MedicalResearch.com Interview with:
Medical Research: What is the background for this study? What are the main findings?
Dr. Viswanathan: Medications, when used appropriately, can alleviate symptoms. Often, however, they result in side effects, interact with one another, are prescribed incorrectly, or are taken incorrectly. These problems are particularly pronounced for the elderly who may have multiple chronic conditions and may be on numerous medications. We evaluated a variety of research studies and program evaluations regarding a distinct type of health care service known as Medication Therapy Management or “MTM.” The goals of MTM services are to help patients and their clinicians to optimize prescription and nonprescription drug regimens, thereby achieving better health outcomes from drug therapy, and. at the same time to minimize the potential for harms, such as incorrect dosing and duplicate medications. Some have proposed that optimizing drug regimens and preventing adverse drug events may reduce health-care-related costs.
Medication Therapy Management services are most often provided directly to patients by pharmacists. Sometimes the same pharmacists who dispense medications to patients offer Medication Therapy Management services as well; in other models, pharmacists working in a nondispensing role within a health care system, health insurance plan administering a prescription drug benefit program, or a centralized pharmacy call center may offer such services Although Medication Therapy Management can vary quite substantially in specifics, Medication Therapy Management programs in general share common elements; these include medication therapy review of all prescription drugs, over-the-counter products, and herbal or dietary supplements; patient education and counseling to solve issues with the drug regimen that a patient may be experiencing, such as side effects or difficulty remembering to take medications; and coordination and communication with the prescribing provider. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 allowed Medicare to expand access to Medication Therapy Management services for selected patients through Medicare Part D prescription drug benefits.
Through a rigorous and systematic review of health care research literature, we identified 44 studies that compared one or more groups of patients who received Medication Therapy Management services with a group of patients who did not. In some studies, patients were randomly assigned to the groups; for others, patients “opted in” to receive services through a prescription drug benefit or other program available to them as part of their usual health care. The investigators reported their findings using a diverse set of outcomes: impacts on health (e.g., symptoms, quality of life, adverse drug events, death), on quality of care (e.g., blood pressure and diabetes control, medication-related problems), or on costs and health care use (e.g., hospital admissions, clinic visits, drug costs). For most of the outcomes we evaluated, evidence was insufficient to draw conclusions about effectiveness, because the studies yielded inconsistent results or had too small sample sizes. We found adequate evidence to determine that Medication Therapy Management improves a few outcomes, such as medication appropriateness and adherence, but it has no impact on others, such as health-related quality of life and patient satisfaction. The strength of these conclusions is considered “low.”
Medical Research: What should clinicians and patients take away from your report?
Dr. Viswanathan: As researchers, we find it challenging to provide an actionable message to clinicians and patients on reports such as this one, where the findings are largely inconsistent and Medication Therapy Management is not yet a proven strategy for accomplishing the many goals set for it. Safe and effective use of medications for all populations is critically important, and we need to find efficient, practical ways to accomplish this. Medication Therapy Management is one possible strategy, but more needs to be understood about the successful elements of the various models now in play. We hope that our report increases awareness about Medication Therapy Management services, so that all parties can make informed decisions about whether such programs are likely to bring meaningful benefits to both patients and clinicians.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Viswanathan: Because Medication Therapy Management studies to date have varied widely in their design and implementation, they understandably produce inconsistent results. As a result, the benefits of Medication Therapy Management are yet to be proven. Investigators reporting on newer studies should describe MTM service components and report on fidelity of service delivery. This information will help to mitigate the problem of comparing markedly dissimilar programs or trying to combine information from such studies. Attention to design and full reporting can also contribute to knowledge about how the effectiveness of Because Medication Therapy Management studies to date have varied widely in their design and implementation, they understandably produce inconsistent results. may vary by component or the context of implementation of such programs. Because of the complexity of these kinds of interventions and the fact that Because Medication Therapy Management studies to date have varied widely in their design and implementation, they understandably produce inconsistent results. programs are already in widespread practice, we believe that future investigations and evaluations need to move beyond the “does it work?” issues to research questions that explore the “how,” “why,” and “where” of MTM programs.