharmacists are uniquely suited for this role."

Iowa's Pharmaceutical Case Management program is another example of a successful state MTM program. In all, Iowa pharmacists met with 943 patients, sent recommendations to physicians for 500 of them, and detected an average of 2.6 medication-related problems per patient. Pharmacists recommended new medications in 52 percent of these patients. Data showed that during the fiscal years 2002 through 2005, $254,797 was paid for pharmaceutical case management, with $241,784 paid to pharmacists.

Getting involved

To become involved in such programs, Diagle suggests pharmacists contact their state departments or offices that provide healthcare programs, including their state's department of health, human services, or aging. In addition, she said, most of the programs identified by ASHP provide services for Medicaid patients, so contacting the state's Medicaid office would also be helpful.

"If a similar program does not exist in the pharmacist's state, he or she can talk with peers and with the state's pharmacist organization to see if there is interest in creating such a program. Once interest in creating a program is established, faculty from the state's school of pharmacy should be engaged, as should state legislators," Diagle said.

Pharmacists looking to learn more about the MTM services provided in state health programs can learn more by accessing ASHP's policy analysis paper on this topic at http://www.ashp.org/.

Campaign 2011: MTM for the elderly

The American Society of Consultant Pharmacists (ASCP) has rolled out a multifaceted initiative program known as Campaign 2011. The program is designed to:

Claudia Schlosberg, JD, ASCP's director of policy and advocacy, explained that Campaign 2011 was conceived "to raise awareness that medications, while incredibly important, are also the cause of many problems. In our country, we spend a lot of money on medications, but we also spend an almost equal amount in resolving the problems caused by medications. ASCP wants to raise awareness because pharmacists play an important role in addressing these problems."

Pharmacists' clinical knowledge is not widely known, Schlosberg added. "People really don't understand what pharmacists do or the level of education that they have. Pharmacists are the medication experts. Ten years ago, the Institute of Medicine talked about utilizing pharmacist expertise in our healthcare system, but we're really not doing that."

ASCP is a 40-year-old professional association representing approximately 7,000 pharmacists who specialize in providing clinical geriatric care. "Our passion is promoting the appropriate, safe, and effective use of medications in the elderly," Schlosberg said.

In connection with safety, ASCP has noted that up to 24 percent of drug use by seniors may be inappropriate or unnecessary, and thousands of seniors suffer from medication-related problems each year, with the annual cost of treatment exceeding $200 billion.

ASCP rolled out Campaign 2011 during its annual meeting in New Orleans in November 2008. Working through state chapters and several workshop sites in Florida and Washington, ASCP will use Campaign 2011 to pursue leadership initiatives, strengthen grassroots advocacy, advance a legislative platform, and push for improved senior care and increased availability of MTM.

The year 2011 refers to the year the first baby boomers turn 65 and become eligible for Medicare, Schlosberg said, adding that in the next 20 to 30 years, the number of individuals age 65 and over is expected to double.

Pharmacists are the solution

ASCP hopes Campaign 2011 will make the public aware of both the problem and its solution.

"Pharmacists are uniquely positioned to ensure the safe, effective, and appropriate use of medication by older adults," Schlosberg said. "Pharmacists are the medication experts. I don't think people realize that many pharmacists have a focus on clinical assessment and evaluation of medication use and the medication process. The Institute of Medicine said it best: 'Because of the immense variety and complexity of medications now available, it's impossible for nurses and physicians to keep up with all the information required for safe medication use.

"The pharmacist has become an essential resource, and access to his or her expertise must be made possible at all times,'" she said.

"There is no other healthcare professional who spends as much time and is as focused on medications as the pharmacist."

Liz Meszaros is a freelance writer in eastern Pa.