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Medication Therapy Management

By January 15, 2014Commentary

A draft report from the Agency for Healthcare Research and Quality examines the research evidence relating to medication therapy management.   (AHRQ Report)   Medication therapy management, also sometimes referred to as pharmaceutical care, intensively focuses on the drug use of patients and identifies potential issues interfering with maximum value of drug therapies.  It results in an individualized care plan for each patient and typically involves ongoing followup.  CMS has required Medicare Advantage plans to engage a class of patients with high drug use or expenses in MTM and recently released a proposed rule which would greatly expand the patients for whom the MA plans should be doing MTM.  The key questions addressed by the AHRQ report included describing the intervention components and implementation features, assess the effectiveness of MTM on outcomes, identify intervention features or patient characteristics that appear associated with effects on outcomes and identify any potential harms from MTM.  Out of a large pool, only 36 studies met the criteria to be included in the review and most of those were considered low strength.  Compared to usual care, the outcomes had low strength evidence of improving medication appropriateness, the use of generic medications and lowering the rate of hospitalization among heart failure patients.  No benefit was found for most other outcomes examined, including general reduction of hospitalizations or quality of life, but again the evidence for no benefit is low strength.   The authors called for a significant improvement in the research to evaluate MTM.  The draft report should not be too discouraging to MTM vendors; like most AHRQ systematic reviews the problem is just a lack of good quality studies.  The real-life experience of many plans deploying MTM is far more positive than the report would suggest.  Properly done research will eventually catch up and validate MTM’s value.

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  • Ian Spector says:

    I suspect that what from a distance appears to be a generic grouping of MTM providers, closer inspection will show a heterogeneity of approaches and efficacies. A quick Medi-span check for drug interactions might qualify as MTM and in which case I am not surprised that the (albeit low strength) evidence showed little benefit. An arrestingly high proportions of hospital readmissions seem to be as a result of ‘medication issues’ so I believe that a detailed MTM review might potentially be a key tool in this regard.

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