Safety-Focused Medication Therapy Management: A Randomized Controlled Trial
Journal of the American Pharmacists Association (Impact Factor: 1.24). 09/2012; 52(5):603-12. DOI: 10.1331/JAPhA.2012.12036
OBJECTIVE To evaluate the effect of a medication therapy management (MTM) intervention on adverse drug events (ADEs), health care visits, and drug-related problems (DRPs). DESIGN Randomized, controlled, clinical trial. SETTING Academic medical center community pharmacies and family medicine clinics at three U.S. sites between December 2007 and January 2010 PATIENTS Individuals aged 65 years or older with three or more chronic illnesses, six or more prescription medications, and at risk for a DRP. INTERVENTION At 0 and 3 months, pharmacists conducted comprehensive medication reviews and screened for and resolved DRPs through patient education and recommendations to physicians. MAIN OUTCOME MEASURES Frequency of ADEs reported by patients and confirmed by clinical algorithm, health care visits at 3 and 6 months, and number of DRPs, pharmacist recommendations, and medication discrepancies. RESULTS 637 participants enrolled. No differences were observed in potential ADEs or health care visits among the usual care and MTM groups. DRPs declined in both MTM intervention groups over time. Physicians responded to 54.6% of pharmacist recommendations. Enhanced MTM patients had fewer medication list discrepancies than basic MTM patients (33.8% vs. 47.1%, P < 0.001). CONCLUSION This specific design of MTM was associated with reduced DRPs but did not reduce potential ADEs or health care visits.
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ABSTRACT: One of the basic questions in the early uses of pharmacogenetic (PGx) testing revolves around the clinical delivery of testing. Because multiple health professionals may play a role in the delivery of PGx testing, various clinical delivery models have begun to be studied. We propose that a partnership between genetic counselors and pharmacists can assist clinicians in the delivery of comprehensive PGx services. Based on their expert knowledge of pharmacokinetics and pharmacodynamics, pharmacists can facilitate the appropriate application of PGx test results to adjust medication use as warranted and act as a liaison to the healthcare team recommending changes in medication based on test results and patient input. Genetic counselors are well-trained in genetics as well as risk communication and counseling methodology, but have limited knowledge of pharmaceuticals. The complementary knowledge and skill set supports the partnership between genetic counselors and pharmacists to provide effective PGx testing services.
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ABSTRACT: Objective To evaluate the effectiveness of a telephonic medication therapy management (MTM) service on reducing hospitalizations among home health patients.SettingForty randomly selected, geographically diverse home health care centers in the United States.DesignTwo-stage, randomized, controlled trial with 60-day follow-up. All Medicare- insured home health care patients were eligible to participate. Twenty-eight consecutive patients within each care center were recruited and randomized to usual care or MTM intervention. The MTM intervention consisted of the following: (1) initial phone call by a pharmacy technician to verify active medications; (2) pharmacist-provided medication regimen review by telephone; and (3) follow-up pharmacist phone calls at day seven and as needed for 30 days. The primary outcome was 60-day all-cause hospitalization.Data CollectionData were collected from in-home nursing assessments using the OASIS-C. Multivariate logistic regression modeled the effect of the MTM intervention on the probability of hospitalization while adjusting for patients’ baseline risk of hospitalization, number of medications taken daily, and other OASIS-C data elements.Principal FindingsA total of 895 patients (intervention n = 415, control n = 480) were block-randomized to the intervention or usual care. There was no significant difference in the 60-day probability of hospitalization between the MTM intervention and control groups (Adjusted OR: 1.26, 95 percent CI: 0.89–1.77, p = .19). For patients within the lowest baseline risk quartile (n = 232), the intervention group was three times more likely to remain out of the hospital at 60 days (Adjusted OR: 3.79, 95 percent CI: 1.35–10.57, p = .01) compared to the usual care group.Conclusions This MTM intervention may not be effective for all home health patients; however, for those patients with the lowest-risk profile, the MTM intervention prevented patients from being hospitalized at 60 days.
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ABSTRACT: For over 20 years, researchers wanting to record, discuss and compare drug-related problems (DRPs) have had the task of choosing between a multiplicity of classification systems offering a variable number of categories identified as causes of DRPs and DRPs. To characterise studies which have reported DRPs through the use of a DRP classification system to determine types of classification systems chosen, factors influencing their choice, and methodological issues that may have affected their application. A systematic search of MEDLINE, CINAHL, International Pharmaceutical Abstracts (Ovid), EMBASE and PubMed was performed. All English language studies reporting DRPs through the use of a classification system published between January 2000 and July 2013 were reviewed, with no limitation on the type of study. Of 2,774 articles screened, 268 met our inclusion criteria. We identified the use of 20 different types of DRP classification systems. Three quarters of studies modified an existing classification system or developed their own. Few studies stated reasons for choice of system. We identified issues such as variability in skills of data collectors, selective choice of patients and missing data, affecting application of classification systems and limiting quality, analysis and comparison of studies. There appeared to be no consensus on preference or structure of classification systems. Future studies should consider addressing or acknowledging the methodological issues identified. Through identification and discussion of these problems, recommendations for future studies and for practice have been made.
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