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Integration of collaborative medication therapy management in a safety net patient-centered medical home

https://doi.org/10.1331/JAPhA.2011.10191Get rights and content

Objective

To describe the integration of collaborative medication therapy management (CMTM) into a safety net patient-centered medical home (PCMH).

Setting

Federally qualified Health Care for the Homeless clinic in Richmond, VA, from October 2008 to June 2010.

Practice description

A CMTM model was developed by pharmacists, physicians, nurse practitioners, and social workers and integrated with a PCMH. CMTM, as delivered, consisted of (1) medication assessment, (2) development of care plan, and (3) follow-up.

Practice innovation

CMTM is integrated with the medical and mental health clinics of PCMH in a safety net setting that serves homeless individuals.

Main outcome measures

Number of patients having a CMTM encounter, number and type of medication-related problems identified for a subset of patients in the mental health and medical clinics, pharmacist recommendations, and acceptance rate of pharmacist recommendations.

Results

Since October 2008, 695 patients have had a CMTM encounter. An analysis of 209 patients in the mental health clinic indicated that 425 medication-related problems were identified (2.0/patient). Pharmacists made 452 recommendations to resolve problems, and 384 (85%) pharmacist recommendations were accepted by providers and/or patients. For 40 patients in the medical clinic, 205 medication-related problems were identified (5.1/patient). Pharmacists made 217 recommendations to resolve the problems, and 194 (89%) recommendations were accepted.

Conclusion

Integrating CMTM with a safety net PCMH was a valuable patient-centered strategy for addressing medication-related problems among homeless individuals. The high acceptance rate of pharmacist recommendations demonstrates the successful integration of pharmacist services.

Section snippets

Objective

This report describes the implementation and initial outcomes associated with a patient-centered collaborative medication therapy management (CMTM) program that is integrated with a PCMH in a safety net setting.

Daily Planet medical home

Daily Planet is a HRSA-funded Health Care for the Homeless clinic that serves adults primarily. Its mission is to provide accessible, comprehensive, and integrated quality health services to the citizens of the Greater Richmond Metropolitan area. All Daily Planet patients (n = 4,594) have an income 200% or less of the poverty level, and 95% are uninsured. The majority (52%) of patients are black, 29% white, 16% Hispanic, 2% Asian American, and 1% other. The majority of patients are male (54%).

Outcome measures

We report the results from a retrospective analysis of the number and type of medication-related problems identified during CMTM in the mental health and medical clinics, as well as pharmacist recommendations and acceptance rate of pharmacist recommendations. The categories of medication-related problems and pharmacist recommendations are listed in Tables 1 and 2.

Results

Since October 2008, various components of CMTM have been provided to 695 patients (1,005 encounters) in the Richmond community. An analysis of 209 patients who received CMTM in the mental health clinic revealed that 425 medication-related problems were identified (2.0/patient). A total of 452 recommendations to resolve the problems were made by pharmacists, and 384 (85%) pharmacist recommendations to resolve the problems were accepted by providers and/or patients.

An analysis of 40 patients who

Discussion

Pharmacists in collaboration with other health care providers are in an ideal position to optimize medication-related outcomes for patients with chronic diseases.23–26 Successful pharmacist patient care models, which are precursors to CMTM, have been documented in both community and ambulatory care settings.27–30 Based on these previous positive outcomes and our experience with CMTM, the integration of a pharmacist in a safety net medical home model is a useful strategy for addressing

Future opportunities

The CMTM/PCMH team has begun to reach out to community pharmacists to facilitate coordination of medications for homeless patients throughout the community. As this evolves, a definitive role for the community pharmacist is expected to emerge. Interprofessional education opportunities for pharmacy, nursing, and medical students also are beginning to become available. A prospective study of the impact of CMTM on medication-related health outcomes, such as medication-related hospitalizations and

Conclusion

Integration of CMTM within a safety net PCMH is a patient-centered strategy for addressing medication-related problems among homeless individuals. The high acceptance rate of pharmacist recommendations demonstrates the successful integration of CMTM. Additional research is needed to further define pharmacists’ roles and responsibilities and expected outcomes as members of interprofessional health care teams. This information will be helpful in understanding how pharmacists can be incorporated

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      Finally, the ability to be reimbursed for MTM (cost) is close to essential for implementation, and when combined with the limited availability of resources posed implementation challenges. While this study focused on community pharmacy settings, there are also studies that provide insights into the experiences of providing professional services in ambulatory and hospital settings,80–83 which may also be informative for future implementation research in pharmacy, generally. While the practice of MTM has been around for over a decade (and longer if you consider pharmaceutical care practice as its predecessor), there has been little implementation literature on it; however, there have been numerous cross-sectional studies of pharmacists', providers' and patients' attitudes about MTM.

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    Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.

    Acknowledgments: To Lauren Cox, BS, Justin Siegfried, BS, and Antoinette B. Coe, PharmD, for assistance with data collection and to Daily Planet providers and administrative staff for support of pharmacist services.

    Funding: Supported in part by a Virginia Commonwealth University Council for Community Engagement Grant and National Institutes of Health Clinical and Translational Science Award K12 Scholar Award (1KL2RR031989-01) to Dr. Moczygemba.

    Previous presentations: American College of Clinical Pharmacy Annual Meeting, Anaheim, CA, October 18–21, 2009, and American Pharmacists Association Annual Meeting, Washington, DC, March 12–15, 2010.

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