Comprehensive Medication Therapy Management: Identifying and Resolving Drug-Related Issues in a Community Pharmacy

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• 作者：William R. Doucette ; Randal P. McDonough ; Donald Klepser and Renee McCarthy
• 刊名：Clinical Therapeutics
• 出版年：2005
• 出版时间：2005
• 年：2005
• 卷：27
• 期：7
• 页码：1104-1111
• 全文大小：793 K

文摘

Abstract

Objective:

<p>The aim of this study was to characterize comprehensive medication therapy management (MTM) involving a community pharmacy and local physicians by describing the drug-related issues encountered, identifying which medication types were associated with these issues, and listing the actions taken by physicians and pharmacists to address them.

Methods:

<p>In the MTM program studied, community pharmacists and physicians worked together to manage the drug therapy of ambulatory Iowa Medicaid recipients dispensed ≥4 medications for chronic conditions by a community pharmacy. After initial assessment, pharmacists made written recommendations to the patient's physician, and the physicians subsequently responded. Data were extracted from pharmacy records for patients who made ≥1 visit during the first 2 yearsof the program. Collected data included patient demographics, number of chronic conditions and medications at enrollment, type and number of drug-related issues, medication category, pharmacist recommendations, and physician acceptance of recommendations.

Results:

<p>Data were gathered for 150 patients. The mean (SD) age was 54.4 (19.4) years and 74.0 % were female. They were taking a mean (SD) of 9.3 (4.6) medications and had a mean (SD) of 6.1 (3.1) medical conditions at enrollment. A total of 886 drug-related issues were classified into 7 categories: inappropriate adherence (25.9 % ), needsadditional therapy (22.0 % ), wrong drug (13.2 % ), unnecessary drug therapy (12.9 % ), adverse drug reaction (11.1 % ), dose too low (9.7 % ), and dose too high (5.3 % ). Overall, physicians accepted 313 (47.4 % ) of the 659 recommendations to alter drug therapy made by pharmacists, with the highest rates of agreement to stop or change a medication (50.3 % and 50.0 % , respectively) and the lowest rate of agreement to starta new medication (41.7 % ).

Conclusion:

<p>The MTM program showed that drug therapy for ambulatory patients taking multiple medications to treat chronic conditions can be improved through collaboration between physicians and community pharmacists.