Medication therapy management (MTM) is a comprehensive way to enhance medication use, improve adherence, and reduce the risk of adverse events.1

The Centers for Medicare & Medicaid Services emphasizes MTM measures that include adherence for Part C and Part D plans to achieve higher Medicare star ratings.2 Pharmacists play an important role in improving adherence through MTM services and can also reduce hospital admissions.

PHARMACIST-LED LITERATURE REVIEW
One study involving a patient-centered, pharmacist- led adherence program that incorporated motivational interviewing (MI) for behavior change was implemented at Envolve Pharmacy Solutions.2 Envolve provides an in-house MTM program to improve adherence rates and Medicare star ratings.2 The MI program used coaching, skills assessment, teaching, and a train-the-trainer intervention as part of the study. The program was found to be effective, increasing adherence rates by 5% to 9% (P <.05) over 5 years and improving Medicare star ratings by 1 to 2 stars.2 This study demonstrated that pharmacists can play an important role in improving adherence through MI.

Pharmacist-led MTM was compared with usual care in a randomized controlled study in patients with type 2 diabetes.3 Study participants in the control group received usual care provided in the diabetes clinic; this included a discussion lasting 3 to 4 minutes with the physician regarding their disease state, the importance of medication adherence, and follow-up appointments. Patients in the MTM group received usual care in combination with MTM by the pharmacist immediately after the physician consult. The clinical pharmacist used a patient-centered approach, and the average appointment was about 45 minutes. Each consult included a medication review, customized education and training on the drug regimen, and discussion on the importance of lifestyle modifications, such as diet, exercise, and smoking cessation. Pharmacists provided free follow-up counseling by telephone to address patients’ questions. The study showed a significant increase in medication adherence from baseline to 3 months and 6 months in the MTM group compared with the control group (P <.01). Also, there were 52.1% fewer hospital admissions arising from uncontrolled blood glucose levels in the MTM group (P <.001).3 Pharmacist-led programs can have a huge impact on diabetes care and reduce hospital admissions.

Acute inpatient admissions and emergency department visits were compared between patients participating in MTM and patients who were eligible but not receiving the services in a retrospective study.4 Patients with Medicare Part D coverage who received MTM services between January 1, 2014, and December 31, 2015, were included in the study conducted by Humana. Eligible patients were required to have at least 3 of the 5 core chronic health conditions (diabetes, heart failure, hypertension, hyperlipidemia, and osteoporosis), to have been prescribed at least 8 chronic medications, and to meet the minimum medication-cost criteria. The study demonstrated that receiving MTM services that resolved medicationrelated problems increased medication adherence and reduced hospital admissions.4

A CLOSER LOOK
In an interview, Maegan Lee Thornton, PharmD, an MTM pharmacist at Carlie C’s Pharmacy in Benson, North Carolina, discussed how pharmacists can truly make an impact on their patients. Carlie C’s Pharmacy has 5 locations in North Carolina, and she performs MTM services for all the pharmacies.

Thornton primarily uses Mirixa and Outcomes and noted that they recently merged into the same platform. She said this would facilitate the MTM documentation and submission process. OptumRx is another MTM platform for which the pharmacies recently signed up, and she has already begun completing cases.

Thornton began providing MTM services in 2016, and she truly enjoys building a rapport with her patients. MTM connects all aspects of pharmacy, she says.




Patient compliance rates have improved with antihypertensive medications, diabetes pharmacotherapy, and statin therapies.

Thornton also discussed MTM consult opportunities, which include identifying high-risk medications, preventing potential drug–drug interactions, and providing cost-effective treatment options for patients. Weekly pill boxes are one of the compliance tools that Thornton recommends, and she also conducts follow-up
calls to check on patients. “I personally feel that MTM acts as a bridge between the physician, pharmacist, and patient,” she said.

ADHERENCE TOOLBOX
Pharmacists can provide patients with a variety of resources from their MTM toolboxes to increase medication adherence (see figure) with health-literacy tools.1 Brown bag reviews can help answer questions and identify potential medication errors. Medication action plans describe the details of the comprehensive medication review, and the personal medication list shows all of the patient’s active medications. The teach-back method is a great way to ensure that patients understand all the information.1

REFERENCES
  1. Health literacy tools for providers of medication therapy management.  AHRQ website. ahrq.gov/health-literacy/pharmhealthlit/mtm.html. Updated November 2017.  Accessed January 12, 2020.
  2. Spears J, Erkens J, Misquitta C, Cutler T, Stebbins M. A pharmacist-led, patient-centered program incorporating motivational interviewing for behavior change to improve adherence rates and star ratings in a Medicare plan. J Manag Care Spec Pharm. 2020;26(1):35-41. doi: 10.18553/jmcp.2020.26.1.35.
  3. Erku DA, Ayele AA, Mekuria AB, Belachew SA, Hailemeskel B, Tegegn HG. The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes: a randomized controlled study. Pharm Pract (Granada). 2017;15(3):1026. doi: 10.18549/PharmPract.2017.03.1026.
  4. Ferries E, Dye JT, Hall B, Ndehi L, Schwab P, Vaccaro J. Comparison of medication therapy management services and their effects on health care utilization and medication adherence. J Manag Care Spec Pharm. 2019;25(6):688-695. doi: 10.18553/jmcp.2019.25.6.688.