Comprehensive medication therapy management: identifying and resolving drug-related issues in a community pharmacy.
OBJECTIVE
The aim of this study was to characterize comprehensive medication therapy management (MTM) involving a community pharmacy and local physicians by describing the drug-related issues encountered, identifying which medication types were associated with these issues, and listing the actions taken by physicians and pharmacists to address them.


METHODS
In the MTM program studied, community pharmacists and physicians worked together to manage the drug therapy of ambulatory Iowa Medicaid recipients dispensed > or =4 medications for chronic conditions by a community pharmacy. After initial assessment, pharmacists made written recommendations to the patient's physician, and the physicians subsequently responded. Data were extracted from pharmacy records for patients who made > or =1 visit during the first 2 years of the program. Collected data included patient demographics, number of chronic conditions and medications at enrollment, type and number of drug-related issues, medication category, pharmacist recommendations, and physician acceptance of recommendations.


RESULTS
Data were gathered for 150 patients. The mean (SD) age was 54.4 (19.4) years and 74.0% were female. They were taking a mean (SD) of 9.3 (4.6) medications and had a mean (SD) of 6.1 (3.1) medical conditions at enrollment. A total of 886 drug-related issues were classified into 7 categories: inappropriate adherence (25.9%), needs additional therapy (22.0%), wrong drug (13.2%), unnecessary drug therapy (12.9%), adverse drug reaction (11.1%), dose too low (9.7%), and dose too high (5.3%). Overall, physicians accepted 313 (47.4%) of the 659 recommendations to alter drug therapy made by pharmacists, with the highest rates of agreement to stop or change a medication (50.3% and 50.0%, respectively) and the lowest rate of agreement to start a new medication (41.7%).


CONCLUSIONS
The MTM program showed that drug therapy for ambulatory patients taking multiple medications to treat chronic conditions can be improved through collaboration between physicians and community pharmacists.
Doucette
William R
WR
University of Iowa, Iowa City, IA 52242, USA. william-doucette@uiowa.edu
McDonough
Randal P
RP
Klepser
Donald
D
McCarthy
Renee
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration; D002648:Child; D002908:Chronic Disease; D003157:Community Pharmacy Services / Q000458:organization & administration*; D004358:Drug Therapy; D064420:Drug-Related Side Effects and Adverse Reactions; D005194:Family Practice / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D007484:Iowa; D008484:Medicaid; D054539:Medication Therapy Management; D008875:Middle Aged; D019338:Polypharmacy; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies