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, firstname.lastname@example.org.
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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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.
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.
Shadowing emergency medicine residents by medical education specialists to provide feedback on non-medical knowledge-based ACGME sub-competenciesWaterbrook, Anna L.; Ellinwood, Karen C. Spear; Pritchard, T. Gail; Bertels, Karen; Johnson, Ariel C.; Min, Alice; Stoneking, Lisa R.; Univ Arizona, Coll Med, Dept Emergency Med; Univ Arizona, Coll Med, Dept Obstet & Gynecol; Univ Arizona, Coll Med, Dept Pediat; et al. (DOVE MEDICAL PRESS LTD, 2018)Objective: Non-medical knowledge-based sub-competencies (multitasking, professionalism, accountability, patient-centered communication, and team management) are challenging for a supervising emergency medicine (EM) physician to evaluate in real-time on shift while also managing a busy emergency department (ED). This study examines residents' perceptions of having a medical education specialist shadow and evaluate their nonmedical knowledge skills. Methods: Medical education specialists shadowed postgraduate year 1 and postgraduate year 2 EM residents during an ED shift once per academic year. In an attempt to increase meaningful feedback to the residents, these specialists evaluated resident performance in selected nonmedical knowledge-based Accreditation Council of Graduate Medical Education (ACGME) sub-competencies and provided residents with direct, real-time feedback, followed by a written evaluation sent via email. Evaluations provided specific references to examples of behaviors observed during the shift and connected these back to ACGME competencies and milestones. Results: Twelve residents participated in this shadow experience (six post graduate year 1 and six postgraduate year 2). Two residents emailed the medical education specialists ahead of the scheduled shadow shift requesting specific feedback. When queried, five residents voluntarily requested their feedback to be included in their formal biannual review. Residents received milestone scores and narrative feedback on the non-medical knowledge-based ACGME sub-competencies and indicated the shadow experience and subsequent feedback were valuable. Conclusion: Medical education specialists who observe residents over the course of an entire shift and evaluate non-medical knowledge-based skills are perceived by EM residents to provide meaningful feedback and add valuable information for the biannual review process.