Patient desire to be involved in medication treatment decisions.

OBJECTIVES: To identify unmet needs of patients taking medications for chronic health conditions and identify medication-related services that patients with chronic health conditions would desire. DESIGN: Descriptive, exploratory, nonexperimental study. SETTING: Large midwestern state in spring 2010. PARTICIPANTS: 465 patients 45 years or older taking one or more prescriptions for chronic health problems. INTERVENTION: Cross-sectional survey. MAIN OUTCOME MEASURES: Patient-reported usefulness of, satisfaction with, and intention to use medication-related services. RESULTS: Respondents wanted to be highly involved in treatment decisions but found medication information they received to be moderately useful and satisfactory. Medication-related services fell into three groups based on reported intention to use: therapy advice, cost advice, and medication organization. Desire to be involved in treatment decisions was a key factor in predicting reported intention to use therapy advice and cost advice services. The perceived affordability of medications was another important factor in patients' intention to use cost advice and medication organization services. Age, chronic conditions, number of prescription drugs, and the cost of therapy were not important in predicting the intention to use medication-related services in this population. CONCLUSION: Patient desire to be involved in treatment decisions was a key factor in explaining intention to use medication-related services. Identifying individuals with desire for involvement in treatment decisions may increase medication therapy management (MTM) participation. Strategies to provide personalized MTM services to these individuals should be developed and evaluated.

Employer-based patient-centered medication therapy management program: evidence and recommendations for future programs.

OBJECTIVE: To evaluate a patient-centered employer-based medication therapy management (MTM) program. DESIGN: Randomized controlled study. SETTING: Health promotion program at the University of Michigan from June 2009 to December 2011. PARTICIPANTS: Employees, retirees, and their dependents taking seven or more prescription medications. INTERVENTION: Focus on Medicines (FOM) was a two-visit, patient-centered service with a 4-month follow-up. A comprehensive medication review occurred during the first visit. Pharmacists provided recommendations and a medication action plan at the second visit. The MAP incorporated patient preferences for problem resolution. MAIN OUTCOME MEASURES: Patient uptake, medication cost, medication adherence, patient satisfaction with treatment, patient reasons for participation, patient satisfaction with the FOM program, drug-related problems, pharmacist recommendations, implementation of recommendations. RESULTS: The FOM program attracted 128 individuals wanting information about their medications and an individualized drug regimen assessment to ensure that their therapy was safe and effective and that all medications were necessary. On average, 3.3 medication therapy problems were identified per patient; most were safety related. Overall, 63% of pharmacist recommendations were implemented. When a prescriber was contacted, 83% of pharmacist recommendations were implemented. A reduction in drug cost for patients and the employer was shown. Patients reported improved convenience in taking medications and rated the program favorably. CONCLUSION: A personalized dialogue about medication use appears to meet a need among individuals taking large numbers of medications. Understanding why patients participate in MTM programs and what program features patients appreciate is useful in designing quality MTM programs.

Transgender/gender nonconforming adults' worries and coping actions related to discrimination: Relevance to pharmacist care.

PURPOSE: Transgender/gender nonconforming (TGNC) adults' worries and coping actions related to discrimination by healthcare professionals were evaluated. METHODS: A community-led participatory approach was used to develop, implement, and analyze the survey. Respondents were recruited using a snowball recruitment method. The questionnaire measured population demographics, health status, worry about discrimination, perceptions of health professional competency in gender-affirming care, and actions taken to cope with discrimination. Analysis used mainly descriptive methods and chi-square analysis, where appropriate. RESULTS: There were 316 usable responses from a total of 325 responses. The typical respondent was young, white, lived within the Midwest and in urban/suburban areas. About half had college degrees and 41.7% had annual household incomes of less than $25,000. High degrees of depression risk and anxiety were reported along with low self-reported health status. Most used pharmacist services with 41.6% reporting worry about discrimination associated with such services. About half (52.5%) reported pharmacists as having very little or no competency in providing gender-affirming care. Common coping actions included delayed seeking of healthcare and non-disclosure of authentic gender identity. Thirteen percent of respondents avoided healthcare because of perceived purposeful embarrassment experienced at a pharmacy. CONCLUSION: Worry about discrimination from pharmacists was common among TGNC adults and was associated with high levels of anxiety. The majority perceived pharmacists to lack competency in transgender care.

The Medication Assessment Program: comprehensive medication assessments for persons taking multiple medications for chronic diseases.

