Measurable Benefit of Targeted versus Comprehensive Medication Reviews in Medication Therapy Management

Abstract

Objectives: 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.