Impact of passive and active promotional strategies on patient acceptance of medication therapy management services

Objectives To assess the impact of passive and active promotional strategies on patient acceptance of medication therapy management (MTM) services, and to identify reasons for patient acceptance or refusal. Methods Four promotional approaches were developed to offer MTM services to eligible patients, including letters and bag stuffers (“passive” approaches), and face-to-face offers and telephone calls (“active” approaches). Thirty pharmacies in a grocery store chain were randomized to one of the four approaches. Patient acceptance rates were compared among the four groups, and between active and passive approaches using hierarchical logistic regression techniques. Depending on their decision to accept or decline the service, patients were invited to take part in one of two brief telephone surveys. Results No significant differences were identified among the four promotional methods or between active and passive methods in the analyses. Patients’ most frequent reasons for accepting MTM services were potential cost savings, review of how the medications were working, the expert opinion of the pharmacist, and education about medications. Patients’ most frequent reasons for declining MTM services were that the participant already felt comfortable with their medications and felt their pharmacist provides these services on a regular basis. Conclusion No significant difference was found among any of the four groups or between active or passive approaches. Further research is warranted to identify strategies for improving patient engagement in MTM services

Predictors of medication-related problems among medicaid patients participating in a pharmacist-provided telephonic medication therapy management program

STUDY OBJECTIVE: To identify predictors of medication-related problems (MRPs) among Medicaid patients participating in a telephonic medication therapy management (MTM) program. DESIGN: Retrospective analysis of data from patients enrolled in a previously published study. DATA SOURCES: Two Medicaid administrative claims file databases (for health care utilization and prescription dispensing information) and one pharmacy organization file for MTM program information. PATIENTS: Seven hundred twelve adult Medicaid patients who participated in a statewide pharmacist-provided telephone-based MTM program and who received an initial medication therapy review. MEASUREMENTS AND MAIN RESULTS: The primary dependent variable was the number of MRPs detected during the initial medication therapy review. Secondary dependent variables were the detection of one or more MRPs related to indication, effectiveness, safety, and adherence. Predictor variables were selected a priori that, from the literature and our own practice experiences, were hypothesized as being potentially associated with MRPs: demographics, comorbidities, medication use, and health care utilization. Bivariate analyses were performed, and multivariable models were constructed. All predictor variables with significant associations (defined a priori as p<0.1) with the median number of MRPs detected were then entered into a three-block multiple linear regression model. The overall model was significant (p<0.001, R(2) = 0.064). Significant predictors of any MRPs (p<0.05) were total number of medications, obesity, dyslipidemia, and one or more emergency department visits in the past 3 months. For indication-related MRPs, the model was significant (p<0.001, R(2) = 0.049), and predictors included female sex, obesity, dyslipidemia, and total number of medications (p<0.05). For effectiveness-related MRPs, the model was significant (p<0.001, R(2) = 0.054), and predictors included bone disease and dyslipidemia (p<0.05). For safety-related MRPs, the model was significant (p<0.001, R(2) = 0.046), and dyslipidemia was a predictor (p<0.05). No significant predictors of adherence-related MRPs were identified. CONCLUSION: This analysis supports the relative importance of number of medications as a predictor of MRPs in the Medicaid population and identifies other predictors. However, given the models' low R(2) values, these findings indicate that other unknown factors are clearly important and that criteria commonly used for determining MTM eligibility may be inadequate in identifying appropriate patients for MTM in a Medicaid population

Experience Developing a Community Pharmacy Practice-based Research Network

In 2010, the Purdue University College of Pharmacy established the Medication Safety Research Network of Indiana (Rx-SafeNet), the first practice-based research network (PBRN) in Indiana comprised solely of community pharmacies. In the development of Rx-SafeNet and through our early project experiences, we identified several "lessons learned." We share our story and what we learned in an effort to further advance the work of the greater PBRN community. We have formed the infrastructure for Rx-SafeNet, including an Executive Committee, Advisory Board, member pharmacies/site coordinators, and Project Review Team. To date, 22 community pharmacies have joined and we have recently completed data collection for the network's first project. Lessons learned during the development of Rx-SafeNet may benefit PBRNs nationally. Although community pharmacy PBRNs are not yet commonplace in the U.S., we believe their development and subsequent research efforts serve as an important avenue for investigating medication use issues. &nbsp; Type:&nbsp;Idea Pape

