Medication Therapy Management (MTM)
For more than three decades, individuals within the pharmacy profession have advocated a vision for the more effective use of pharmacists to address medication use problems which most logically fall into the pharmacist’s sphere of expertise and influence. Pharmacy organizations throughout the US have spent millions of dollars over the last several decades to turn this vision into a reality.
MTM has successfully taken hold around the country and is a growing industry. From the North Carolina "Ashville" project to successful business models in California, opportunities for pharmacists to build MTM into their practice flow abounds. The following organizations are leading the charge to implement effective MTM business models around the county:
American Pharmacists Association "MTM Central"
Outcomes Pharmaceuticals Health Care
Outcomes Pharmaceuticals Region 24 Snapshot - 7.16.10
Best Practices
How to Change Your Login Password:
You may have recently received an alert notifying you that new TIPs have been generated for your MTM Center. If you are having difficulty logging in to the Outcomes System because you have forgotten your password or your password has expired, below are a few simple steps to re-gain access to the system and begin acting on your TIPs.
- Go to www.getoutcomes.com, select “Login” and enter your login ID
- Leave the password field blank and click “Forgot your password?”
- You will be prompted to access your email to retrieve a new password. This new password will be sent to the email you have on file with Outcomes.
- The new password is comprised of 8 random characters. Copy the new password from your email and then paste it into the password field of the login page to ensure password accuracy. Note: Be careful not to capture any extra spaces when copying.
- After steps 1-4 are completed you will be prompted to create a custom password for accessing your Outcomes account.
We encourage you to login to the Outcomes System today to complete your pending TIPs and schedule your MTM eligible patients for their annual Comprehensive Medication Review! If you need further assistance in resetting your password or have questions regarding the Targeted Intervention Program, please contact Outcomes at 877.237.0050 or info@getoutcomes.com.
If you have any questions regarding patient eligibility or new opportunities, please contact Outcomes at info@getoutcomes.com or 877.237.0050. Happy New Year!
Feature Encounter
Feature Encounter #1059020 – Diabetes Management
At Ralph’s Pharmacy 111 in Gardena, CA, Outcomes Personal Pharmacist, Michael Marquez, discovered an Outcomes-eligible patient with diabetes had stopped taking an important medication for blood pressure control. The pharmacist educated the patient on the importance of continuing therapy to prevent diabetes-associated complications. The physician was contacted and the order was renewed. The pharmacist’s intervention prevented complications related to poor diabetes management. Good job, Michael!
For additional Feature Encounters, click: Feature Encounters.
Top Pharmacies
- Clinical Pharmacy Interventions - Beverly Hills, CA
- Jupiter Consulting - San Jose, CA
- Raleys Pharmacy 344 - Vacaville, CA
- Davita RX - San Bruno, CA
- Katherine Yep - San Francisco, CA
Pharmacies are rated based on the degree to which they have implemented Outcomes' procedures and services. To view other Top Pharmacies, click: Top Pharmacies.
Provider Update
Impact of hard copy prescription on prescribing rates of low dose aspirin post-AMI or CABG
Low dose aspirin has long been shown to improve outcomes secondary to an acute cardiovascular event. Despite numerous quality initiatives and guideline programs by the American College of Cardiologists, American Heart Association, and The Centers for Medicare and Medicaid, many patients hospitalized with acute cardiovascular events are not discharged on aspirin. A recent study in the Journal of Managed Care Pharmacy aimed to determine if providing a hard copy prescription for low-dose aspirin would increase the likelihood that patients hospitalized with Acute Myocardial Infarction (AMI) or Coronary Artery Bypass Graft surgery (CABG) would be discharged on the medication. The post intervention group consisted of patients who were admitted with an identified AMI or patients admitted who were scheduled to have CABG surgery. Patients over the age of 18 with no contraindications to aspirin use were selected to participate and subsequently had a prescription for aspirin placed in their chart. The central measure of the study was presence of aspirin on the discharge medication list. A retrospective pre-intervention group of AMI and CABG patients who had no aspirin prescription placed in their charts was used as a comparator group. The study found that 98.9% of patients in the post intervention group had aspirin on their discharge medication list as compared to 94.9% in the pre intervention group. The difference between the pre and post intervention groups may have been small yet the impact this intervention has on continuity of care is immeasurable.
Post AMI and CABG patients may present to the pharmacy with a handful of new prescriptions; however, being an OTC medication, aspirin can often fall through the cracks. For an Outcomes eligible patient post AMI or CABG without an order for aspirin, an Outcomes Personal Pharmacist should recommend to the patient initiation of low dose aspirin therapy for the prevention of further cardiovascular events. This MTM service would be documented as outlined below:
1. Reason – OTC Therapy (117)
2. Action – Patient Education & Monitoring (210)
3. Result – Therapeutic Success (310) or Therapeutic Failure (320)
For more information, click here.
Medication education and personalized monitoring key to improving adherence
Adherence with therapy continues to be a challenge for both patients and their health care providers. One study reported as many as 26% of hospitalizations are due to medication nonadherence in patients 75 years of age or older. A recent meta analysis published in JAPhA identified the many challenges to patient adherence and potential solutions that are feasible in every-day pharmacy practice. Nonadherence to therapy may have multiple underlying causes, including adverse effects, complex dosing regimens, asymptomatic disease states, family/cultural issues, cost, special administration techniques, and health literacy. Because there is often times no single underlying cause to explain why a patient is nonadherent, a multi-faceted individually tailored intervention is necessary. One study included in the review reported a positive effect from pharmacist intervention, through standardized medication education combined with regular personalized follow-up and compliance packag ing, on adherence and persistence rates for patients aged 65 or older with at least four chronic medications for coronary disease. In addition, patients are more likely to adhere to therapy if they know they are being monitored - "white coat effect".
Pharmacists are uniquely positioned to monitor refill rates and establish an open relationship with patients. By initiating one-on-one follow-up with patients who have been identified as underusing therapy, pharmacists can help patients identify barriers to adherence and develop a solution to meet each individual patient's needs. Providing enhanced education and monitoring for patients initiating new therapy will help the patient to get off to the right start and identify any potential adherence issues early on. In addition, TIPs distributed via the Outcomes Targeted Intervention Program can help pharmacists identify patients with a potential pattern of underuse.
For an Outcomes-covered patient identified as underusing therapy, an Outcomes Personal Pharmacist should consult with the patient to discern why the patient is nonadherent and work with the patient to develop a solution to keep them on track. To demonstrate a change in behavior, the pharmacist should then monitor the patient's next refill or follow-up with the patient in a few weeks to determine if compliance has been altered. This MTM service would be documented as outlined below:
1. Reason - Underuse (160)
2. Action - Patient Compliance Consultation (215)
3. Result - Altered Compliance (360)
For more information, click here.
For additional Provider Updates, click: Provider Updates.
Outcomes MTM services are in place for the following program sponsors in this region: Humana, Alameda Alliance for Health (Medicare), Community Health Group (Medicare), Easy Choice Health Plan (Medicare), Fresno City Employees Health & Welfare Trust (Medicare), Health Plan of San Mateo (Medicare), L.A. Care Health Plan (Medicare), Partnership Healthplan of California (Medicare), and Santa Fe Employes Hospital Association-Coast Lines (Medicare). For more information, contact Outcomes at 515-237-0001 or info@getoutcomes.com.
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