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1.  An Online Virtual-Patient Program to Teach Pharmacists and Pharmacy Students How to Provide Diabetes-Specific Medication Therapy Management 
Objective. To develop, implement, and assess the effectiveness of an online medication therapy management (MTM) program to train pharmacists and pharmacy students in providing MTM services for patients with diabetes and to increase their intent to perform these services.
Design. An online program was created using an Internet-based learning platform to simulate 4 MTM meetings between a pharmacist and a virtual patient diagnosed with diabetes.
Assessment. Eighty students and 42 pharmacists completed the program. After completing the program, scores on post-intervention assessments showed significant improvement in 2 areas: control over performing MTM, and knowledge of how to perform MTM. Students had a significantly less-positive attitude about MTM and a decline in their perception of the social expectation that MTM is part of the practice of pharmacy, while pharmacists’ attitudes did not change significantly in these areas.
Conclusion. This online program using a virtual patient improved both participants’ belief that they have control over performing MTM, and their knowledge of how to perform MTM for diabetic patients, which may increase the likelihood that pharmacists and pharmacy students will perform MTM in the future.
doi:10.5688/ajpe767131
PMCID: PMC3448469  PMID: 23049103
medication therapy management; diabetes; pharmacist; virtual patient; simulation; pharmacy student
2.  An Advanced Pharmacy Practice Experience in a Student-Staffed Medication Therapy Management Call Center 
Objective. To describe the implementation of an advanced pharmacy practice experience (APPE) in medication therapy management (MTM) designed to contribute to student pharmacists’ confidence and abilities in providing MTM.
Design. Sixty-four student pharmacists provided MTM services during an APPE in a communication and care center.
Assessment. Students conducted 1,495 comprehensive medication reviews (CMRs) identifying 6,056 medication-related problems. Ninety-eight percent of the students who completed a survey instrument (52 of 53) following the APPE expressed that they had the necessary knowledge and skills to provide MTM services. Most respondents felt that pharmacist participation in providing Medicare MTM could move the profession of pharmacy forward and that pharmacists will have some role in deciding the specific provisions of the Medicare MTM program (92% and 91%, respectively).
Conclusion. Students completing the MTM APPE received patient-centered experiences that supplemented their confidence, knowledge, and skill in providing MTM services in the future.
doi:10.5688/ajpe766110
PMCID: PMC3425925  PMID: 22919086
medication therapy management; advanced pharmacy practice experience; student pharmacists; patient-centered care
3.  Evaluation of Pharmacist Provided Medication Therapy Management Services in an Oncology Ambulatory Setting at a Comprehensive Cancer Center 
Journal of the American Pharmacists Association : JAPhA  2012;52(2):10.1331/JAPhA.2012.11171.
Objective
In 2005 a definition for medication therapy management services (MTM) was developed by eleven pharmacy organizations. That year the American Medical Association introduced three temporary Current Procedural Terminology (CPT) codes for MTM. In 2008 these codes were made permanent making billing for outpatient MTM services possible. In 2010 our institution implemented a MTM program to augment services already provided. Clinical pharmacy specialists documented within the electronic medical record (EMR) upon completion of service and submitted a charge for MTM. The primary objective was to determine the effect of formal MTM services on pharmacist workload. Secondary objectives included describing the population receiving MTM, describing services provided, and determining the reimbursement rate for billed MTM services.
Data Sources
MTM CPT code claims, EMR, pharmacist MTM log
Study Selection
Not applicable
Data Synthesis
A retrospective review of all MTM charges from 1/1/2010-3/31/2010 was performed. Data collected included: location of MTM visit, age, gender, insurance, primary malignancy, comorbidities, home medications, time completing and documenting MTM visit, and rate of reimbursement.
Results
In the three month period 239 MTM visits were completed. It took pharmacists a median of 20 minutes (range: 15–127 minutes) of face-to-face time and 18 minutes (range: 5–90 minutes) for documentation per visit. To date no claims for MTM have been rejected and reimbursement rates range from 47–79% depending on the insurance provider.
Conclusions
MTM in the ambulatory clinic is feasible despite the increase in pharmacist work load from documenting and billing. Increased visibility of clinical pharmacy services justify the extra time required for formal MTM.
doi:10.1331/JAPhA.2012.11171
PMCID: PMC3868215  PMID: 22370379
Medication therapy management; clinical pharmacy; reimbursement; ambulatory clinic; CPT codes
4.  Medication Therapy Management Services Provided by Student Pharmacists 
Objectives. To evaluate the impact of student pharmacists delivering medication therapy management (MTM) services during an elective advanced pharmacy practice experience (APPE).
