Special Feature
Medication therapy management in pharmacy practice: Core elements of an MTM service model (version 2.0)

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Abstract

Objective

To further develop the service model for medication therapy management (MTM) delivery by pharmacists in settings where patients or their caregivers can be actively involved in managing their medications.

Data sources

Peer-reviewed literature, structured discussions with pharmacy leaders from diverse patient care settings, input from pharmacists and pharmacy associations, recommendations on patient-centered documents (personal medication record and medication-related action plan) from experts in the field of health literacy, and incorporation of extensive feedback received during an extended public comment period open to all MTM stakeholders and interested parties.

Summary

Built on an MTM consensus definition adopted by 11 national pharmacy organizations in July 2004, Medication Therapy Management in Community Pharmacy Practice: Core Elements of an MTM Service (Version 1.0) described core elements of an MTM service model that can be provided by pharmacists across the spectrum of community pharmacy. Version 2.0 of that model, presented in this article, maintains the original five core elements of an MTM service: medication therapy review (MTR), a personal medication record (PMR), a medication-related action plan (MAP), intervention and referral, and documentation and follow-up. The MTR can be comprehensive or targeted, depending on the needs of the patient. In Version 2.0, the PMR and MAP have been redesigned with the assistance of a health literacy expert to be more “patient friendly,” effective, and efficient for patients to use in medication self-management.

Conclusion

The developing service model presented in this article for use by pharmacists involved in providing MTM services in diverse patient care settings consists of five core elements. The service model provides a consistent and recognizable framework for MTM service delivery by pharmacists that enhances efficient delivery of the service and improves patient outcomes.

Section snippets

Framework for pharmacist-provided MTM services

This framework for MTM service delivery in pharmacy practice is designed to facilitate collaboration among the pharmacist, patient, physician, and other health care professionals to promote safe and effective medication use and achieve optimal patient outcomes. MTM services in all patient care settings should include structures supporting the establishment and maintenance of the patient–pharmacist relationship.

Providing MTM services in various patient care settings

Patients with a potential need for MTM services can be identified by the pharmacist, physician, or other health care professionals; the health plan; or patients themselves when medication-related problems are suspected. Appendix 4 provides considerations for identification of patients who may benefit from MTM services. Patients may be especially vulnerable to medication-related problems during transitions of care, such as when their health care setting changes, when they change physicians, or

The delivery of MTM services by the pharmacist

Within the MTM core elements service model, the patient receives an annual comprehensive medication therapy review and additional medication therapy reviews according to the patient's needs. The patient may require ongoing monitoring by the pharmacist to address new or recurring medication-related problems.

The total number of reviews required to successfully manage a patient's therapy will vary from patient to patient and will be ultimately determined by the complexity of the individual

Core elements of an MTM service model in pharmacy practice

The MTM service model in pharmacy practice includes the following five core elements:

  • Medication therapy review (MTR)

  • Personal medication record (PMR)

  • Medication-related action plan (MAP)

  • Intervention and/or referral

  • Documentation and follow-up

These five core elements form a framework for the delivery of MTM services in pharmacy practice. Every core element is integral to the provision of MTM; however, the sequence and delivery of the core elements may be modified to meet an individual patient's

External communication of MTM documentation

Following documentation of the MTM encounter, appropriate external communication should be provided or sent to key audiences, including patients, physicians, and payers. Providing the patient with applicable documentation that he or she can easily understand is vital to facilitating active involvement in the care process. Documentation provided to the patient at the MTM encounter may include the PMR, MAP, and additional education materials. Documentation to physicians and other health care

Follow-up

When a patient's care setting changes (e.g., hospital admission, hospital to home, hospital to long-term care facility, home to long-term care facility), the pharmacist transitions the patient to another pharmacist in the patient's new care setting to facilitate continued MTM services. In these situations, the initial pharmacist providing MTM services participates cooperatively with the patient's new pharmacist provider to facilitate the coordinated transition of the patient, including the

Conclusion

The MTM core elements, as presented in this document, are intended to be applicable to patients in all care settings where the patients or their caregivers can be actively involved with managing their medication therapy, taking full advantage of the pharmacist's role as the “medication therapy expert.” Figure 3 presents a flow chart of the core elements of an MTM service model contained in this document. As the core elements service model continues to evolve to meet diverse patient needs,

References (40)

  • M.S. McGivney et al.

    Medication therapy management: its relationship to patient counseling, disease management, and pharmaceutical care

    J Am Pharm Assoc

    (2007)
  • Institute of Medicine. Report brief: preventing medication errors

    (1 September 2007)
  • Centers for Medicare & Medicaid Services. Medicare Prescription Drug Benefit final rule: 42 CFR parts 400, 403, 411, 417, and 423 Medicare Program. Federal Register. 2005;70(18): January 28

    (1 September 2007)
  • C.W. Cranor et al.

    The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program

    J Am Pharm Assoc

    (2003)
  • B.A. Bunting et al.

    The Asheville Project: long-term clinical, humanistic, and economic outcomes of a community-based medication therapy management program for asthma

    J Am Pharm Assoc

    (2003)
  • J. Jameson et al.

    The impact of a pharmacotherapy consultation on the cost and outcome of medical therapy

    J Fam Pract

    (1995)
  • H.L. Lipton et al.

    The impact of clinical pharmacists' consultations on physicians' geriatric drug prescribing

    Med Care

    (1992)
  • G.T. Schumock et al.

    Evidence of the economic benefit of clinical pharmacy services: 1996–2000

    Pharmacotherapy

    (2003)
  • Minnesota Department of Human Services. MHCP enrolled providers

    (5 February 2007)
  • K. Traynor

    Wyoming program brings pharmacist consultations home

    Am J Health Syst Pharm

    (2004)
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    Developed through a joint initiative of the American Pharmacists Association and the National Association of Chain Drug Stores Foundation.

    Disclosure: The organizations declare no conflicts of interest regarding products or services discussed in this manuscript. The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.

    Acknowledgments: Individuals and organizations participating in the review of this document are listed in Appendices 1 and 2.

    Copyright © 2008, American Pharmacists Association, Inc., and the National Association of Chain Drug Stores Foundation, Inc. All rights reserved.

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