Abstract 

Background

Patient satisfaction with medication therapy management (MTM), a required component of the Medicare Part D benefit, is an important outcome to consider when evaluating MTM programs.

Objective

To measure patient satisfaction with a pharmacist-provided telephone MTM program.

Methods

The study design was nonexperimental and cross sectional. A survey was mailed to Scott & White Health Plan Medicare Part D beneficiaries (n=60) who received telephone MTM in 2007. The survey was composed of 15 Likert-scaled questions (1=strongly disagree to 5=strongly agree) that assessed satisfaction with MTM. Descriptive statistics were used for quantitative data analysis. A qualitative content analysis of patients' responses to 3 open-ended questions was also conducted.

Results

The response rate for the survey was 80% (47 of 59). Study participants were 70.8 (±7.9) years old, and most were white (84.1%) and female (54.3%). The alpha coefficient for the satisfaction scale was 0.88. Overall mean satisfaction score was 4.0 (±0.6), with items ranging from 3.6 to 4.3. The highest level of agreement (mean=4.3) was with the following statements: (1) I can easily contact my pharmacist when I have questions or concerns; (2) My pharmacist adequately answers my questions; and (3) I am content receiving MTM over the telephone. The patients agreed least (mean=3.6) with the following statements: (1) When necessary, my pharmacist has encouraged me to receive preventive health care services; and (2) When needed, my pharmacist refers me to other health care providers.

Conclusions

Most of the beneficiaries were satisfied with their MTM care. The positive response to telephone MTM is important because Medicare Part D plans are using the telephone as a method of MTM delivery. Education regarding the pharmacist's role in preventive care and pharmacist follow-up with non-pharmacist health care providers may lead to greater satisfaction levels.

Why Pharmacists Belong In The Medical Home

Marie Smith^1,*, David W. Bates², Thomas Bodenheimer³ and Paul D. Cleary⁴

¹ Marie Smith (marie.smith@uconn.edu) is head of the Department of Pharmacy Practice, School of Pharmacy, at the University of Connecticut in Storrs.
² David W. Bates is division chief of general medicine at Brigham and Women’s Hospital in Boston, Massachusetts.
³ Thomas Bodenheimer is an adjunct professor of family and community medicine at the University of California, San Francisco.
⁴ Paul D. Cleary is dean of the School of Public Health, Yale University, in New Haven, Connecticut.

Pharmacists can affect the delivery of primary care by addressing the challenges of medication therapy management. Most office visits involve medications for chronic conditions and require assessment of medication effectiveness, the cost of therapies, and patients’ adherence with medication regimens. Pharmacists are often underused in conducting these activities. They perform comprehensive therapy reviews of prescribed and self-care medications, resolve medication-related problems, optimize complex regimens, design adherence programs, and recommend cost-effective therapies. Pharmacists should play key roles as team members in medical homes, and their potential to serve effectively in this role should be evaluated as part of medical home demonstration projects.

Great article; this is the type of professional advocacy we need.

In a letter to American Medical Association (AMA) CEO Michael D. Maves, MD, MBA, ASHP CEO Henri R. Manasse, Jr., Ph.D., Sc.D., expressed his extreme disappointment with a recent members-only-access publication by the AMA entitled “AMA Scope of Practice Data Series: Pharmacists.”  The AMA document, which includes a categorical analysis of pharmacists’ scope of practice in each state, contains numerous inaccuracies, false statements, and mischaracterizations about pharmacy practice and pharmacist education.  ASHP calls on the AMA to retract the document, or, at minimum, correct the inaccuracies and mischaracterizations.

 

Of particular concern, is the repeated characterization of pharmacists as having inadequate education and training, suggesting that their patient care roles should be limited.

Proud that ASHP is aggressively pursuing these type of issues!

Letter to AMA [PDF]: http://www.ashp.org/DocLibrary/News/NewsCapASHPlettertoAMAreScopeofPractice03...

he Academy of Managed Care Pharmacy (AMCP) today unveiled the AMCP eDossier System in a partnership with Dymaxium Inc. This powerful electronic dossier system promises to revolutionize the way health care professionals access and evaluate information needed to make evidence-based formulary decisions.

The AMCP eDossier System combines the familiar structure of paper-based dossiers with technologies that are flexible and interactive. The new system allows drug formulary decision makers to easily search and filter through the often overwhelming volumes of information within product dossiers and greatly improves the accessibility of critical evidence

Electronic tools such as this will help in focusing investigators and practitioners towards Comparative Effective Research (CER), for which $1.1 billion was allocated in the American Recovery and Reinvestment Act (ARRA).

"Comparative effectiveness research provides information on the relative strengths and weakness of various medical interventions. Such research will give clinicians and patients valid information to make decisions that will improve the performance of the U.S. health care system"

(http://www.hhs.gov/recovery/programs/os/cerbios.html)

In a follow-up to Dr. Flynn’s commentary, John Poikonen, PharmD, director of clinical informatics at University of Massachusetts Memorial Medical Center, in Worcester, agreed that study is needed. Writing in the April 15 issue of AJHP (2009;66:704-705). Dr. Poikonen urged the design of a study “to assess the patient-safety effects of eliminating NUPOR on certain orders.” 

He stressed that cutting NUPOR would not be appropriate for chemotherapy or other high-risk medications, but rather for a “ ‘sweet spot’ of medications that can be safely and effectively reviewed electronically without pharmacist review.”

Dr. Maddux agreed that in certain settings, prospective order review can be valuable, particularly “in cases where patients and therapy are complex.” But, he added, in other situations, such as when CPOE and/or standardized order sets are used, “you are committing pharmacists to reviewing orders that have already been vetted and standardized.”

A better approach, according to Dr. Maddux, is to have more pharmacists on clinical teams actively involved in patient management at the bedside and in the clinic. “Prospective review at the time of the order may be more beneficial,” he said. If a pharmacist is involved on the clinical team caring for the patient, and “a suboptimal order is avoided to begin with, then there is no need for a pharmacist to go through all that review later,” when he or she may or may not have access to all the relevant information required to make the most informed decision regarding the order.

While recognizing the importance of order entry review, Dr. Maddux stressed that “there could be improvements; NUPOR, in and of itself, for all comers, may not be the best way to go.”

Great article summarizing the interesting discussion that Dr. Poikonen recently prodded into the limelight.

Also nice to see the quote(s) from Dr. Maddux - the former clinical Dean from my alma mater - and his well-worded statement on the issue.