Medication Therapy Management: Methods to Increase Comprehensive Medication Review Participation
AffiliationCollege of Pharmacy, The University of Arizona
Comprehensive Medication Review (CMR)
Medication Management Center (MMC)
Medication Therapy Management Program (MTMP)
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, Librarian and Clinical Instructor, Pharmacy Practice and Science, email@example.com.
PublisherThe University of Arizona.
AbstractSpecific 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.
DescriptionClass of 2013 Abstract
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Medication Reconciliation at an Academic Medical Center: Perceptions from Medical ProfessionalsWarholak, Terri; Candlish, Karol; Young, Genevieve; Warholak, Terri; College of Pharmacy, The University of Arizona (The University of Arizona., 2012)Specific Aims: The goal of this project was to assess perceptions of medication reconciliation from medical professionals who perform them. Specific areas of interest included the perceived: amount of time spent on medication reconciliation; process complexity; and effectiveness of the current process. Opinions concerning the use of alternative processes were also solicited. Methods: This prospective qualitative study involved four focus group sessions at one tertiary referral teaching hospital in Tucson, Arizona. Nurses involved in admissions medication reconciliation in the emergency department were invited to participate, and their perceptions were categorized and summarized. Main Results: Participants reported a range of times to complete the medication reconciliation from zero to greater than 20 minutes. According to the participants, the time spent on each patient depended on patients’ medication knowledge and the complexity of their regimens. Participants wanted the medication list entry screen to be easier to use, and they also suggested patients’ medication lists from previous visits and from outpatient clinics associated with the medical center be easily accessible. Participants felt that emergency triage may not be the most ideal time in which to perform medication reconciliation, and they expressed concerns about accuracy of these medication lists. While some were interested in the possibility of using a patient medication database and expected that it would improve accuracy and save time, others were less open to a perceived additional step. Concusions: Participants provided suggestions for changes in the current medication reconciliation process that they feel could improve patient satisfaction and increase efficiency.
Description of a Pharmacy Technician and Student Intern-Driven Medication Reconciliation Process and Evaluation of Medical Provider Acceptance of Recommendations to Reorder Critical MedicationsSalek, Ferena; Hall, Edina; Glover, Jon; Hall, Scott Thomas; Salek, Ferena; Hall, Edina; Glover, Jon; College of Pharmacy, The University of Arizona (The University of Arizona., 2011)OBJECTIVES: To describe a pharmacy technician and student intern-driven medication reconciliation process and to evaluate medical provider acceptance of recommendations to reorder critical medications. METHODS: Patients admitted to Northwest Medical Center had medication histories taken on admission. A specially trained pharmacy technician or student intern reviewed these histories, with emphasis placed on critical medications as defined by the Pharmacy and Therapeutics Committee. Recommendations to re-order these critical medications were made to medical providers. All patients, excluding those under 18 years of age or current enrollment in the prison system, admitted during the months of May-June 2010 were reviewed for acceptance of critical medication recommendations through information recorded in the pharmacy electronic medical record system. RESULTS: One hundred seventy-eight (178) recommendations were made on 132 patients requiring recommendations. All medical providers accepted 102 (57%, p-value=0.008) of the recommendations made. Hospitalists were more likely than physician specialists or surgeons to accept recommendations made (62.5%, p-value<0.001). Recommendations made regarding thyroid products were accepted the greatest majority of the time (82.1%, p-value<0.001); antidepressants (54.8%, p-value=0.321), anticonvulsants (63.2%, p-value=0.194), and medications classified as other (55.6%, p-value=0.480) were also accepted a majority of the time. Vitamin K antagonists did not have recommendations accepted a majority of the time (31.8%, p-value=0.034). CONCLUSION: Medical providers accepted a majority of recommendations to reorder critical medications made by pharmacy technicians or student interns.
Impact of the Bar Code Medication Administration (BCMA) System on Medication Administration ErrorsSnyder, Rita; Doyle, Mary Davis; Snyder, Rita; Effken, Judith; Lamb, Gerri; Verran, Joyce (The University of Arizona., 2005)Medication errors are the second most frequent cause of injury among all types of medical errors (Leape, et al., 1991). Of concern to nursing practice, medication administration errors (MAE) are second only to ordering errors (Bates, Cullen, et al., 1995). The introduction of information technology designed to promote safe medication practice, such as the Bar Code Medication Administration (BCMA) system, offers new opportunities for reducing MAE. BCMA was developed to improve patient safety, improve documentation of medication administration, decrease medication errors, and capture medication accountability data. The overall goal of this study was to evaluate the impact of BCMA on medication administration errors: wrong patient, medication, dose, time, and route. Rogers' (1995) theory, organizational diffusion of innovations, provided the study's framework.A descriptive comparative design examined incidence of MAEs before (Time 1) and after implementation (Time 2) of BCMA on eight units in one medical center. MAE incidence was calculated using MAE and patient-days data. Nurse adherence to BCMA usage procedure was assessed with a questionnaire created for the study.Findings indicated that total MAEs increased from Time 1 to Time 2, however, wrong patient and wrong dose errors decreased. There was a statistically significant (p < 0.05) increase in wrong route errors at Time 2. Comparing these findings with previous research demonstrated a diversity of methods, limiting conclusions. Nurse adherence findings indicated high overall adherence. However, completion of certain steps was hindered by software, equipment, or the work environment.Study findings were significant to nursing, informatics and patient safety research. Findings demonstrated the early state of BCMA research, added to knowledge about MAE detection methods, and brought a nursing perspective to information technology research on a process primarily within nursing purview. Implications for future research include improvement in MAE definitions and detection methods to support reliable data collection for research and quality improvement analysis. Also, sociotechnical theory recognizes health care as an interwoven, heterogeneous environment with complex roles and work practices, and may provide a more appropriate framework for evaluation of medication safety technology innovations than the linear model used in this study.