Medication Therapy Management as a tool for reduced cost of care and fewer readmissions

A colleague asked me if I had any information on the use of Medication Therapy Management (MTM) as a way to reduce healthcare cost and prevent, or decrease, readmissions.

I’m kind of a digital packrat and I knew that I had some stuff sitting in Evernote, so I spent the better part of a day rummaging through the information I had. The deeper I dug the more I realized that MTM is a no-brainer. There’s enough information out there to convince even the staunchest opposition.

Some thoughts I had as I read through my Evernote notes:

  1. I find it interesting that we’ve coined the phrase Medication Therapy Management (MTM) for something that pharmacists have been doing for decades. I remember interning for a community pharmacy back in the late 90’s. Speaking to the patient about their medication, adherence, compliance, adverse effects, etc was simply part of the job. Have we forgotten about that?
  2. MTM comes in many forms. Positive intervention can be achieved over the phone, via Telepharmacy, face-to-face with a pharmacist or technician, and so on. It is not a one size fits all approach.
  3. Even the simplest interaction between provider and patient can create a positive impact.
  4. MTM should start when a patient is admitted for any condition, continue throughout their hospital stay, and follow the patient out the door to their homes. In other words it should be continuous.
  5. Not everyone will need pharmacist intervention once they leave the hospital. Healthcare systems should first target patients with chronic conditions, problems with cognition, poor history of compliance, or a heavy medication burdens. Like everything else in the world around us, some people will do better with more help while others will prefer less.
  6. mHealth and sensors should be part of MTM. Continuous glucose monitoring, heart monitors, blood pressure sensors, smart bottles, devices to monitor and record inhaler use – classic area for pharmacist intervention, wireless digital scales for weight – think heart failure, and so on . This information should be fed directly into the patients MTM record for review by the pharmacist, physician and nurse.

Below is a summary of the MTM information I sent my colleague.
Continue reading Medication Therapy Management as a tool for reduced cost of care and fewer readmissions

Saturday morning coffee [May 18 2013]

So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

The coffee mug below was a gift that I received from the unSUMMIT U for giving a barcoding webinar back in January. For those of you that don’t know, the unSUMMIT is all about barcoding, of which I have a fair amount of experience/expertise.  The unSUMMIT U is an extension of the unSUMMIT that offers webinars about barcoding throughout the year. I’ve attended a couple.

Continue reading Saturday morning coffee [May 18 2013]

Medication therapy management at TEDxUniversity [video]

Thanks to Megan Hartranft (@MeganPharmD) and John Poikonen (@poikonen) for tweeting this. It’s nothing earth shattering, but it sums up why pharmacists should be more involved. Tim Ulbrich does a really nice job.

Pharmacy schools should show this short video to all their pharmacy students before turning them loose on the world. I talked about some of this in my presentation at the HIMSS Southern California Annual Clinical Informatics Summit a couple of weeks ago.

There was a time when I thought that the best place to engage patients was in the hospital, but I’m starting to rethink that position. If you think about it, engaging patients in the hospital is a bit of a reactive approach. We need to engage patients before they’re hospitalized to get the most bang for our buck.

Pharmacy student adherence to a simulated medication regimen

A Tweet from Anthony Cox (@drarcox) led me to this article in the American Journal of Pharmaceutical Education.

In this study, 72 second-year pharmacy students were given “medications” (Starburst JellyBeans) to take with varying administration schedules. The table below shows the results of the little experiment, and it speaks volumes.

Not surprisingly a “once daily” regimen was the easiest to follow, but still resulted in more than 10% of the doeses being missed. As the regimens grew in complexity, the percentage of missed doses increased.

We did a similar experiment with M&M’s when I was a pharmacy student at UCSF. The results were similar, i.e. the more complex the regimen, the harder it was to adhere.

Oh, and these were pharmacy students we’re talking about here. What do you think happens when you ask the average non-healthcare professional to adhere to a medication regimen?

The entire article is available for free here.