Follow-up Evaluations Are Essential

Pharmacy TimesMay 2023
Volume 89
Issue 5

These appointments help identify medication-related problems and serve as a platform for additional education.

Following up with patients is a critical component of the medication therapy management (MTM) services pharmacists provide to identify adherence issues, detect adverse drug reactions (ADRs), educate patients, and review potential drug interactions.1

The Agency for Healthcare Research and Quality considers pharmacists to be the ideal health care professionals for following up with patients about medications.2 If an MTM consult pinpoints a problem, pharmacists play a key role in facilitating its resolution (Figure1-4).

As highlighted by a recently published pilot study, pharmacists are vital members of the multidisciplinary teams that monitor pharmacotherapy regimens. Conducted between September and November 2019, the randomized, controlled trial evaluated the impact of MTM on 120 patients with hypertension and other chronic, noninfectious conditions. Participants were included if they were between aged 45 and 80 years, had experienced more than 2 chronic medical conditions, and were taking more than 5 medications.3

Patients in the intervention group received MTM services from clinical pharmacists in person and by phone. Results showed that at 12 months after hospital discharge, the intervention group had lower blood pressure (P < .001 and P = .023 for diastolic andsystolic pressure, respectively) and significantly lower average daily medication costs (P = .049) than the control group.3

Patients may be followed via automated calling systems, letters, phone calls, secure email, and texts. However, during MTM consults, pharmacists can also recommend that patients track values for such chronic conditions as diabetes and hypertension,2 and patients can talk with clinicians about their progress with medication and lifestyle modifications.

One prospective, quasi-experimental 3-month study evaluated the pharmacist-led, postdischarge telephone follow-up (TFU) of 200 adult patients receiving at least 10 prescription medications for chronic conditions.4 Three members of the hospital’s pharmacy team conducted the TFU to assess medication-related problems, adherence, and patients’ ability to manage a drug regimen.4 TFU was scheduled within 10 days of discharge, at 1 month, and at the start of the third month after discharge.4 Results showed that pharmacist-led TFU reduced 30- and 90-day hospital readmission rates, with 9.9% of readmissions among those in the intervention group (P < .001) and 15.2% (P = .021) in the control group.4


1. American Pharmacists Association and National Association of Chain Drug Stores Foundation. Medication therapy management in pharmacy practice: core elements of an MTM service model. March 2008. Accessed March 9, 2023.

2. Brega AG, Barnard J, Mabachi NM, et al. AHRQ Health Literacy Universal Precautions Toolkit. 2nd ed. Agency for Healthcare Research and Quality. Updated September 2020. Accessed March 9, 2023.

3. Li N, Song JF, Zhang MZ, Lv XM, Hua HL, Chang YL. Impact of medication therapy management (MTM) service model on multi-morbidity (MMD) patients with hypertension: a pilot RCT. BMC Geriatr. 2023;23(1):10. doi:10.1186/s12877-023-03725-4

4. Odeh M, Scullin C, Fleming G, Scott MG, Horne R, McElnay JC. Ensuring continuity of patient care across healthcare interface: telephone follow-up post-hospitalization. Br J Clin Pharmacol. 2019;85(3):616-625. doi:10.1111/bcp.13839

About the Author

Jennifer Gershman, PharmD, CPh, PACS, is a drug information pharmacist and Pharmacy Times contributor who lives in South Florida.

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