Methods. Student pharmacists provided MTM services at community pharmacy APPE sites, documented their recommendations, and then made follow-up telephone calls to patients to determine the impact of the MTM provided. Students were surveyed about the MTM experience.
Results. Forty-seven students provided MTM services to 509 patients over 2 years and identified 704 drug-related problems (average of 1.4 problems per patient). About 53% of patients relayed the recommendations to their physician and 205 (75%) physicians accepted the recommendations. Eighty-eight percent of patients reported feeling better about their medications after receiving MTM services. A majority of the students perceived their provision of MTM services as valuable to their patients.
Conclusions. Providing MTM services to patients in a pharmacy practice setting allowed student pharmacists to apply skills learned in the doctor of pharmacy (PharmD) curriculum.
doi:10.5688/ajpe76351
PMCID: PMC3327249  PMID: 22544968
medication therapy management; experiential education; doctor of pharmacy program; advanced pharmacy practice experience; community pharmacy
5.  Community pharmacy-based medication therapy management services: financial impact for patients 
Pharmacy Practice  2012;10(3):119-124.
Objective
To determine the direct financial impact for patients resulting from Medication Therapy Management (MTM) interventions made by community pharmacists. Secondary objectives include evaluating the patient and physician acceptance rates of the community pharmacists' recommended MTM interventions.
Methods
This was a retrospective observational study conducted at 20 Price Chopper and Hen House grocery store chain pharmacies in the Kansas City metro area from January 1, 2010 to December 31, 2010. Study patients were Medicare Part D beneficiaries eligible for MTM services. The primary outcome was the change in patient out-of-pocket prescription medication expense as a result of MTM services.
Results
Of 128 patients included in this study, 68% experienced no out-of-pocket financial impact on their medication expenses as a result of MTM services. A total of 27% of the patients realized a cost-savings (USD440.50 per year, (SD=289.69)) while another 5% of patients saw a cost increase in out-of-pocket expense (USD255.66 per year, (SD=324.48)). The net financial impact for all 128 patients who participated in MTM services was an average savings of USD102.83 per patient per year (SD=269.18, p<0.0001). Pharmacists attempted a total of 732 recommendations; 391 (53%) were accepted by both the patient and their prescriber. A total of 341 (47%) recommendations were not accepted because of patient refusal (290, 85%) or prescriber refusal (51, 15%).
Conclusions
Patient participation in MTM services reduces patient out-of-pocket medication expense. However, this savings is driven by only 32% of subjects who are experiencing a financial impact on out-of-pocket medication expense. Additionally, the majority of the pharmacists' recommended interventions (53%) were accepted by patients and prescribers.
PMCID: PMC3780492  PMID: 24155827
Community Pharmacy Services; Medication Therapy Management; Drug Costs; United States
6.  Simulated Medication Therapy Management Activities in a Pharmacotherapy Laboratory Course 
Objective. To measure the impact of medication therapy management (MTM) learning activities on students’ confidence and intention to provide MTM using the Theory of Planned Behavior.
Design. An MTM curriculum combining lecture instruction and active-learning strategies was incorporated into a required pharmacotherapy laboratory course.
Assessment. A validated survey instrument was developed to evaluate student confidence and intent to engage in MTM services using the domains comprising the Theory of Planned Behavior. Confidence scores improved significantly from baseline for all items (p < 0.00), including identification of billable services, documentation, and electronic billing. Mean scores improved significantly for all Theory of Planned Behavior items within the constructs of perceived behavioral control and subjective norms (p < 0.05). At baseline, 42% of students agreed or strongly agreed that they had knowledge and skills to provide MTM. This percentage increased to 82% following completion of the laboratory activities.
Conclusion. Implementation of simulated MTM activities in a pharmacotherapy laboratory significantly increased knowledge scores, confidence measures, and scores on Theory of Planned Behavior constructs related to perceived behavioral control and subjective norms. Despite these improvements, intention to engage in future MTM services remained unchanged.
doi:10.5688/ajpe75595
PMCID: PMC3142971  PMID: 21829269
medication therapy management; active learning; theory of planned behavior; laboratory course; student confidence; intention
7.  A Scale to Measure Pharmacy Students’ Self-Efficacy in Performing Medication Therapy Management Services 
Objective. To determine whether a college of pharmacy curriculum creates a sense of self-efficacy among students with respect to providing medication therapy management (MTM) services.
Methods. An electronic survey instrument was sent to all pharmacy students to elicit information on their perceived confidence in providing MTM services, and the results were reviewed.
