There exists a need for a standard of care to ensure that each patient's medications are appropriate, effective, safe, and able to be taken as intended. Medication therapy management (MTM) is a professional service that can help meet this need. Although the practice of providing comprehensive MTM services by phone has many positive attributes, there are many challenges associated with this type of intervention.
There exists a need for a standard of care to ensure that each patient’s medications are appropriate, effective, safe, and able to be taken as intended. Medication therapy management (MTM) is a professional service that can help meet this need. Although the practice of providing comprehensive MTM services by phone has many positive attributes, there are many challenges associated with this type of intervention.
In a session entitled “A Comparison of Telephonic vs. Face-to-Face MTM Services,” researchers reviewed the need for medication therapy management, described the processes of delivering this service via phone and face-to-face to patients, identified the challenges associated with these methods, and examined the differences and similarities in outcomes in terms of prescription claims cost, adherence, and return on investment.
Because 80% of all treatments involve medication, a standard of care is needed that ensures that each patient’s medications are appropriate, effective, safe, and able to be taken as intended. MTM is a professional service to the patient, and it must be clearly defined and well executed, or the method of delivery can interfere with the outcomes.
The presenters on this topic, who were introduced by moderator Renee Fleming, PRN Managed Care Consulting Services, LLC, included Linda Strand, PharmD, PhD; Tom Albers, RPh; and Alisa Thomas, PharmD, BCPS. According to the panelists, the value of pharmacy lies in the evaluation of problems related to drug therapy. In order to have a measurable impact, and to be cost-effective, pharmacists need to diagnose drug therapy problems such as issues with indication, safety, and compliance.
Face-to-face MTM is frequently integrated as part of total patient care, and there are many positive attributes to these types of services. Face-to-face MTM can provide practitioners with many of the parameters they need to assess patient response, the presenters noted. Because practitioners and patients are in the same physical vicinity, face-to-face services provide more of an opportunity to establish a therapeutic relationship, which is especially beneficial if this interaction keeps the patient in close proximity to other care providers. Lastly, by conducting a face-to-face assessment of a patient’s medication regimen, the pharmacist has a better opportunity to collect the results of laboratory tests and values of clinical parameters that may be crucial to a positive health outcome.
A major challenge related to face-to-face MTM is that the space and time needed for a thorough medication assessment may not be readily available for pharmacists, especially in the retail setting, noted Alisa Thomas, PharmD, BCPS. Pharmacists who perform MTM tasks in addition to their regular work duties may not be able to provide a thorough assessment, and there are a limited number of pharmacists who are trained to provide these services. Patient mobility barriers to face-to-face inventions should also be considered.
According to researchers, 60% of patients actually prefer phone MTM service over face-to-face MTM. Member demographic and prescription profiles provide a complete picture of what is going on with the patient, and connecting via telephone is a way to reach more of these patients for longer periods of time without as many interruptions.
Although the practice of providing comprehensive medication management services by phone has many positive attributes, and allows the patient to gather all of his or her medication bottles for a consultation from home in any part of the country, there are many challenges associated with this type of intervention. First, the pharmacist has to get in contact with the patient via an accurate phone number and then convince the patient that they are not selling anything; instead, the pharmacist is providing a service that the patient wants. Second, there is a limit to the lab values and clinical information that can be obtained for or from the patient. Lastly, it may be difficult for a pharmacist to conduct a phone session if the patient claims that he or she does not have time for a comprehensive overview.
Evaluating and collecting clinical outcomes data via the phone method can be difficult. The data are subjective; however, healthcare providers can still evaluate the patient’s response to drug therapy through a comparison of values (eg, A1C levels recorded by the patient). Phone consultations can help to clear up the lack of knowledge associated with expected clinical outcomes. The researchers on the panel at the Academy of Managed Care Pharmacy’s Educational Conference 2012 noted that of 249 patients who completed surveys, 70% said they found phone medication therapy management service helpful, and 40% said changes to their medications were made as a result of the support.
The researchers reported that the economic impact of phone versus face-to-face MTM services is very similar. Also, Dr Thomas noted that “The number and type of drug therapy problems found is the same if done in each setting by a qualified pharmacist using the same standard of care.”