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I recently had an interesting conversation with a pharmacist who had started her own company to do medication therapy management (MTM). Many community pharmacists conduct MTM that is not really MTM, although it was often referred to as MTM. By implication, it was obvious that she felt these sessions were of little value. Without taking a side at that time, I concluded that MTM may mean different things to pharmacy providers, patients, and payers.
This situation may not be good for our profession. As this colleague related, she has been having trouble getting payers to cover her services. Most of her initial success has come from adult children of elderly parents who want a comprehensive review of mom’s or dad’s medications and are willing to pay cash for the assessment. Although such businesses may still be rare in pharmacy, I keep learning about new ones that are being set up around the country. I think it is very good for our profession’s future.
This conversation caused me to reflect on this question—what is MTM? Is comprehensive medication review the only form of MTM? In describing MTM in her promotional brochure, this pharmacist stated, “MTM is a medical service performed by an MTM-certified pharmacist that ensures that you safely and effectively achieve the targeted outcomes from your medications. The MTM pharmacist joins your medical team and uses special analytical tools and processes to identify opportunities. Your pharmacist then acts as your advocate to help make improvements to your lifestyle.”
Such a service seems to be consistent with MTM in Pharmacy Practice: Core Elements of an MTM Service Model Version 2.0. This type of MTM activity is comprehensive, but also includes documentation and follow-up as well as a longitudinal focus, working with the patient over time to assure appropriate outcomes.
In contrast, many activities performed under the MTM label could be called “target MTM.” Such activities focus on a specific patient problem with a medication, for example, using a less expensive generic medication, avoiding a real or potential side effect, or preventing a drug interaction. Such interventions are episodic in nature, solving particular problems at the time care is offered. But often no follow-up occurs unless the patient returns later and the same pharmacist sees the patient. No care plan is documented and no follow-up is planned.
Another activity that some call MTM is medication reconciliation. Since 2005, The Joint Commission has required medication reconciliation as a National Patient Safety Goal, although they revised the requirement effective July 1, 2011. This comprehensive evaluation of a patient’s medication regimen should occur at every transition of care. In many settings, medication reconciliation is not performed by pharmacists— suggesting that MTM may not require a pharmacist in order to be performed well.
As pharmacy practice deemphasizes the prescription-filling process in order to take responsibility for assuring drug therapy outcomes, performing MTM well becomes critically important for pharmacy’s future.
Each pharmacy practitioner needs to understand how the profession has described MTM as a comprehensive review with intervention, documentation, and follow-up. All the other activities we do to help patients use correct medications safely are important— but they are not a substitute for true MTM services.