Results. Of the 1,160 students targeted, 464 (40%) completed the survey instrument. Responses indicated that overall self-efficacy increased with each successive year of the curriculum that students completed. Fourth-year students completing an advanced pharmacy practice experience (APPE) in medication therapy management (MTM) had significantly higher self-efficacy than did other fourth-year students, whose self-efficacy was similar to that of third-year students.
Conclusion. In this study population, students’ self-efficacy increased with each successive year in pharmacy school, with those who completed an APPE in MTM exhibiting the highest level of self-efficacy. These students may be more likely to pursue MTM opportunities in future careers.
doi:10.5688/ajpe779191
PMCID: PMC3831402  PMID: 24249853
medication therapy management; student self-efficacy; advanced pharmacy practice experience
8.  Assessing Medicare Beneficiary Eligibility for Medication Therapy Management Programs Using PINNACLE, a National Cardiovascular Data Registry 
American Health & Drug Benefits  2013;6(7):367-374.
Background
Medication therapy management (MTM) is a mandated component of the 2003 Medicare Modernization Act for Part D prescription drug plans and Medicare Advantage plans, authorizing the pharmacist or other qualified provider to identify, resolve, and prevent medication-related problems for patients with chronic diseases. MTM programs have been shown to improve medication adherence and reduce medication errors while reducing overall costs in patients with cardiovascular (CV) disease; however, MTM has been greatly underutilized for patients with chronic diseases.
Objective
To identify the proportion of Medicare beneficiaries who are eligible for, and who could potentially benefit from, participating in MTM among patients enrolled in the National Cardiovascular Data Registry's PINNACLE Registry.
Methods
Patient MTM eligibility is based on the presence of multiple chronic diseases and meeting a minimum annual insurance medication costs. We used patient data from 462 academic and private cardiology practices in the United States who participated in the PINNACLE Registry between May 1, 2008, and September 30, 2010, to determine Medicare beneficiaries' eligibility to participate in an MTM program for patients meeting the MTM criteria of (1) a number of chronic diseases (in this case, the number of CV conditions) and (2) an estimated minimum annual medication expenses, using a weighted average cost calculated based on the average wholesale price of the most often prescribed medications, by class, as extracted from the HealthCore Integrated Research Database and weighted according to prescribing frequency within a class.
Results
Among the Medicare beneficiaries in the PINNACLE Registry, 93,089 (58%) had ≥3 chronic CV conditions, and the median annual estimated medication expenditure per patient enrolled in the PINNACLE Registry was $1329. Of the total of 93,089 Medicare beneficiaries, 21.4% were eligible for MTM, based on the 2010 minimum eligibility criterion of an annual insurer medication expenditure of $3000 or more. These costs ranged from $366 for low-cost generics to $3958 for the highest-cost drug in a class. In addition, based on the 2010 minimum eligibility rule, the proportion of patients eligible for MTM ranged from 7.9% for those eligible for MTM for low-cost generics to 64% of patients eligible for MTM for the highest-cost medication in a class.
Conclusions
These data serve to raise awareness regarding patients' potential eligibility to receive the benefits of MTM programs. Providers caring for patients with multiple CV conditions, including specialists such as cardiologists, should explain to eligible patients about MTM programs and encourage these patients to take advantage of such programs.
PMCID: PMC4031728  PMID: 24991369
9.  An Introductory Pharmacy Practice Experience Based on a Medication Therapy Management Service Model 
Objective. To implement and evaluate an introductory pharmacy practice experience (IPPE) based on the medication therapy management (MTM) service model.
Design. Patient Care 2 is an IPPE that introduces third-year pharmacy students to the MTM service model. Students interacted with older adults to identify medication-related problems and develop recommendations using core MTM elements. Course outcome evaluations were based on number of documented medication-related problems, recommendations, and student reviews.
Assessment. Fifty-seven older adults participated in the course. Students identified 52 medication-related problems and 66 medical problems, and documented 233 recommendations relating to health maintenance and wellness, pharmacotherapy, referrals, and education. Students reported having adequate experience performing core MTM elements.
Conclusion. Patient Care 2 may serve as an experiential learning model for pharmacy schools to teach the core elements of MTM and provide patient care services to the community.
doi:10.5688/ajpe75582
PMCID: PMC3142972  PMID: 21829256
medication therapy management; introductory pharmacy practice experience; patient care service learning
10.  Elective Course on Medication Therapy Management Services 
Objectives
To determine the impact of active-learning strategies in a medication therapy management (MTM) elective on pharmacy students' preparedness to participate in real-life MTM counseling sessions.