Experience Developing a Community Pharmacy Practice-based Research Network

In 2010, the Purdue University College of Pharmacy established the Medication Safety Research Network of Indiana (Rx-SafeNet), the first practice-based research network (PBRN) in Indiana comprised solely of community pharmacies. In the development of Rx-SafeNet and through our early project experiences, we identified several "lessons learned." We share our story and what we learned in an effort to further advance the work of the greater PBRN community. We have formed the infrastructure for Rx-SafeNet, including an Executive Committee, Advisory Board, member pharmacies/site coordinators, and Project Review Team. To date, 22 community pharmacies have joined and we have recently completed data collection for the network's first project. Lessons learned during the development of Rx-SafeNet may benefit PBRNs nationally. Although community pharmacy PBRNs are not yet commonplace in the U.S., we believe their development and subsequent research efforts serve as an important avenue for investigating medication use issues. &nbsp; Type:&nbsp;Idea Pape

Fellowships in Community Pharmacy Research: Experiences of Five Schools and Colleges of Pharmacy

Objective To describe common facilitators, challenges, and lessons learned in 5 schools and colleges of pharmacy in establishing community pharmacy research fellowships. Setting: Five schools and colleges of pharmacy in the United States. Practice description: Schools and colleges of pharmacy with existing community partnerships identified a need and ability to develop opportunities for pharmacists to engage in advanced research training. Practice innovation: Community pharmacy fellowships, each structured as 2 years long and in combination with graduate coursework, have been established at the University of Pittsburgh, Purdue University, East Tennessee State University, University of North Carolina at Chapel Hill, and The Ohio State University. Evaluation: Program directors from each of the 5 community pharmacy research fellowships identified common themes pertaining to program structure, outcomes, and lessons learned to assist others planning similar programs. Results: Common characteristics across the programs include length of training, prerequisites, graduate coursework, mentoring structure, and immersion into a pharmacist patient care practice. Common facilitators have been the existence of strong community pharmacy partnerships, creating a fellowship advisory team, and networking. A common challenge has been recruitment, with many programs experiencing at least one year without filling the fellowship position. All program graduates (n = 4) have been successful in securing pharmacy faculty positions. Conclusion: Five schools and colleges of pharmacy share similar experiences in implementing community pharmacy research fellowships. Early outcomes show promise for this training pathway in growing future pharmacist-scientists focused on community pharmacy practice

Pharmacists\u27 Experiences With a Telephonic Medication Therapy Management Program for Home Health Care Patients

Objective: This study was designed to better understand perceived barriers and facilitators to providing medication therapy management (MTM) services by pharmacists who recently provided telephonic MTM services to home health care patients. These services were provided as part of a randomized, controlled trial (RCT) to develop suggested quality improvement strategies for future service design. Design: This was a qualitative study. A semi-structured individual interview format was used to elicit responses. Setting: Interviews were conducted by phone with participants. Participants: All pharmacists who recently provided telephonic MTM services as a part of an RCT participated in this study. Interventions: Pharmacists were asked questions regarding their perceptions of the services, training opportunities, patient perceptions of the services, interactions with physicians, and suggestions for improvement. General demographic information was collected for each pharmacist and summarized using descriptive statistics. Interview data were analyzed using inductive qualitative methods to reveal key themes related to facilitators and barriers of MTM services in home health care patients. Main Outcome Measures: The main outcome measures were major themes identified from pharmacist interviews pertaining to barriers, facilitators, and quality improvement strategies for telephonic MTM delivery. Results: A total of four pharmacists (i.e., 100% of those who participated in the prior RCT) were interviewed. Several themes emerged from the analysis, including: communication and relationships, coordinating care and patient self-management, logistics, professional fulfillment, service delivery and content, and training opportunities. Conclusions: This study provides possible strategies to overcome barriers and facilitate service provision for future telephonic MTM services

Opioid Prescribing During Pregnancy: Eight-Year Secular Trends at HealthPartners Medical Group

Background: Nationally, opioid prescribing for chronic noncancer pain has increased significantly over the last 20 years. Recently published evidence suggests that 20% to 40% of women received opioid prescriptions of varying doses and durations during pregnancy, which may cause increased risks of harm to mother and fetus. The purpose of this retrospective observational study was to determine the prevalence of opioid prescribing 3 months before pregnancy, each trimester of pregnancy and 3 months postpartum, as well as the secular utilization trend over an 8-year period, among member-patients at HealthPartners Medical Group (HPMG). Methods: All pregnant member-patients of HPMG who delivered a live birth from 2006 to 2014 and had continuous pharmacy benefits beginning 3 months prior to their estimated pregnancy start through 3 months postpartum were included. Demographic, clinical, pharmaceutical and provider variables of interest were identified and described. Significant opioid prescribing during pregnancy was defined as more than 5 days’ supply prescribed in any 3-month period, excluding the 2-week postpartum period. Time trends for 2006–2014 were examined using linear regression. Results: Of 11,565 pregnancies during the study period, significant opioid prescribing during 3 months before pregnancy, pregnancy or 3 months postpartum were observed in 862 (7.5%) pregnancies (816 unique women). A total of 454 (3.9%) pregnant women received significant opioid prescriptions during one or more trimesters of their pregnancy. From 2006 to 2014, the rate of significant opioid prescribing during each trimester of pregnancy and 3 months before and after pregnancy decreased -0.2% per year. Conclusion: Significant opioid prescribing during the three trimesters of pregnancy as well as 3 months before and after pregnancy for member-patients of HPMG was significantly lower than reported studies from other populations and locations across the United States over the last 15 years. Furthermore, significant opioid prescribing was trending downward slightly over time, rather than rising as reported elsewhere. Explanatory factors for these findings should be explored