OBJECTIVE: To describe the development, implementation, and evaluation of a pharmacist patient care program for persons taking multiple medications for chronic diseases. DESIGN: Pilot study. SETTING: Services were provided in Michigan within community pharmacies and through home and work-site visits, between October 2004 and September 2006. PARTICIPANTS: 30 pharmacists and 67 patients 18 years of age or older who took four or more medications on a routine basis (three or more times per week). INTERVENTIONS: The comprehensive medication assessments identified medication- and health-related problems. Pharmacists provided patient education supported by written educational materials and written recommendations for improving drug therapy and overall patient health. MAIN OUTCOME MEASURES: Patient knowledge regarding medications, diagnoses, and healthy lifestyle practices; types of recommendations made; recommendation acceptance rates; pharmacist assessment of program effects. RESULTS: The program was developed and implemented through a collaborative approach that included pharmacists, colleges of pharmacy, and employers. Pharmacists were supported by various administrative and clinical services offered by the colleges. Three employers adopted the program as a service for their employees, retirees, and dependents. A total of 67 patients received comprehensive medication assessments. Patients tended to be women, tended to be older, and took an average of 12.6 medications. Pharmacists provided 662 recommendations related to drug therapy, healthy lifestyle practices, and the need for medical evaluation. Recommendation acceptance rates, changes in patient knowledge, and pharmacist evaluation of program effects indicated that the program had a positive effect on patient health. CONCLUSION: A collaborative approach to developing and implementing comprehensive medication assessments was found to be beneficial in improving patient understanding of medications, diagnoses, and healthy lifestyle choices. Written pharmacist recommendations resulted in actions that improved self-monitoring skills and drug therapy appropriateness. College of pharmacy administrative and clinical service support was instrumental in network participation and the provision of care.

Exploring patient experiences with prescription medicines to identify unmet patient needs: implications for research and practice.

BACKGROUND: Pharmacy services are offered to patients, and often, they decline participation. Research is needed to better understand patients' unmet needs when taking prescribed medications. OBJECTIVE: To identify and characterize patients' unmet needs related to using prescribed medication for chronic conditions. METHODS: Focus groups of patients using prescription medication for chronic conditions discussed their experiences with medications, starting from initial diagnosis to ongoing management. Sessions involved 40 patients from 1 Midwestern U.S. state. Major themes were identified using content analysis. RESULTS: Three major themes emerged. First, patients seek information to understand their health condition and treatment rationale. Patients form an illness perception (its consequence, controllability, cause, and duration) that dictates their actions. Second, patients desire to be involved in treatment decisions, and they often feel that decisions are made for them without their understanding of the risk-to-benefit trade-off. Third, patients monitor the impact of treatment decisions to determine if anticipated outcomes are achieved. CONCLUSION: The results were consistent with Dowell's therapeutic alliance model (TAM) and Leventhal's common sense model (CSM). The TAM can be used to model the consultative services between pharmacists and patients. The impact of the new services (or interventions) can be evaluated using the CSM. Patients expressed a strong desire to be involved in their treatment decisions. The effectiveness of medication therapy management services may be enhanced if pharmacists build on patients' desire to be involved in their treatment decisions and assist them to understand the role of medications and their risks and expected outcomes within the context of the patients' perceptions of illness and desired coping strategies.

Integrating medication therapy management in the primary care medical home: A review of randomized controlled trials.

PURPOSE: Randomized controlled trials (RCTs) that evaluated the effect of medication therapy management (MTM) on patient outcomes in the primary care medical home were reviewed to determine how these services may be integrated into the primary care medical home. METHODS: A literature search was conducted to identify RCTS published between 1989 and 2009 that evaluated the impact of MTM services on patient outcomes. To qualify as MTM services, the interventions had to include both a review of medication therapy and patient interactions, including educating patients about drug therapy, identifying potential barriers to medication adherence, and helping patients manage their diseases. The internal validity of the studies was evaluated using previously published criteria. The description, specification, and appropriateness of study objectives, study population, intervention, randomization, blinding, outcome measures, statistical analysis, and conclusions were evaluated. RESULTS: A total of 1795 publications were identified, but only 8 met the inclusion criteria. These studies targeted patients with specific medical conditions or patients with multiple medications without specifying a medical condition. The interventions varied in intensity (i.e., frequency and length of patient contact), ranging from a single patient contact in a community pharmacy setting to multiple visits with an ambulatory care pharmacist practicing in a collaborative care model. Two of the 8 studies obtained expected results. These studies targeted patients with unrealized therapeutic goals, and the interventions involved collaboration between pharmacists and physicians and extensive patient follow-up. CONCLUSION: Of 1795 publications identified, 8 were RCTs meeting selection criteria for evaluation of the effect of MTM services on patient outcomes. Two service elements that benefit patient care were identified: (1) selecting patients with specific therapeutic problems and (2) implementing MTM services that involve timely communication with primary care providers to discuss therapeutic problems, along with routine patient follow-up to support medication adherence to changes in therapy.