Medication Therapy Management (MTM) entails a range of health care services that are provided by pharmacists. The health care services provided under MTM program are geared at optimizing the medical outcomes of individual patients.1 This implies that the scope of work of pharmacists increases and they can offer services that otherwise could be provided by physicians. For example, pharmacists are involved in preventive medication plans such anticoagulation management, pharmacotherapy consultations, disease management support, and medication safety surveillance. Under MTM services, pharmacists are also involved in other preventive and curative care practices. The implication of MTM is that work pressures on physicians caused by patients going to the emergency room (ER) and doctor’s offices are significantly reduced. Hence, the medication errors that result due to overwork are greatly reduced. There is research evidence that MTM services can lower costs and improve patients’ health. Therefore, if MTN is included in the Integrated Delivery Network (IDN), it will reduce overall health costs and still maintain the positions of the pharmacists.
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Role of MTM Services in Reducing Costs and Improving Patient’s Health
First, the fear that automation of every pharmacy within IDN will lead to pharmacists losing their positions is not right; instead, having MTM services will help sustain the positions of the pharmacists and bring down the cost of health care. It is important to note that under the MTN, there is a shift from the traditional care provision where pharmacists are normally relegated to drug dispensation. MTM services are designed on the recognition that pharmacists can provide a wide range of health care services. For example, through MTM, pharmacists are involved in the assessment of how the patients use drugs and the possibilities of side effects. Also, they participate in enhancing the adherence to the medication; an activity that most of the time has been left to physicians who are not suited to it. The MTN services ensure that pharmacists can manage different states of diseases.
In essence, this integrates primary and secondary care activities to the roles of the pharmacists. The range of services provided are immunization, management of diseases, medication safety surveillance, pharmacotherapy, anticoagulation management, application of pharmacogenomics and other related clinical services. Therefore, the new IDN’s robotic machines that will reduce dispensing time by 75% will not take the position of the pharmacists. The dispensation is a small fraction of the broad spectrum services encompassed in the MTN. Instead; there will be a need for more pharmacists. Pharmacists can address the majority of public health priorities due to their nature of interacting with patients.1 (972)Also, MTN services place pharmacists in a better position to make an impact on health priorities that in turn reduces the cost of health care. This increases efficiency and effectiveness of care delivery which are crucial in reducing costs. Efficiency implies that many patients will no longer go to the doctors’ offices because pharmacists can provide the services.
Second, there is the need for pharmacists to understand that MTM will significantly increase the utilization of the healthcare services at the IDN and subsequently reduce the costs related to traditional care provision where physicians are left to do all the care activities. For example, a study to evaluate the impact of comprehensive MTM compared care provision and costs in two groups of patients who had type 1 and 2 diabetes.2 The intervention patients were put under the MTM program for four visits over a duration of six months. The control group was a historical patient care plan as captured in the electronic medical records from 8th August 2008 to March 2012.
The study compared the rate of readmissions and the reason for the readmission. The intervention group comprised of 28 patients while the control group had 73 participants. For the two groups, there was 0% readmission in the first thirty-day post discharge. The weighted utilization rate showed that there were no significant differences. However, the costs incurred by the intervention group were lower compared to those of the control patients.2 (829) This is an evidence-based research that denotes the cost implications of MTM. Thus, it is evident the MTM services enhance care and consequently reduce the overall costs of medication. Therefore, the implication is that new IDN will not substitute the roles of pharmacists; in fact, the inclusion of the MTM services will be critical in reducing healthcare costs and make the pharmacists more relevant in the facility.
Finally, in perspective of costs, it is important to note that the largest cost drivers in the current health care setting are the ER use and hospitalization. Besides, readmissions have become a big health challenge that has been increasing the cost of care for patients. They have strained the public health delivery system by increasing the expenses.2 (829) This is the case especially for the beneficiaries of Medicare because they form the bulk of the hospital readmissions. It is projected that the readmissions cost over 24 billion U.S. dollars annually. One of the reasons for the readmissions among the Medicare beneficiaries is the adverse medical reactions that have been found to account for 70% of the cases. This is a pointer that the problem can be solved if there is an efficient medication program. Fortunately, pharmacists under the MTM can provide these services and reduce the readmission cases. This is because MTM services ensure that pharmacists are involved in the medication reconciliation accuracy.
Also, the services help the patients to understand the intended medication changes after they have been discharged. Adverse drug reactions after the discharge are very high, and they have serious implications. Therefore, the involvement of pharmacists in the whole care of patients can reduce the adverse drug reactions and subsequently lower costs.3 By targeting the patients who have been discharged and are susceptible to readmissions, MTM programs are crucial in reducing the financial penalties that result from increased hospital stay. For instance, bearing in mind that thirty-day post-discharge readmissions have been on the increase.
It is evident that from the various studies, the MTM services reduce costs and provide the pharmacist with a broad scope of responsibilities in the care delivery. A case in point is that under the program, many costs that are associated with patients visiting the ER and doctors’ offices can be solved by pharmacists. The result is that physicians are not overworked, and the overall cost of care is reduced. Therefore, pharmacists should not fear that their positions will be taken away. This is because the integral role of the pharmacists under the MTM services puts them at the core of health care provision, a situation that cannot be substituted by robotics.
Casserlie LD, MagerDN. Pharmacists’ perceptions of advancing public health priorities through medication therapy management. PharmPract. 2016; 14(3):792.
Shaya F, Chirikov V, Rochester C, Zaghab R, Kucharski K. Impact of a comprehensive pharmacist medication-therapy management service. J Med Econ. 2015; 18(10):828-837.
Ziaeian B, Araujo KL, Van Ness PH, Horwitz LI. Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge. J Gen Intern Med. 2012; 27(11):1513-1520.