Opioid Prescribing During Pregnancy: Eight-Year Secular Trends at HealthPartners Medical Group

Background: Nationally, opioid prescribing for chronic noncancer pain has increased significantly over the last 20 years. Recently published evidence suggests that 20% to 40% of women received opioid prescriptions of varying doses and durations during pregnancy, which may cause increased risks of harm to mother and fetus. The purpose of this retrospective observational study was to determine the prevalence of opioid prescribing 3 months before pregnancy, each trimester of pregnancy and 3 months postpartum, as well as the secular utilization trend over an 8-year period, among member-patients at HealthPartners Medical Group (HPMG). Methods: All pregnant member-patients of HPMG who delivered a live birth from 2006 to 2014 and had continuous pharmacy benefits beginning 3 months prior to their estimated pregnancy start through 3 months postpartum were included. Demographic, clinical, pharmaceutical and provider variables of interest were identified and described. Significant opioid prescribing during pregnancy was defined as more than 5 days’ supply prescribed in any 3-month period, excluding the 2-week postpartum period. Time trends for 2006–2014 were examined using linear regression. Results: Of 11,565 pregnancies during the study period, significant opioid prescribing during 3 months before pregnancy, pregnancy or 3 months postpartum were observed in 862 (7.5%) pregnancies (816 unique women). A total of 454 (3.9%) pregnant women received significant opioid prescriptions during one or more trimesters of their pregnancy. From 2006 to 2014, the rate of significant opioid prescribing during each trimester of pregnancy and 3 months before and after pregnancy decreased -0.2% per year. Conclusion: Significant opioid prescribing during the three trimesters of pregnancy as well as 3 months before and after pregnancy for member-patients of HPMG was significantly lower than reported studies from other populations and locations across the United States over the last 15 years. Furthermore, significant opioid prescribing was trending downward slightly over time, rather than rising as reported elsewhere. Explanatory factors for these findings should be explored

A Randomized, Controlled Pragmatic Trial of TelephonicMedication Therapy Management to ReduceHospitalization inHomeHealth Patients

OBJECTIVE: To evaluate the effectiveness of a telephonic medication therapy management (MTM) service on reducing hospitalizations among home health patients. SETTING: Forty randomly selected, geographically diverse home health care centers in the United States. DESIGN: Two-stage, randomized, controlled trial with 60-day follow-up. All Medicare- insured home health care patients were eligible to participate. Twenty-eight consecutive patients within each care center were recruited and randomized to usual care or MTM intervention. The MTM intervention consisted of the following: (1) initial phone call by a pharmacy technician to verify active medications; (2) pharmacist-provided medication regimen review by telephone; and (3) follow-up pharmacist phone calls at day seven and as needed for 30 days. The primary outcome was 60-day all-cause hospitalization. DATA COLLECTION: Data were collected from in-home nursing assessments using the OASIS-C. Multivariate logistic regression modeled the effect of the MTM intervention on the probability of hospitalization while adjusting for patients' baseline risk of hospitalization, number of medications taken daily, and other OASIS-C data elements. PRINCIPAL FINDINGS: A total of 895 patients (intervention n = 415, control n = 480) were block-randomized to the intervention or usual care. There was no significant difference in the 60-day probability of hospitalization between the MTM intervention and control groups (Adjusted OR: 1.26, 95 percent CI: 0.89-1.77, p = .19). For patients within the lowest baseline risk quartile (n = 232), the intervention group was three times more likely to remain out of the hospital at 60 days (Adjusted OR: 3.79, 95 percent CI: 1.35-10.57, p = .01) compared to the usual care group. CONCLUSIONS: This MTM intervention may not be effective for all home health patients; however, for those patients with the lowest-risk profile, the MTM intervention prevented patients from being hospitalized at 60 days