Nationwide estimates of medication therapy management delivery under the Medicare prescription drug benefit.

OBJECTIVE: To describe the national delivery of medication therapy management (MTM) to Medicare beneficiaries in 2013 and 2014. METHODS: Descriptive cross-sectional study using the 100% sample of 2013 and 2014 Part D MTM data files. We quantified descriptive statistics (counts and percentages, in addition to means and standard deviations) to summarize the delivery of these services and compare delivery between 2013 and 2014. RESULTS: Medicare beneficiaries eligible for MTM increased from 4,281,733 in 2013 to 4,552,547 in 2014. Among eligible beneficiaries, the number and percentage who were offered a comprehensive medication review (CMR) increased from 3,473,004 (81.1%) to 4,394,822 (96.5%), and beneficiaries receiving a CMR increased from 526,203 (12.3%) to 767,286 (16.9%). In 2014, CMRs were most frequently delivered by telephone (83.2%) and provided by either a plan sponsor (29.0%) or an MTM vendor in-house pharmacist (35.0%). In 2014, pharmacists provided 93.5% of all CMRs, and other providers (e.g., nurses and physicians) provided 6.5% of CMRs. Few patients who received a CMR received more than 1 within the same year (2.2% in 2014). Medication therapy problem (MTP) resolution among patients receiving a CMR stayed roughly the same between 2013 and 2014 (19.2% vs. 18.7%, respectively; P < 0.001). Finally, most beneficiaries (96.9% in 2014) received a targeted medication review, regardless of whether a CMR was offered or provided. CONCLUSION: More than 4 million Medicare beneficiaries were enrolled in Part D MTM in both 2013 and 2014. However, less than 20% of eligible beneficiaries received a CMR during those years, and rates of MTP resolution were low. Future evaluation of Part D MTM delivery should examine changes in eligibility criteria and delivery over time to inform MTM policy and changes in practice.

Alerts for community pharmacist-provided medication therapy management: recommendations from a heuristic evaluation.

BACKGROUND: Medication therapy management (MTM) is a service, most commonly provided by pharmacists, intended to identify and resolve medication therapy problems (MTPs) to enhance patient care. MTM is typically documented by the community pharmacist in an MTM vendor's web-based platform. These platforms often include integrated alerts to assist the pharmacist with assessing MTPs. In order to maximize the usability and usefulness of alerts to the end users (e.g., community pharmacists), MTM alert design should follow principles from human factors science. Therefore, the objectives of this study were to 1) evaluate the extent to which alerts for community pharmacist-delivered MTM align with established human factors principles, and 2) identify areas of opportunity and recommendations to improve MTM alert design. METHODS: Five categories of MTM alerts submitted by community pharmacists were evaluated: 1) indication, 2) effectiveness; 3) safety; 4) adherence; and 5) cost-containment. This heuristic evaluation was guided by the Instrument for Evaluating Human-Factors Principles in Medication-Related Decision Support Alerts (I-MeDeSA) which we adapted and contained 32 heuristics. For each MTM alert, four analysts' individual ratings were summed and a mean score on the modified I-MeDeSA computed. For each heuristic, we also computed the percent of analyst ratings indicating alignment with the heuristic. We did this for all alerts evaluated to produce an "overall" summary of analysts' ratings for a given heuristic, and we also computed this separately for each alert category. Our results focus on heuristics where ≤50% of analysts' ratings indicated the alerts aligned with the heuristic. RESULTS: I-MeDeSA scores across the five alert categories were similar. Heuristics pertaining to visibility and color were generally met. Opportunities for improvement across all MTM alert categories pertained to the principles of alert prioritization; text-based information; alarm philosophy; and corrective actions. CONCLUSIONS: MTM alerts have several opportunities for improvement related to human factors principles, resulting in MTM alert design recommendations. Enhancements to MTM alert design may increase the effectiveness of MTM delivery by community pharmacists and result in improved patient outcomes.

What predicts medication therapy management completion rates? The role of community pharmacy staff characteristics and beliefs about medication therapy management.