Design
The elective included active-learning assignments such as patient cases, group discussions, role playing, and use of actual patients to prepare students for MTM services.
Assessment
A survey was administered before (week 11) and after (week 15) completing a face-to-face comprehensive medication review (CMR) to evaluate achievement of course objectives and students' preparedness to participate in MTM. In the pre-CMR survey, 66.7% of the students strongly agreed that the course prepared them to provide MTM services. In the post-CMR survey, 88.9% of the students strongly agreed (p = 0.046).
Conclusion
The active-learning strategies used in the MTM elective course provided students with the skills necessary to participate in MTM counseling sessions. Face-to-face CMRs better prepared pharmacy students to provide MTM services.
PMCID: PMC2865406  PMID: 20498733
medication therapy management; elective; active learning; comprehensive medication review
11.  Improving the economic and humanistic outcomes for diabetic patients: making a case for employer-sponsored medication therapy management 
Background
The purpose of this study was to determine the cost savings of a pharmacist-led, employer-sponsored medication therapy management (MTM) program for diabetic patients and to assess for any changes in patient satisfaction and self-reported medication adherence for enrollees.
Methods
Participants in this study were enrollees of an employer-sponsored MTM program. They were included if their primary medical insurance and prescription coverage was from the City of Toledo, they had a diagnosis of type 2 diabetes, and whether or not they had been on medication or had been given a new prescription for diabetes treatment. The data were analyzed on a prospective, pre-post longitudinal basis, and tracked for one year following enrollment. Outcomes included economic costs, patient satisfaction, and self-reported patient adherence. Descriptive statistics were used to characterize the population, calculate the number of visits, and determine the mean costs for each visit. Friedman’s test was used to determine changes in outcomes due to the nonparametric nature of the data.
Results
The mean number of visits to a physician’s office decreased from 10.22 to 7.07. The mean cost of these visits for patients increased from $47.70 to $66.41, but use of the emergency room and inpatient visits decreased by at least 50%. Employer spending on emergency room visits decreased by $24,214.17 and inpatient visit costs decreased by $166,610.84. Office visit spending increased by $11,776.41. A total cost savings of $179,047.80 was realized by the employer at the end of the program. Significant improvements in patient satisfaction and adherence were observed.
Conclusion
Pharmacist interventions provided through the employer-sponsored MTM program led to substantial cost savings to the employer with improved patient satisfaction and adherence on the part of employees at the conclusion of the program.
doi:10.2147/CEOR.S40735
PMCID: PMC3629878  PMID: 23610526
costs; patient satisfaction; adherence; pharmaceutical care; diabetes
12.  Medication therapy management clinic: perception of healthcare professionals in a University medical center setting 
Pharmacy Practice  2013;11(3):173-177.
Objective
To determine the overall perception and utilization of the pharmacist managed medication therapy management (MTM) clinic services, by healthcare professionals in a large, urban, university medical care setting.
Methods
This was a cross-sectional, anonymous survey sent to 195 healthcare professionals, including physicians, nurses, and pharmacists at The University of Illinois Outpatient Care Center to determine their perception and utilization of the MTM clinic. The survey consisted of 12 questions and was delivered through a secure online application.
Results
Sixty-two healthcare professionals (32%) completed the survey. 82% were familiar with the MTM clinic, and 63% had referred patients to the clinic. Medication adherence and disease state management was the most common reason for referral. Lack of knowledge on the appropriate referral procedure was the prominent reason for not referring patients to the MTM clinic. Of the providers that were aware of MTM services, 44% rated care as ‘excellent’, 44% as ‘good’, 5% as ‘fair’, and 0% stated ‘poor’. Strengths of MTM clinic identified by healthcare providers included in-depth education to patients, close follow-up, and detailed medication reconciliation provided by MTM clinic pharmacists. Of those familiar with MTM clinic, recommendations included; increase marketing efforts to raise awareness of the MTM clinic service, create collaborative practice agreements between MTM pharmacists and physicians, and ensure that progress notes are more concise.
Conclusions
In a large, urban, academic institution MTM clinic is perceived as a valuable resource to optimize patient care by providing patients with in-depth education as it relates to their prescribed medications and disease states. These identified benefits of MTM clinic lead to frequent patient referrals specifically for aid with medication adherence and disease state management.
