title: Design of a medication therapy management program for Medicare beneficiaries: qualitative findings from patients and physicians.
abstract: BACKGROUND
  The quality of pharmacologic care provided to older adults is less than optimal. Medication therapy management (MTM) programs delivered to older adults in the ambulatory care setting may improve the quality of medication use for these individuals.
  
  
  OBJECTIVE
  We conducted focus groups with older adults and primary care physicians to explore (1) older adults' experiences working with a clinical pharmacist in managing medications, (2) physician perspectives on the role of clinical pharmacists in facilitating medication management, and (3) key attributes of an effective MTM program and potential barriers from patient and provider perspectives.
  
  
  METHODS
  Five focus groups (4 with older adults, 1 with physicians) were conducted by a trained moderator using a semistructured interview guide. Each participant completed a demographic questionnaire. Sessions were recorded, transcribed verbatim, and analyzed using qualitative analysis software for theme identification.
  
  
  RESULTS
  Twenty-eight older adults and 8 physicians participated. Older adults valued the professional, trusting nature of their interactions with the pharmacist. They found the clinical pharmacist to be a useful resource, thorough, personable, and a valuable team member. Physicians believe that the clinical pharmacist fills a unique role as a specialized practitioner, contributing meaningfully to patient care. Physicians emphasized the importance of effective communication, pharmacist access to the medical record, and a mutually trusting relationship as key attributes of a program. Potential barriers to an effective program include poor communication and lack of familiarity with the patient's history. The lack of a sustainable reimbursement model was cited as a barrier to widespread implementation of MTM.
  
  
  CONCLUSIONS
  This study provides information to assist pharmacists in designing MTM programs in the ambulatory setting. Key attributes of an effective program include being comprehensive and addressing all medication-related needs over time. The clinical pharmacist's ability to build trusting relationships with patients and providers is essential.
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Lauffenburger
authors.forename: Maihan B
authors.initials: MB
authors.lastname: Vu
authors.forename: Jena Ivey
authors.initials: JI
authors.lastname: Burkhart
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: Mary T
authors.initials: MT
authors.lastname: Roth
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration / Q000592:standards; D003142:Communication; D003157:Community Pharmacy Services / Q000458:organization & administration* / Q000592:standards; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D006278:Medicare; D054539:Medication Therapy Management / Q000458:organization & administration* / Q000592:standards; D005791:Patient Care / Q000592:standards; D010595:Pharmacists / Q000458:organization & administration* / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards; D011787:Quality of Health Care; D012051:Reimbursement Mechanisms; D014481:United States