Medication Therapy Management (MTM) What is the role of the pharmacist in Home Healthcare? Cory Phillips PharmD D Candidate Belmont University College of Pharmacy Abstract Classifying Interventions3 Collaborative Medication Conclusions There are many issues that have developed in the setting of 1. No Indication Medications Regimen Reviews (MRR)1,2,9 Home Healthcare due to poor management of medication 2. Untreated Indication Therapy Management (CMTM) Save on patient and facility costs regimens.1,2 Some of these problems include adverse drug 3. Improper Medication Selection The CMTM model (figure in column 2) is a modification of Promote facility quality assurance reactions, excessive medication doses, medication 4. Subtherapeutic Dose MTM (figure in column 1) core elements and integrated into Ensure medication use system quality assurance 5. Overdosage duplications, overuse of psychotropic the mental health and medical clinics of the Daily Planet Tool to identify and solve system problems 6. Adverse Drug Reaction medications, polypharmacy, practicing cascades, limited PCMH.4 Improves residents’ quality of care and quality of life 1. Geriatric Syndromes training in geriatric medicine, and geriatric syndromes, such 7. Drug Interaction CMTM was developed to adopt a standard process of care Can prevent adverse medication events and save lives as falls.1,2,3 Rigorous and collaborative medication with defined roles and responsibilities of the pharmacist in a 8. Failure to Receive Medication Role in3 management and review using programs that specify 9. Monitoring and Follow-up PCMH Long-term care facilities problem identification, problem solving, and outcomes can This may promote more fee-for-service payments Ambulatory care improve medication use in patients, especially the elderly.3 Methods and Results Expected outcomes were analyzed MRR findings and recommendations must be effectively Models that have been developed and improved to tackle 1. Integration of collaborative medication therapy Patients with one or more chronic diseases and taking two communicated to other healthcare professionals for this problem include Home Medication Reviews management (CMTM) in a safety net patient-centered or more chronic medications are eligible for CMTMhttp://findinghomehealthcareprofessionals.blogspot.com/2010/0 optimum intervention results.38/home-healthcare-for-unhealthy-people.html (HMRs), Medication Therapy Management medical home (PCMH).4 Out of 452 recommendations made by pharmacists’ to (MTM), Collaborative MTM (CMTM), Drug Burden Indices Retrospective Analysis Study resolve problems at the mental health clinic, 85% were (DBIs), and Telehealth.4,5,6,7,8 The following information accepted by providers and/or patients. Initiate CMTM encounter presents these models and their benefits for patients and Out of 217 medication-related problems found by Identify medication related problems pharmacists. pharmacists at the medical clinic, 89% of recommendations Introduction Pharmacist makes recommendations www.accoras.com.au Acceptance rate of recommendations was 89% were accepted.4 Medication Regimen Review (MRR) is the primary process that allows consultant pharmacists to improve medication use in the 2. A pharmacist-led intervention for increasing the uptake of http://www.alternativehomehealth.com/ facility, collaborate with physicians on residents’ Home Medicines Review (HMR) among residents of medications, and interact with other members of the retirement villages (PHARMER): protocol for a cluster interdisciplinary team.1 randomized control trial (RCT).5 MRR improves the health and quality of life (QOL) of residents Current prospective cluster of RCT in the facility.1 Ongoing study The goal of MRRs is to help identify and resolve problems Ten retirement villages are chosen associated with medication use in the nursing facility population. Residents are randomly recruited Pharmacists’ Gains1,2,3 The MRR Checklist reviews medication HMR education and risk assessment is made Medication Therapy Management indications, efficacy, safety, monitoring, errors, and costs.1 Successes of interventions assessed by interviews Participation in Pharmacy Committees 3. Drug Burden Index (DBI) and Potentially Inappropriate Formulary Management Medications (PIM) in Community-Dwelling Older People: Staff Education Collaboration