PMCID: PMC3809139  PMID: 24223083
Medication Therapy Management; Professional Practice; Academic Medical Centers; Personal Satisfaction; Attitude of Health Personnel; Pharmacists; United States
13.  Contingent Valuation and Pharmacists' Acceptable Levels of Compensation for Medication Therapy Management Services 
Research in social & administrative pharmacy : RSAP  2012;10.1016/j.sapharm.2012.02.001.
Background
Pharmacists' acceptable level of compensation for medication therapy management (MTM) services needs to be determined using various economic evaluation techniques.
Objectives
Using contingent valuation method, determine pharmacists' acceptable levels of compensation for MTM services.
Methods
A mailing survey was used to elicit Tennessee (US) pharmacists' acceptable levels of compensation for a 30-minute MTM session for a new patient with 2 medical conditions, 8 medications, and an annual drug cost of $2,000. Three versions of a series of double-bounded, closed-ended, binary discrete choice questions were asked of pharmacists for their willingness-to-accept (WTA) for an original monetary value ($30, $60, or $90) and then follow-up higher or lower value depending on their responses to the original value. A Kaplan-Meier approach was taken to analyze pharmacists' WTA, and Cox's proportional hazards model was used to examine the effects of pharmacist characteristics on their WTA.
Results
Three hundred and forty-eight pharmacists responded to the survey. Pharmacists' WTA for the given MTM session had a mean of $63.31 and median of $60. The proportions of pharmacists willing to accept $30, $60, and $90 for the given MTM session were 30.61%, 85.19%, and 91.01%, respectively. Pharmacists' characteristics had statistically significant association with their WTA rates.
Conclusions
Pharmacists' WTA for the given MTM session is higher than current Medicare MTM programs' compensation levels of $15 to $50 and patients' willingness-to-pay of less than $40. Besides advocating for higher MTM compensation levels by third-party payers, pharmacists also may need to charge patients to reach sufficient compensation levels for MTM services.
doi:10.1016/j.sapharm.2012.02.001
PMCID: PMC3445666  PMID: 22436583
Medication therapy management services; contingent valuation; pharmacists; compensation; willingness to accept
14.  Provision of Medication Therapy Management to University Faculty and Staff Members by Third-year Pharmacy Students 
Objective
To develop and implement a medication therapy management (MTM) curriculum and assess students' skills and attitudes after the provision of MTM services to faculty and staff members.
Design
Third-year students enrolled in a pharmaceutical care laboratory course received lectures and participated in MTM activities in preparation for an MTM encounter. Students conduced MTM sessions with university faculty and staff members, providing comprehensive medication review, blood pressure checks, and optional blood glucose and cholesterol (total cholesterol and HDL) screenings.
Assessment
A faculty-developed rubric was used to evaluate students' ability to explain MTM to the participant and address medication-related problems. Students' responses on pre- and post-encounter survey instruments showed their confidence to provide MTM services, communicate with participants and other health care providers, and provide point-of-care screening services had increased.
Conclusion
Incorporating MTM into an existing laboratory course increased students' confidence and perceived ability to provide MTM services.
PMCID: PMC3058456  PMID: 21436923
medication therapy management; medication review; patient-centered care
15.  Integration of Remote Blood Glucose Meter Upload Technology into a Clinical Pharmacist Medication Therapy Management Service 
A pharmacist-delivered, outpatient-focused medication therapy management (MTM) program is using a remote blood glucose (BG) meter upload device to provide better care and to improve outcomes for its patients with diabetes. Sharing uploaded BG meter data, presented in easily comprehensible graphs and charts, enables patients, caregivers, and the medical team to better understand how the patients’ diabetes care is progressing.
Pharmacists are becoming increasingly more active in helping to manage patients’ complex medication regimens in an effort to help detect and avoid medication-related problems. Working together with patients and their physicians as part of an interdisciplinary health care team, pharmacists are helping to improve medication outcomes. This article focuses on two case studies highlighting the Diabetes Monitoring Program, one component of the Meridian Pharmacology Institute MTM service, and discusses the clinical application of a unique BG meter upload device.
PMCID: PMC3045227  PMID: 21303643
blood glucose meter upload device; clinical pharmacist; diabetes monitoring program; medication compliance; medication therapy management; Metriklink; pharmacist
16.  Impact of an Elective Course on Pharmacy Students’ Attitudes, Beliefs, and Competency Regarding Medicare Part D 
Objective. To determine the impact of an elective course on pharmacy students’ perceptions, knowledge, and confidence regarding Medicare Part D, medication therapy management (MTM), and immunizations.
Design. Thirty-three pharmacy students were enrolled in a Medicare Part D elective course that included both classroom instruction and experiential training.
