Tip of the Week: Focus On the “Management” in Medication Therapy Management

Organizational determinants can play an important role in whether or not MTM programs are successful.

Medication therapy management (MTM) is at the heart of what pharmacists do. This is not a new responsibility, although some literature suggests otherwise. The name for this task has changed over the years and pharmacy has become more systematic in the implementation of medication management, but this has always been at the core of pharmacy.

Particular attention is rightfully paid to providing MTM services for entire populations, rather than simply to individual patients. In fact, it is the most vulnerable populations where pharmacy services might make the greatest difference. The “management” in medication therapy management is a critical piece. Without proper management, our services are inefficient and ineffective. Relying on foundational management concepts and even management theories can often make the difference between successful and unsuccessful approaches for these services.

Turner et al. examined the different factors that result in the successful implementation of community pharmacy MTM programs. Specifically, they took a closer look at organizational determinants such as implementation climate and innovation-values fit. These are part of implementation effectiveness paradigms, which were designed for complex innovations such as medication management programs, which often require coordinate efforts by multiple individuals to be successful.

A positive implementation climate would suggest that a pharmacy has formal policies to support implementation of an MTM program that includes things such as employee training and reward and recognition programs for implementation. This in turn affects employees’ shared perceptions about the extent to which the MTM program is supported and even expected.

Innovation-values fit refers to pharmacy employees’ perceptions about how well medication management programs align with the values of the pharmacy and the pharmacy profession. If the employee believes that the program is not a good fit, they will be less committed to it.

Turner et al. studied community pharmacies that participated in either the first or second year of the 3-year North Carolina Community Pharmacy Enhanced Services Network (NC-CPESN). Participating pharmacies received a survey assessing their structural characteristics, experience with NC-CPESN, and perceptions about implementation. They compared these responses across 2 outcome variables. One was implementation versus non-implementation of a comprehensive medication review (CMR) program for high-risk patients. The other was the program’s reach, which was calculated as the number of attributed high-risk patients receiving a CMR divided by the number of high-risk patients in the pharmacy’s catchment area as described from county health agencies.

In their analysis, researchers found that the implementation climate and perceptions of pharmacy had a significant impact on the success of the program and how many patients it reached. Additional analyses found that pharmacies located in rural areas were associated with lower implementation of CMRs per high-risk patient, and that pharmacies associated with the 340B program were associated with higher implementation.

The study results support the fundamental need for the “management” in MTM programs. Managers who institutionalized a culture of implementation and who provided an environment for employees to self-motivate and believe in the value of CMR services were able to successfully implement these programs and reach more patients. The pharmacy manager can do these things through such things as a rewards systems, well-defined policies and procedures, and also simply emphasizing the importance of reaching vulnerable patients as part of the pharmacy’s mission.

Additional information about The Management in Medication Therapy Management can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.

About the Author

Shane P. Desselle, RPh, PhD, FAPhA, is a professor of social and behavioral pharmacy at the Touro University California College of Pharmacy.

Reference

Turner K, Trogdon JG,Weinberger M, Stoyer AM, et al. Testing the organizational theory of innovation implementation effectiveness in a community pharmacy medication management program: A hurdle regression analysis. Implementation Sci. 2018;13: 105.