Improving medication adherence with MTM
One to one
Although research has shown that medication therapy management (MTM) services improve the health outcomes of patients who take multiple medications for multiple chronic medical conditions, participation in MTM services has been much lower than expected, both by enrollees and by those who provide MTM. Pharmacists who have successfully integrated MTM, including being compensated for Medicare Part D MTM services, “are the exception rather than the norm,” according to N. Lee Rucker, MSPH, Senior Strategic Policy Advisor, AARP, and Chair, National Council on Patient Information and Education (NCPIE), in a June 2012 report.
APhA and NCPIE are issuing a clarion call for greater pharmacist involvement in providing MTM services and improving pharmacist–patient communication. As defined by APhA, MTM consists of medication therapy reviews, pharmacotherapy consults, anticoagulation management, immunizations, health and wellness programs, and many other clinical services. MTM services include at a minimum the following four elements:
- Comprehensive medication review, including a personal medication report that lists all the medications the patient is taking
- Medication action plan
- Education and counseling or other resources to enhance understanding about using the medication and to improve adherence
- Coordination of care, including documenting MTM services, providing the documentation to other providers, and referring patients to other providers as needed
Lack of medication adherence has been cited as the cause of treatment failures, serious adverse reactions, and deaths, according to a Community Pharmacy Foundation report. By working collaboratively with patients, physicians, and other health professionals, pharmacists can increase medication adherence by helping patients identify, resolve, and prevent issues that may affect their decision not to take a medication as intended.
Interact with patients face to face and begin with a comprehensive evaluation of all medications patients are taking, including prescription and nonprescription drugs, herbal products, dietary/nutritional supplements, and samples.
Discuss with patients the appropriateness of each medication and its impact on their multiple medical conditions. Evaluate the effectiveness and safety of each medication, and assess whether some medications may be unnecessary and should be discontinued. If any problems are identified, discuss the need to change medications or doses, and educate patients on maximizing the effectiveness of the medications. Once each medication has been determined to be appropriate, effective, and safe, evaluate patients’ adherence to the intended regimen. Research has shown that when problems with appropriateness, effectiveness, and safety are solved, patients are willing and able to take medications as intended.
Develop a care plan for patients, including individualized therapy goals for each medical condition. Follow up with patients to determine the actual outcomes and the need for further modifications.
Refer patients to “Your Medicine: Be Smart. Be Safe,” a brochure available from NCPIE and the Agency for Healthcare Research and Quality. The brochure answers common questions about taking medicines and has handy forms to help patients keep track of information. Offer patients the NCPIE wallet card featuring seven key questions they should ask whenever a new medicine is either prescribed or recommended. Patients can use it to record all prescription and nonprescription medicines, allergies, and emergency contact names.