Assessment. Students’ self-reported confidence in and knowledge of Part D significantly improved upon course completion. End-of-course student perceptions about the relative importance of various aspects of MTM interventions and their confidence in performing MTM services significantly improved from those at the beginning of the course. Students’ confidence in performing immunizations also increased significantly from the start of the course.
Conclusion. A classroom course covering Medicare Part D with an experiential requirement serving beneficiaries can improve students’ attitudes and knowledge about Medicare Part D and their confidence in providing related services to beneficiaries in the community.
doi:10.5688/ajpe76591
PMCID: PMC3386042  PMID: 22761532
Medicare Part D; medication therapy management; student attitudes; experiential learning
17.  Enhancing Community Pharmacy Through Advanced Pharmacy Practice Experiences 
The pressures driving the need for an expanded practice scope in community pharmacy have been building for the past 2 decades. Many pharmacists have chosen to embrace the pharmaceutical care model in their practice sites to meet patient and healthcare system needs. The potential for medication therapy management (MTM) services provide an additional career opportunity for pharmacy graduates. Colleges of pharmacy offer advanced pharmacy practice experiences (APPEs) in the community setting that are designed to prepare students for these opportunities. These sites provide students with the opportunity to observe the integration of pharmaceutical care activities into community practice. Although developing an APPE site is challenging, serving as a preceptor benefits the students, the site, and the patients served. Therefore, colleges of pharmacy and community pharmacists are collaborating to increase the number of APPE sites to prepare pharmacy students for practice today and tomorrow.
PMCID: PMC1636895  PMID: 17136162
curriculum; advanced pharmacy practice experience; community pharmacy; preceptor
18.  Design of a medication management program for Medicare beneficiaries: Qualitative findings from patients and physicians 
Background
The quality of pharmacologic care provided to older adults is less than optimal. Medication therapy management (MTM) programs delivered to older adults in the ambulatory care setting may improve the quality of medication use for these individuals.
Objectives
We conducted focus groups with older adults and primary care physicians to explore: (1) older adults' experiences working with a clinical pharmacist in managing medications, (2) physician perspectives on the role of clinical pharmacists in facilitating medication management, and (3) key attributes of an effective MTM program and potential barriers from both patient and provider perspectives.
Methods
Five focus groups (4 with older adults, 1 with primary care physicians) were conducted by a trained moderator using a semi-structured interview guide. Each participant completed a demographic questionnaire. Sessions were recorded, transcribed verbatim, and analyzed using qualitative analysis software for theme identification.
Results
Twenty-eight older adults and 8 physicians participated. Older adults valued the professional, trusting nature of their interactions with the pharmacist. They found the clinical pharmacist to be a useful resource, thorough, personable, and a valuable team member. Physicians believe the clinical pharmacist fills a unique role as a specialized practitioner, contributing meaningfully to patient care. Physicians emphasized the importance of effective communication, pharmacist's access to the medical record, and a mutually-trusting relationship as key attributes of a program. Potential barriers to an effective program include poor communication and lack of familiarity with the patient's history. The lack of a sustainable reimbursement model was cited as a barrier to widespread implementation of MTM.
Conclusions
This study provides information to assist pharmacists in designing MTM programs in the ambulatory setting. Key attributes of an effective program include one that is comprehensive, addressing all medication-related needs over time. The clinical pharmacist's ability to build trusting relationships with both patients and providers is essential.
doi:10.1016/j.amjopharm.2012.01.002
PMCID: PMC3322273  PMID: 22284582
older adults; medication management; focus groups; collaborative practice; pharmacists
19.  Medication Therapy Management Training Using Case Studies and the MirixaPro Platform 
Objective
To implement and assess a medication therapy management (MTM) training program for pharmacy students using the MirixaPro (Mirixa Corporation, Reston, VA) platform and case studies.
Design
Students received lectures introducing MTM and were given a demonstration of the MirixaPro platform. They were divided into teams and assigned cases and times to interview patients portrayed by faculty members. Using the MirixaPro system, students performed 2 comprehensive medication reviews during the semester, recording the patient's current medications, indications, side effects, allergies, health conditions, and laboratory test recommendations and developed a personal medication record and medication action plan.
Assessment
Based on a rubric with a rating scale of 0-10, campus and distance pathway students received mean scores ranging from 6.3-7.4 for their performance on the second MTM exercise, an increase of 47%-54% over the first MTM exercise. In qualitative assessments, the majority of students believed that their confidence in providing MTM was enhanced by the activity, while faculty members recognized the advantage of using MirixaPro, which allowed students to experience what is required in processing a pharmacist led, billable MTM encounter.
