Medication Management Services: MTM or Pharmaceutical Care?

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Administered properly, medications can alleviate agonising symptoms that compromise physical and psychological well-being, help prevent the onset of many acute and chronic illnesses, and improve patient health outcomes. Too often, however, medications are not used appropriately. In the United States in 2001, adverse drug events led to an estimated 4.3 million ambulatory visits. To boot problems involving adverse drug events, many patients do not receive optimal pharmaceutical prescriptions. Even when optimal therapy is prescribed, patient inability to adhere closely to medication regimens may lead to poor health outcomes.

Medication therapy management (MTM) services are intended to address issues of polypharmacy, preventable adverse drug events, medication adherence, and medication misuse. MTM is the current term that represents a suite of healthcare services provided by pharmacists – the medication experts on the healthcare team – that have evolved out of the philosophy and processes described in the early 1990s as “pharmaceutical care.”

In 2008, a subset of national pharmacy organisations established five core elements for an MTM service model. These elements include a medication therapy review, a personal medication record, a medication action plan, intervention and/or referral, documentation and follow-up. Every core element is integral to the provision of MTM. However, the sequence and delivery of the core elements may be modified to meet an individual patient’s needs. Pharmacists provide medication therapy management to help patients get the best benefits from their medications by actively managing drug therapy and by identifying, preventing and resolving medication-related problems.

MTM provided by pharmacists, the medication therapy experts, results in: a review of all medications prescribed by all prescribers providing care to the patient, and any over-the-counter and herbal products the patient may be taking to identify and address medication problems (problems may include medications not being used correctly, duplication of medications, unnecessary medications, and the need for medication(s) for an untreated or inappropriately managed condition); in-depth medication-related education, consultation, and advice provided to patients, family and/or caregivers to ensure proper use of medications; collaboration with the patient, physician, and other healthcare providers to develop and achieve optimal goals of medication therapy.

An example of pharmacist-provided services that include medication management is medication therapy review, a systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritised list of medication-related problems, and creating a plan to resolve them.

Conversely, pharmacotherapy consults, another example, refers to services provided by pharmacists on referrals from other healthcare providers or other pharmacists. These consult services are typically reserved for more complicated patient cases – specifically for patients who have complex medical conditions and who have either already experienced medication-related problems or who have a  high potential to develop them. A pharmacotherapy consult incorporates the pharmacist’s expertise into achieving desired therapeutic goals for patients by promoting safe, appropriate, and cost-effective use of medications.  Patients requiring pharmacotherapy consults may have a single or multiple complex medical conditions that require medication therapy to effectively manage.

Furthermore, pharmacogenomics application is a new and emerging medication therapy management service provided by pharmacists. Here, pharmacists play a role in the interpretation and application of a patient’s genetic information to optimise a patient’s response to medication therapy. In various patient care settings from hospitals to community pharmacies pharmacists are comparing patient-specific treatments based on genetic markers, predicting patients’ response to therapy, dosing medications based on genetic test results, predicting which patients will experience adverse reaction to selected therapies, and making informed recommendations to prescribers on the best treatments for that individual patient that maximise effectiveness while minimising risk.  Pharmacogenomics has also been referred to as “personalised medicine.”

As pharmacist-provided medication therapy management services continue to evolve, pharmacists roles continues to expand into new and emerging areas. These diverse clinical services all focus on optimising medication outcomes for the individual patient. Examples of other clinical services in medication therapy management include employee health services & screening, travel medicine, nuclear pharmacy, veterinary pharmacy, nutrition and many others.

Predominantly, MTM focuses on ongoing management of the patient’s entire medication regimen, with a concentration on optimising therapeutic effectiveness, preventing adverse events and achieving optimal medication therapy goals. Active involvement of patients is critical, empowering them to be a full participant in their own care through better understanding and use of their medications.

By Pharm.Patience Scholastica Godwin & Pharm. Ekpeyong Nsidibe