What is medication therapy management

Organizations looking to deliver stronger care and further maximize the benefits of comprehensive medication management can now pair the CMM process with supporting technology, i. How does this work? Cureatr clinical pharmacists virtually assess patients, evaluate medication care plans, and enable real-time monitoring of medication-taking behavior. The pharmacists also benefit from clinical event notification technology, which informs them when a patient under their supervision experiences a healthcare event, such as an emergency room visit, annual wellness visit, or surgical procedure, that could lead to changes to a medication regimen e.

To learn more about Cureatr's innovative, tech-enable comprehensive medication management service, schedule a time to speak with one of our specialists. Medication Management. Cureatr News. Company Culture. We provide real-time, universal access to accurate medication data for over Million patient and high-quality interventions by board certified telepharmacists. We have the expertise, resources, and technology to help you get the meds right and keep your patients out of the hospital.

Take the Quiz Contact Resources Blog. I want to learn more about: all topics. All Topics. The Problems With Medication Therapy Management On the surface, medication therapy management may seem like a good service to offer and provide to patients. Not all private insurers cover MTM services. The degree to which MTM component services differ for Medicare beneficiaries when compared with non-Medicare beneficiaries is not known.

Finally, certain patient populations may have considerable difficulty accessing or participating in MTM services; examples include individuals who are homebound, individuals who have physical or cognitive disabilities, patients without health insurance, and patients living in rural areas. Potential audiences for our review include payers of MTM services such as CMS; providers of MTM services, particularly pharmacists and pharmacy benefit organizations; health care providers; and patients.

We received comments from 23 professional organizations and individuals. We revised the KQs in response to these comments by:.

The revised KQs are listed below; specific details regarding patient population, intervention components, and outcomes are provided in the section that follows the analytic framework. In adults with one or more chronic diseases who are taking prescription medication, is MTM effective in improving the following:. Does the effectiveness of MTM differ by patient characteristics, including but not limited to patient demographics and numbers and types of conditions and medications?

The following types of interventions generally are not considered MTM interventions and will not be included:. For example, a study with two arms that has one arm with a care management intervention that includes MTM services and the other arm that has the care management intervention without MTM services could be included. A study that includes a care management intervention with MTM in one arm and usual medical care no care management intervention in the other arm would not be included.

We specified our inclusion and exclusion criteria based on the population, intervention, outcome, timing, and settings identified through the topic refinement exercise.

Our exclusion of non—English-language studies is based on limitations of time and resources. We will exclude studies with a high risk of bias and study designs without control groups to ensure that our pool of included studies can inform the causal link between the intervention and outcomes. We will systematically search, review, and analyze the scientific evidence for each KQ. We will take the following steps to perform the literature search.

We will also search the Cochrane Library and the International Pharmaceutical Abstracts database by using analogous search terms. We selected these databases based on preliminary searches and consultation with content experts. We will conduct quality checks to ensure that the search identifies known studies i. If we do not identify the known studies, we will revise and rerun our searches. Potential sources of gray literature include ClinicalTrials.

The Scientific Resource Center of the Agency for Healthcare Research and Quality AHRQ will manage the process of submitting requests for scientific information packets, which contain information about MTM programs and services of interest from relevant providers. We reviewed our search strategy with an independent information specialist and the Technical Expert Panel TEP and supplemented it according to their recommendations.

In addition, to attempt to avoid retrieval bias, we will manually search the reference lists of landmark studies and background articles on this topic to look for any relevant citations that our electronic searches might have missed. We will also conduct an updated literature search of the same databases searched initially concurrent with the peer review process.

We will investigate any literature the peer reviewers or the public suggest and, if appropriate, will incorporate additional studies into the final review. The appropriateness of those studies will be determined using the methods described above.

Studies marked for possible inclusion by either reviewer will undergo a full-text review. For studies that lack adequate information to determine inclusion or exclusion, we will retrieve the full text and then make the determination.

Each full-text article will be independently reviewed by two trained members of the team for inclusion or exclusion based on the eligibility criteria described above. If both reviewers agree that a study does not meet the eligibility criteria, the study will be excluded. If the reviewers disagree, conflicts will be resolved by discussion and consensus or by consulting a third member of the review team.

As described above, all results will be tracked in an EndNote database. We will record the reason why each excluded full-text publication did not satisfy the eligibility criteria so that we can later compile a comprehensive list of such studies. For studies that meet our inclusion criteria, we will abstract relevant information into evidence tables.