Conclusions
Use of the MirixaPro system and patient cases provides students with a “hands-on” experience that may encourage them to promote MTM during their APPEs and provide MTM services as practicing pharmacists.
PMCID: PMC3109803  PMID: 21655403
medication therapy management (MTM); Web-based technology; active learning; patient simulation; case-based learning
20.  Potential Health Implications of Racial and Ethnic Disparities in Meeting MTM Eligibility Criteria 
Research in social & administrative pharmacy : RSAP  2013;10(1):10.1016/j.sapharm.2013.03.007.
Background
Previous studies have found that racial and ethnic minorities would be less likely to meet the Medicare eligibility criteria for medication therapy management (MTM) services than their non-Hispanic White counterparts.
Objectives
To examine whether racial and ethnic disparities in health status, health services utilization and costs, and medication utilization patterns among MTM-ineligible individuals differed from MTM-eligible individuals.
Methods
This study analyzed Medicare beneficiaries in 2004–2005 Medicare Current Beneficiary Survey. Various multivariate regressions were employed depending on the nature of dependent variables. Interaction terms between the dummy variables for Blacks (and Hispanics) and MTM eligibility were included to test whether disparity patterns varied between MTM-ineligible and MTM-eligible individuals. Main and sensitivity analyses were conducted for MTM eligibility thresholds for 2006 and 2010.
Results
Based on the main analysis for 2006 MTM eligibility criteria, the proportions for self-reported good health status for Whites and Blacks were 82.82% vs. 70.75%, respectively (difference=12.07%; P< .001), among MTM-ineligible population; and 56.98% vs. 52.14%, respectively (difference=4.84%; P= .31), among MTM-eligible population. The difference between these differences was 7.23% (P< .001). In the adjusted logistic regression, the interaction effect for Blacks and MTM eligibility had an OR of 1.57 (95% Confidence Interval, or CI=0.98–2.52) on multiplicative term and difference in odds of 2.38 (95% CI=1.54–3.22) on additive term. Analyses for disparities between Whites and Hispanics found similar disparity patterns. All analyses for 2006 and 2010 eligibility criteria generally reported similar patterns. Analyses of other measures did not find greater racial or ethnic disparities among the MTM-ineligible than MTM-eligible individuals.
Conclusions
Disparities in MTM eligibility may aggravate existing racial and ethnic disparities in health outcomes. However, disparities in MTM eligibility may not aggravate existing disparities in health services utilization and costs and medication utilization patterns. Future studies should examine the effects of Medicare Part D on these disparities.
doi:10.1016/j.sapharm.2013.03.007
PMCID: PMC3858402  PMID: 23759673
Health disparities; race; ethnicity; medication therapy management services; eligibility criteria
21.  Facilitating collaboration between pharmacists and physicians using an iterative interview process 
Objective
To elicit and describe mutually agreed upon common problems and subsequent solutions resulting from a facilitated face-to-face meeting between pharmacists and physicians.
Design
Descriptive, exploratory, non-experimental study.
Setting
Wisconsin from October to December 2011.
Participants
Physicians and community pharmacists
Intervention
Face-to-face semi-structured interviews with pharmacists and physicians from the same community, informed by previous individual interviews.
Main outcome measure
Methods to enhance collaboration and barriers to implementing collaboration between pharmacists and physicians
Results
Physicians and pharmacists generated ideas in which collaboration could improve patient care, including controlled substance monitoring, medication adherence, collaborative practice agreements for point of service issues, and a mechanism for urgent communication. Methods on how to collaborate on these issues were also discussed.
Conclusions
Bringing physicians and pharmacists together for a face-to-face interaction that was informed by information gained in previous individual interviews successfully stimulated conversation on ways in which each profession could help the other provide optimal patient care. This interaction appeared to dispel assumptions and build trust. Results of this project may provide pharmacists with the confidence to reach out to their physician colleagues.
doi:10.1331/JAPhA.2014.13104
PMCID: PMC3998751  PMID: 24362573
Collaboration; community pharmacist; physician
22.  Exploring successful community pharmacist-physician collaborative working relationships using mixed methods 
Background
Collaborative working relationships (CWRs) between community pharmacists and physicians may foster the provision of medication therapy management services, disease state management, and other patient care activities; however, pharmacists have expressed difficulty in developing such relationships. Additional work is needed to understand the specific pharmacist-physician exchanges that effectively contribute to the development of CWR. Data from successful pairs of community pharmacists and physicians may provide further insights into these exchange variables and expand research on models of professional collaboration.
