title: Integrating home-based medication therapy management (MTM) services in a health system.
abstract: OBJECTIVE
  To describe the integration of home-based Medication Therapy Management (MTM) into the ambulatory care infrastructure of a large urban health system and to discuss the outcomes of this service.
  
  
  METHODS
  Minnesota from September 2012 to December 2013. The health system has more than 50 primary care and specialty clinics. Eighteen credentialed MTM pharmacists are located in 16 different primary care and specialty settings, with the greatest number of pharmacists providing services in the internal medicine clinic.
  
  
  METHODS
  Home-based MTM was promoted throughout the clinics within the health system. Physicians, advanced practice providers, nurses, and pharmacists could refer patients to receive MTM in their homes. A home visit had the components of a clinic-based visit and was documented in the electronic health record (EHR); however, providing the service in the home allowed for a more direct assessment of environmental factors affecting medication use.
  
  
  RESULTS
  Number of home MTM referrals, reason for referral and type of referring provider, number and type of medication-related problems (MRPs).
  
  
  RESULTS
  In the first 15 months, 74 home visits were provided to 53 patients. Sixty-six percent of the patients were referred from the Internal Medicine Clinic. Referrals were also received from the senior care, coordinated care, and psychiatry clinics. Approximately 50% of referrals were made by physicians. More referrals (23%) were made by pharmacists compared with advanced practice providers, who made 21% of referrals. The top 3 reasons for referral were: nonadherence, transportation barriers, and the need for medication reconciliation with a home care nurse. Patients had a median of 3 MRPs with the most common (40%) MRP related to compliance.
  
  
  CONCLUSIONS
  Home-based MTM is feasibly delivered within the ambulatory care infrastructure of a health system with sufficient provider engagement as demonstrated by referrals to the service.
authors.forename: Shannon
authors.initials: S
authors.lastname: Reidt
authors.forename: Haley
authors.initials: H
authors.lastname: Holtan
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stender
authors.forename: Toni
authors.initials: T
authors.lastname: Salvatore
authors.forename: Bruce
authors.initials: B
authors.lastname: Thompson
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration*; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000458:organization & administration*; D008875:Middle Aged; D010595:Pharmacists; D011320:Primary Health Care / Q000379:methods*