with the Care Management Team The Impact of Home Medicines Review.6 Educational and In-service Programs Retrospective Study Ethics approval by Human Ethics Committee Telehealth Integrated Pharmacy The Care Coordination Home Telehealth (CCHT) rural Management Systems providing: Patients’ referred for HMR based on standard criteria - Drug-Drug Interactions demonstration project: a symptom-based approach for Pharmacists’ recommendations using DBI led to - Drug-Disease Interactions serving older veterans in remote geographical settings.8 Less sedative/anticholinergic issues - Therapeutic Duplication Innovative healthcare delivery strategies needed to Reduction in drug burden Member of multidisciplinary team address the healthcare needs of US Veterans in rural Decrease in prescribing of PIMs Opportunity to make recommendations and interventions areas Job satisfaction Methods and Results cont… Transportation barriers Poverty Challenges Possibility of working from home 4. Collaborative home medicines review delays time to next Limited access to healthcare Continuing Education hospitalization for warfarin associated bleeding in http://www.pharmacist.com/AM/Template.cfm?Section=MTM&Template=/TaggedPage/TaggedPageDispla Multiple chronic diseases Reimbursement for services y.cfm&TPLID=87&ContentID=22413 Australian war veterans.7 Polypharmacy Retrospective Cohort Study Bibliography: Interventions: Understanding the Impact of practitioner-pharmacist collaborative Goals of Study 1. Clark TR, Gruber J, Martin H. Medication Regimen Review: Part I. The Consultant Pharmacist. 2010; 25(11): 710-720. Facilitate primary care 2. Clark TR, Gruber J, Martin H. Medication Regimen Review: Part 2. The Consultant Pharmacist. 2010; 25(12): Big Picture1,2 medication reviews in hospitalization-associated Compile geriatric care management options 788-802. 3. Clark TR, Gruber J, Martin H. Medication Regimen Review: Part 3. The Consultant Pharmacist. 2010; 26(1): Listening to the patient bleeds in patients on warfarin 16-27. Increase early detection of symptoms 4. Moczygemba LR, Goode J-V R, Gatewood SBS, et al. Integration of collaborative medication therapy Meeting patient specific goals HMR delays the time to next hospitalization for management in a safety net patient-centered medical home. J Am Pharm Assoc. 2011; 51: 167-172. Encourage adherence 5. Lee CY, George J, Elliott RA, Stewart K. A pharmacist-led intervention for increasing the uptake of Home Assessing appropriateness of medications bleeding in those on warfarin for 2 to 6 months after Medicines Review (HMR) among residents of retirement villages (PHARMER): protocol for a cluster Participants recruited based on emergency care visits randomised control trial. BMC Health Services Research. 2011; 11: 292. http://www.biomedcentral.com/1471- Management of disease states/conditions review 6963/11/292. 84% of participants installed and used CCHT 6. Castelino RL, Hilmer SN, Bajorek BV, Nishtala P, Chen TF. Drug Burden Index and Potentially Inappropriate Evaluate the benefit vs. risk of recommendations This was not sustained long-term Medications in Community-Dwelling Older People: The Impact of Home Medicines Review. Drugs Aging. Solve quality-of-care issues High dropout rate 2010; 27(3): 135-148. HMRs are needed 7. Roughead EE, Barrett JD, Ramsay E, et al. Collaborative home medicines review delays time to next Identify trends of care and prescribing More studies are needed on efficacy of CCHT but may be hospitalization for warfarin associated bleeding in Austrailian war veterans. Journal of Clinical Pharmacy and Six monthly medication reviews may be needed for Therapeutics. 2011; 36: 27-32. Identify patterns of errors a good option for those with limited access to healthcare8 8. Luptak M, Dailey N, Juretic M, et al. The Care Coordination Home Telehealth (CCHT) rural demonstration patients on warfarin who are considered at high risk project: a symptom-based approach for serving older veterans in remote geographical settings. Australian Identify cost issues Rural Health Education Network. 2010: 1-10. of bleeding 9. Kucukarslan SN, Hagan AM, Shimp LA, Gaither CA, Lewis NJW. Integrating medication therapy management Patient cost issues and facility cost issues in the primary care medical home: A review of randomized controlled trials. Am J Health-Syst Pharm. 2011; 68: 335-345.