Implementation of a medication therapy management program in a primary care clinic

Objective: This study examined the use of a medication therapy management (MTM) program by clinic-embedded pharmacists within a primary care clinic primarily by evaluating the impact on patient identification for pharmacy services. Secondary outcomes included characterizing intervention type, targeted drugs and disease states, and barriers to successful interventions, SETTING: Primary care clinic.

Practice description: CoxHealth Center Steeplechase is a primary care clinic of 13 providers with a clinic-embedded pharmacist, pharmacy residents, and student pharmacists providing chronic disease state management under collaborative practice agreements.

Practice innovation: Community pharmacists have an established history of providing services through MTM programs. Clinic-embedded pharmacists have the potential to participate in these programs as well, and many barriers to providing patient care services reported by community pharmacists can be overcome by clinic-embedded pharmacists, potentially allowing for greater success of MTM interventions.

Evaluation: A 4-week pilot, in which clinic-embedded pharmacists dedicated 4 hours per week of effort to MTM services, examined the effectiveness of the program at identifying patients not otherwise receiving clinical pharmacy services, types of identified interventions, intervention success rates, barriers to intervention success, and revenue generation.

Results: The clinical pharmacy team attempted 46 interventions in 34 unique patients in this 4-week pilot. Of the identified patients, 67.7% (n = 23) had no contact with the clinical pharmacy team in the previous year. Targeted interventions were more frequently attempted (targeted interventions n = 42; comprehensive reviews n = 4) and more successful than comprehensive medication reviews (88% vs. 25% success rate). Barriers to success included patient refusal of services, inability to contact the patient, and inapplicability of targeted interventions.

Conclusion: Implementation of an MTM program in one clinic required coordinated interdepartmental efforts to implement, but it effectively expanded pharmacy services by identifying patients not otherwise referred to the clinical pharmacy team for chronic disease management.