Measurable Benefit of Targeted versus Comprehensive Medication Reviews in Medication Therapy Management
AffiliationCollege of Pharmacy, The University of Arizona
Keywordstargeted medication reviews (TMRs)
comprehensive medication reviews (CMRs)
medication therapy management (MTM)
MeSH SubjectsMedication Therapy Management
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RightsCopyright © is held by the author.
Collection InformationThis item is part of the Pharmacy Student Research Projects collection, made available by the College of Pharmacy and the University Libraries at the University of Arizona. For more information about items in this collection, please contact Jennifer Martin, Associate Librarian and Clinical Instructor, Pharmacy Practice and Science, email@example.com.
PublisherThe University of Arizona.
AbstractObjectives: To determine whether comprehensive medication reviews (CMRs) or non-CMR interventions following targeted medication reviews (TMRs) resulted in more positive medication changes. A CMR is a structured medication management session that includes a full review of an individual’s medical and medication records. Non-CMR interventions are more targeted problem-based interventions that include shorter medication management sessions, written patient outreach, and direct to provider interventions. Methods: This cross-sectional quality improvement project compared the number of individuals with positive medication changes who received a CMR to those with positive medication changes who did not receive a CMR (non-CMR). Individuals were included in this project if they qualified for the Medication Management Center’s (MMC) pharmacist-driven medication therapy management (MTM) program and received their medication review(s) in 2012 or 2013. The addition of an appropriate medication or the removal of an inappropriate medication was considered a positive medication change within 120 days of intervention. Odds ratios were calculated using Wilcoxon Rank Sum. Results: A total of 418,649 participants in 2012 and 370,107 in 2013 had their medications reviewed as part of the MTM program. The non-CMR group accounted for the majority of the interventions (375,159 for non-CMR versus 43,490 for CMR in 2012 and 332,006 versus 38,101 for 2013). Significantly more positive medication changes were achieved in the non-CMR group (n=88,467 for 2012 and n=54,971 for 2013) following the medication review compared to the CMR group (n=9,796 for 2012 and n=7,034 for 2013). CMR recipients were more likely to receive a recommendation (odds ratio 0.70, 95% confidence interval 0.69-0.72 for 2012 and odds ratio 0.62, 95% confidence interval 0.60-0.63 for 2013). Non-CMR recipients were more likely to have a recommendation result in a medication change (odds ratio 1.24, 95% confidence interval 1.21-1.28 for 2012 and 1.26, 95% confidence interval 1.22-1.30 for 2013). Conclusions: While the percentage of participants who received a recommendation in the non-CMR group was lower, a greater percentage of these participants received a medication change. This indicates that non-CMR interventions following TMRs may be more effective in producing a positive medication change compared to CMRs.
DescriptionClass of 2015 Abstract
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An Evaluation of Student Pharmacist Admission Medication Histories at a Level 1 Trauma, Academic Medical Center: A Descriptive StudyCornelison, Bernadette; Chang, Vicki; Campbell, Stephanie; College of Pharmacy, The University of Arizona (The University of Arizona., 2017)Objectives: The purpose of this study is to demonstrate the effect of using advanced pharmacy practice experience (APPE) students in the collection of admission medication history at an academic teaching hospital prior to pharmacist review. Methods: The study is a retrospective, descriptive study. Using electronic medical records, the study looked at patients admitted to specific floors during a two-month period. The primary outcome was number of discrepancies found by the APPE students. The secondary outcome was the type of discrepancy found (omission, duplication, wrong dose, wrong frequency, wrong dosage form, and medications the subject no longer takes). Results: Over eight weeks, the APPE students identified 2,666 discrepancies, which equates to approximately 4.71 ± 4.76 discrepancies per patient. The majority of these discrepancies were identified as omissions of therapy (39.1%), followed by medications the patients were no longer taking (29.8%), and wrong dosing frequencies (18.1%). Conclusions: APPE students assisted the medication reconciliation process by identifying numerous medication discrepancies which may have prevented patient harm. APPE students are an underutilized resource and prove to be an asset to the healthcare team.
Medication Therapy Management: Methods to Increase Comprehensive Medication Review ParticipationBoesen, Kevin; Diaz, Melissa; Ortega, Yanina; Boesen, Kevin; College of Pharmacy, The University of Arizona (The University of Arizona., 2013)Specific Aims: To compare the Comprehensive Medication Review (CMR) rate for Workflow Model #1 (used in 2010) to the CMR rate for Workflow Model #2 (used in 2011) at the Medication Management Center (MMC). Methods: A retrospective database analysis was completed in which Comprehensive Medication Review (CMR) completion rates for 2010 and 2011 were assessed. Comparison included only Center for Medicare and Medicaid Services (CMS) contracts that the Medication Management Center (MMC) provided Medication Therapy Management (MTM) services for both in 2010 and 2011. Data was used to determine the effect a process change had on CMR participation rate at the MMC and best practices for improving the rate of Medication Therapy Management Program (MTMP) beneficiaries participating in a CMR. Main Results: In 2010, patient participation and response to a CMR offer letter was low (0.2%). The changes in process yielded an increase in the CMR completion rate (6.93%); this in turn yielded higher performance measurements for prescription drug plans. Conclusion: Workflow modifications, including a pro-active secondary CMR offer, led to a marked increase in member participation and CMR rates. Patients are more apt to consent to a CMR if they are called for a specific medication related problem. It is recommended to continue to convert TMR calls to CMRs whenever possible, monitor CMR rates at least quarterly, and make cold calls where needed to increase CMR percentages.
The Cinderella Syndrome: A Case Study of Medical School Admission DecisionsRhoades, Gary; Lee, Jenny; Price-Johnson, Tanisha Nichole; Cagrera, Nolan; Rhoades, Gary; Lee, Jenny (The University of Arizona., 2013)Making decisions about whom to admit to medical school and how to create diversity in the process has come under increased scrutiny. An additional layer of complexity is introduced when committees utilize the AAMC's prescribed holistic review in addition to their institutional diversity policies. This comparative case study explores how two medical schools (one public and one private) are charged with implementing holistic review when challenged by the institutional culture which may resist a holistic approach. Through interviews, meeting observations, and document analysis, the study examines how and when diversity is introduced into the admissions process, and how diversity policies function in the overall medical school environment. Applying a framework of institutional isomorphism (DiMaggio & Powell, 1983), the study found that medical schools are highly concerned about a decrease in MCAT scores and coursework grades, which could negatively impact medical school rankings. It could also contribute to institutional inertia when introducing a new review process, causing resistance by admissions committee members. Additionally, admissions committees and leadership may differ regarding philosophical and historical factors that create bias within the process resulting in isomorphic change. Isomorphic change is a result of the ambiguity and the lack of institutional buy-in on various levels (DiMaggio & Powell, 1983). Virtual adoption (Birnbaum, 2000) is a result of an increased focus emulating processes of peer medical schools that misalign the school's priorities, creating confusion about how to address the national shortage of diverse physicians. Future research needs to account for additional influences on admissions decisions, including the impact of the current Fisher v. University of Texas case that may redefine how diversity is measured in medical school admissions.