title: Medication therapy management and complex patients with disability: a randomized controlled trial.
abstract: BACKGROUND
  Drug therapy problems, adverse drug events (ADEs), and symptom burden are high among adults with disabilities.
  
  
  OBJECTIVE
  To compare the effects of a modified medication therapy management (MTM) program within a self-efficacy workshop versus the workshop alone or usual care on symptom burden among adults with activity limitations.
  
  
  METHODS
  Three-group randomized controlled trial among adults (age 40 and older) with self-reported activity limitations in community practice.
  
  
  METHODS
  8 weekly Living Well With a Disability (LWD) 2-hour workshop sessions with and without a collaborative medication management (CMM) module.
  
  
  METHODS
  mean number of moderate to very severe symptoms from a list of 11 physical and mental symptoms. Process measures: changes in medication regimens and self-reported ADEs.
  
  
  METHODS
  general linear mixed models (continuous outcomes) and generalized estimating equations (categorical outcomes).
  
  
  RESULTS
  Participants had high symptom burden, low physical health, and took many medications. There was a significant increase in ADE reporting in the LWD + CMM group relative to the other 2 groups (Study group × Time P = .014), and there were significantly more changes in medication regimens in the LWD + CMM group (P = .013 LWD only vs LWD + CMM). The oldest third of participants had significantly fewer mean symptoms but received more intense CMM. There was no difference between the LWD-only, LWD + CMM, and usual care groups in symptom burden over time.
  
  
  CONCLUSIONS
  Pharmacist MTM practices and MTM guidelines may need to be modified to affect symptom burden in a population with physical activity limitations.
authors.affiliation: University of Iowa, Iowa City, IA, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chrischilles
authors.forename: William
authors.initials: W
authors.lastname: Doucette
authors.forename: Karen
authors.initials: K
authors.lastname: Farris
authors.forename: Scott
authors.initials: S
authors.lastname: Lindgren
authors.forename: Brian
authors.initials: B
authors.lastname: Gryzlak
authors.forename: Linda
authors.initials: L
authors.lastname: Rubenstein
authors.forename: Kelly
authors.initials: K
authors.lastname: Youland
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wallace
mesh_terms: D000328:Adult; D000368:Aged; D006233:Persons with Disabilities / Q000193:education*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000193:education*; D008875:Middle Aged; D010595:Pharmacists / Q000458:organization & administration; D057566:Self Report
keywords: persons with disabilities; pharmacists; symptom evaluation