To test the feasibility of this approach, we will test the approach with a sample of studies. We will design data abstraction forms to gather pertinent information from each article, including the characteristics of the study populations, settings, interventions, comparators, study designs, methods, and results. Specifically, we will abstract information about the interventions as specified in KQ 1, KQ 3, and the analytic framework; outcomes as specified in KQ 2a, 2b, and 2c and the analytic framework; patient characteristics as specified in KQ 4 and the analytic framework, and information about harms as specified in KQ 5 and the analytical framework.

Trained reviewers will extract the relevant data from each included article into the evidence tables. All data abstractions will be reviewed for completeness and accuracy by a second member of the team. We will not plan to routinely contact study authors for additional information. To assess the risk of bias of individual studies, we will use predefined criteria based on those developed by AHRQ. A study with medium risk of bias is susceptible to some bias but probably not sufficient to invalidate its results.

A study with high risk of bias has significant methodological flaws e. Specific concerns for our review include including questions to assess selection bias, confounding, performance bias, detection bias, and attrition bias i. We plan to exclude studies deemed at high risk of bias from our main data synthesis and main analyses; we will include them only in sensitivity analyses.

If we find three or more similar studies for a comparison of interest, we will consider quantitative analysis i. We will also consider conducting mixed-treatment comparisons in a meta-analysis using Bayesian methods to compare the MTM interventions with each other if we identify a sufficient number of studies with a common comparator e.

For all analyses, we will use random-effects models to estimate pooled or comparative effects. To determine whether quantitative analyses are appropriate, we will assess the clinical and methodological heterogeneity of the studies under consideration following established guidance. If we conduct quantitative syntheses i. The importance of the observed value of I 2 depends on the magnitude and direction of effects and on the strength of evidence for heterogeneity e. If we include any meta-analyses with considerable statistical heterogeneity in this report, we will provide an explanation for doing so, considering the magnitude and direction of effects.

We will also examine potential sources of heterogeneity using sensitivity analysis or analysis of subgroups. Planned stratifications or categories for subgroup analyses include the subgroups listed in the analytic framework. When quantitative analyses are not appropriate e. We will grade the strength of evidence based on the guidance established for the Evidence-based Practice Center Program.

It also considers other optional domains that may be relevant for some scenarios, such as a dose-response association, plausible confounding that would decrease the observed effect, strength of association magnitude of effect , and publication bias. Table 3 describes the grades of evidence that can be assigned. Grades reflect the strength of the body of evidence to answer the KQs on the comparative effectiveness, efficacy, and harms of the interventions included in this review.

Module 1. Figure 1. Aug 20, Figure 2. Figure 3. Figure 4. Avalere Health. May Table 2. Table 3. How might MTM services affect workload? Time, workflow challenges Administrative requirements What patient populations will be targeted? How will patients be recruited? How will we address the potential problem of too few referrals? What methods will be used to communicate with payers, physicians, and health systems about MTM? Pharmacist time spent Changes in patients' medications, outcomes Other impact on pharmacy practice What compensation systems will be used in our MTM service?

Figure 6. Per Capita Spending on Prescription Drugs, — Summary of MTM Goals. Patient-centered rather than product-centered Focuses on overall regimen rather than individual medication Collaboration among pharmacists and other healthcare providers.

Increase patients' understanding and self-management skills Improve patient adherence, thereby enhancing efficacy of medications Increase adherence to CMS quality performance standards. Significantly fewer adverse drug events; significantly improved adherence, patient knowledge, quality of life.

Pharmacist interventions in primary care resulted in improvements in blood pressure, glycosylated hemoglobin, cholesterol, CVD risk factors.

Time, workflow challenges Administrative requirements. Is there a need to create a space or find a space for face-to-face MTM consults? MTM is especially effective for patients with multiple chronic conditions, complex medication therapies, high prescription costs, and multiple prescribers. MTM can be performed by pharmacists with or without a collaborative practice agreement CPA , and it is a strategy that can be considered to straddle Domain 3 health care system interventions and Domain 4 community-clinical links.

Strong evidence exists that the use of MTM by pharmacists is effective. Although the exact combination of MTM activities tends to vary between settings, studies examining MTM have generally found it to be effective and to have strong internal and external validity. MTM trials have been replicated in many different contexts with positive results. Implementation guidance on MTM is available from several sources, including the guidance provided under Medicare Part D.

Although some evidence exists that MTM can achieve positive outcomes among minority and low-income populations, the extent of this evidence is limited and inconsistent. Studies have indicated that MTM can produce health care cost savings and a positive return on investment ROI for health care systems. These partners helped plan and develop the assessment.

After 6 months, assessments found that hypertension control had increased to Challenges included finding champions for the MTM model. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Division for Heart Disease and Stroke Prevention. Section Navigation.