Objective
To describe the professional exchanges that occurred between community pharmacists and physicians engaged in successful CWRs, using a published conceptual model and tool for quantifying the extent of collaboration.
Methods
A national pool of experts in community pharmacy practice identified community pharmacists engaged in CWRs with physicians. Five pairs of community pharmacists and physician colleagues participated in individual semistructured interviews, and 4 of these pairs completed the Pharmacist-Physician Collaborative Index (PPCI). Main outcome measures include quantitative (ie, scores on the PPCI) and qualitative information about professional exchanges within 3 domains found previously to influence relationship development: relationship initiation, trustworthiness, and role specification.
Results
On the PPCI, participants scored similarly on trustworthiness; however, physicians scored higher on relationship initiation and role specification. The qualitative interviews revealed that when initiating relationships, it was important for many pharmacists to establish open communication through face-to-face visits with physicians. Furthermore, physicians were able to recognize in these pharmacists a commitment for improved patient care. Trustworthiness was established by pharmacists making consistent contributions to care that improved patient outcomes over time. Open discussions regarding professional roles and an acknowledgment of professional norms (ie, physicians as decision makers) were essential.
Conclusions
The findings support and extend the literature on pharmacist-physician CWRs by examining the exchange domains of relationship initiation, trustworthiness, and role specification qualitatively and quantitatively among pairs of practitioners. Relationships appeared to develop in a manner consistent with a published model for CWRs, including the pharmacist as relationship initiator, the importance of communication during early stages of the relationship, and an emphasis on high-quality pharmacist contributions.
doi:10.1016/j.sapharm.2009.11.008
PMCID: PMC3004536  PMID: 21111388
Pharmacists; Physicians; Collaborative working relationships; Pharmacist-physician collaborative index; Community
23.  Pharmacy Students' Knowledge of the Medicare Drug Benefit and Intention to Provide Medicare Medication Therapy Management Services 
Objectives
To examine PharmD students' knowledge about Medicare Part D and their attitudes toward and intention to provide Medicare medication therapy management services (MTMS).
Methods
Fourth-professional year students were given a self-administered survey instrument that assessed: (1) knowledge about Medicare Part D; (2) attitudes, perceived behavioral control, subjective norms, and intention to provide Medicare MTMS; and (3) demographic and experience information.
Results
Ninety-five students responded for a response rate of 94%. Students showed good basic knowledge about Medicare Part D, with a mean score of 94%. Almost 60% of students agreed that they intended to provide Medicare MTMS, but agreement dropped to 37% when they were asked if they were willing to take initiative to provide MTMS.
Conclusions
The lack of willingness to take initiative to provide Medicare MTMS suggests that colleges and schools of pharmacy must strengthen efforts to encourage students to take on the role of service provider.
PMCID: PMC1913303  PMID: 17619641
Medicare Part D; medication therapy management; assessment; theory of planned behavior
24.  Intervening on Behalf of Patients 
Biotechnology healthcare  2011;8(1):10-15.
Adherence to a biologic treatment regimen is essential for tracking efficacy and justifying its cost. That’s where medication therapy management services come in.
Pharmacists are providing medication therapy management (MTM) services for patients taking biologics, although studies to demonstrate its cost-effectiveness are lacking. Is this the best way to ensure that high-cost, high-impact biologics are used correctly?
PMCID: PMC3086129  PMID: 22478844
25.  The Role of Team-Based Care Involving Pharmacists to Improve Cardiovascular and Renal Outcomes 
Cardiorenal Medicine  2012;2(4):243-250.
The number of patients with cardiovascular and kidney disease in the United States continues to grow as the population ages, increasing the demand on the health care system and its providers. Many patients develop chronic conditions in which optimization of care is labor intensive, specifically hypertension, hyperlipidemia, diabetes, heart failure, and chronic kidney disease. Therefore, innovative and collaborative approaches to health care are warranted. Several team-based health care models have evolved and are gaining popularity, including the Patient-Centered Medical Home (PCMH) and Medication Therapy Management (MTM). Team-based care is widely supported in the literature, demonstrating significant improvement in cardiovascular and renal outcomes. This article will review the premises of PCMH and MTM, review the evidence and roles for team-based care specific to cardiovascular and renal outcomes, and introduce fundamentals to implement collaborative practice focusing on pharmacist-provider teams.
doi:10.1159/000341725
PMCID: PMC3551433  PMID: 23381091
Collaboration; Team-based care; Cardiovascular outcomes; Renal outcomes; Pharmacist; Patient-Centered Medical Home; Medication Therapy Management

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