OBJECTIVES: To model the association between pharmacy technicians' attitudes and planned behaviors toward participating in medication therapy management (MTM) and MTM completion rates. Secondary objectives included 1) to compare pharmacy technician and pharmacist attitudes and planned behaviors toward participating in MTM and 2) to identify respondent and pharmacy demographic factors associated with MTM completion rates. DESIGN: A 27-item survey, adapted from a previously published survey tool based on the Theory of Planned Behavior (TPB), was used to collect respondent perceptions of MTM. Study procedures were approved by the institutional review board. SETTING AND PARTICIPANTS: Pharmacy technicians and pharmacists representing 116 Midwestern community pharmacy locations within a national supermarket chain were eligible to complete a telephone survey during February to May 2017. MAIN OUTCOME MEASURES: MTM completion rates were recorded during the 6-month time frame before survey administration. Unique, nonmeaningful survey codes were used to link responses from respondents to their store's MTM completion rates. Multivariate linear regression analysis was used to model the association between survey responses, pharmacy and staff demographics, and MTM completion rates. RESULTS: Of the 116 eligible pharmacy technicians and 114 pharmacists, 77 pharmacy technicians and 99 pharmacists completed the survey yielding response rates of 66.4% and 86.8%, respectively. Pharmacy technicians held significantly more positive perceptions about MTM delivery, particularly regarding adequate time and support. However, pharmacy technicians reported having the necessary knowledge and skills significantly less frequently compared with pharmacists. TPB variables for pharmacy technicians were not significant predictors of MTM completion rates. However, pharmacist attitudes, pharmacy technician education, and number of technician hours worked per week were positively associated with MTM completion rates. CONCLUSION: Pharmacists' attitudes, pharmacy technician level of education, and number of technician hours worked per week were associated with MTM completion rates.

Perceived Roles of Independent Community Pharmacists and Pharmacy Technicians in Patient Referrals to Community Resources: A Study from the Medication Safety Research Network of Indiana (Rx-SafeNet).

INTRODUCTION: Referrals to community resources represent one element of the Chronic Care Model, however, little is known about the perceived role of community pharmacy staff in referring patients to community resources. OBJECTIVES: The objective of this study was to describe community pharmacists', community pharmacy technicians', and patients' perceptions of pharmacist referrals to community resources. METHODS: Semi-structured interviews were conducted with community pharmacists, pharmacy technicians, and patients from community pharmacies that are members of the Medication Safety Research Network of Indiana (Rx-SafeNet). Qualitative analysis was conducted to identify emergent themes. RESULTS: A total of 37 participants, including six community pharmacists, one pharmacy student completing an advanced pharmacy practice experience, 15 community pharmacy technicians, and 15 patients across four independently-owned community pharmacies were interviewed. Themes included: 1) Need to build on a foundation of strong patient-community pharmacist relationships to clearly define the pharmacist's role in referrals, 2) Need to improve familiarity with community resources, 3) Need to clearly delineate and support the role for pharmacy technicians in making referrals, and 4) Need to follow-up on referrals. CONCLUSION: To enhance community pharmacy staff provision of referrals to community resources, interventions are needed to improve patient and pharmacist familiarity with available resources, patients' perception of the pharmacist's role outside of prescription fulfillment, and follow-up on referrals. Moreover, pharmacy technician education and training could be expanded to optimize their role in supporting community pharmacists in making referrals.

Medication Therapy Management Delivery by Community Pharmacists: Insights from a National Sample of Medicare Part D Beneficiaries.

INTRODUCTION: The Medicare Part D medication therapy management (MTM) program positions pharmacists to optimize beneficiaries' medications and improve care. Little is known regarding Part D MTM delivery by community pharmacists and other pharmacist provider types. OBJECTIVES: To (1) characterize Medicare Part D MTM delivery by community pharmacists, (2) compare MTM delivery by community pharmacists to other pharmacists, and (3) generate hypotheses for future research. METHODS: A descriptive cross-sectional study using merged data from a 20% random sample of Medicare beneficiary enrollment data with a 100% sample of recently available 2014 Part D MTM files was conducted. Andersen's Behavioral Model was applied to describe MTM delivery across beneficiary characteristics. Descriptive and bivariate statistics were used to compare delivery of MTM between community and other pharmacist providers. RESULTS: Among beneficiaries sampled, community pharmacists provided comprehensive medication reviews (CMRs) to 22% (n=26,337) of beneficiaries receiving at least one CMR. Almost half (49.4%) were provided face-to-face. Across pharmacist cohorts, median days to CMR offer of post-MTM program enrollment were within the 60-day policy requirement. The community pharmacist cohort had fewer days from CMR offer to receipt (median 47 days). Community pharmacists provided more medication therapy problem (MTP) recommendations (mean [SD] of 1.8 [3.5]; p<0.001), but resolved less MTPs (0.2 [0.7]; p<0.001), and most commonly served beneficiaries that were in the south but less in the west/northeast. Additionally, community pharmacists served a smaller proportion of black beneficiaries, yet a larger proportion of Hispanic beneficiaries (p<0.001). CONCLUSION: Community pharmacists provided approximately one in five CMRs for MTM eligible beneficiaries in 2014, with CMRs occurring more quickly, resulting in more MTP recommendations, but resolving less MTPs than those provided by non-community pharmacists. Future research should explore geographic/racial-ethnic disparities in beneficiaries served and strategies to increase negligible MTP resolution by community pharmacists.