21st century medication management requires patient-centered approach
Think comprehensive, holistic
The medication therapy management (MTM) for the 21st century hospital pharmacy is one that is comprehensive and keeps the patient at the center of its goals and planning, an expert says.
The hospital pharmacist who solely focuses on a patient's diabetes will not be as successful at managing the patient's therapy as the pharmacist who looks at everything that might be impacting the patient's health, including all of his or her medications, says Jon Schommer, PhD, a professor in the College of Pharmacy at the University of Minnesota in Minneapolis, MN. Schommer has researched pharmacist-provided medication therapy management.
For example, when a patient is admitted to the hospital for kidney stone surgery, most of the patient's health care providers are focused on the surgery, Schommer explains.
"But having the pharmacist involved as the patient is admitted is a more comprehensive approach that can help identify risks and drugs that need to be discontinued or added," Schommer says. "Good patient care is identifying the specific needs of the patient and giving the patient the care he needs to meet those needs."
Having pharmacists on rounds and on hospital interdisciplinary teams helps to improve overall care, he adds.
Hospital pharmacists also should have access to electronic health records (EHRs) that list patients' medications and their reasons for being prescribed, Schommer notes.
"Sometimes a pharmacist will look at the list of drugs and ask why the patient is using that medication," he says. "The pharmacist is key when it comes to medication therapy."
MTM is especially important at the time of hospital discharge, he says.
Often patients are discharged with a list of medications, and they might not know how the new list fits in with the medications they were taking before being admitted to the hospital, Schommer adds.
Schommer once had an experience where a patient was discharged with a list of generic names for his medications. He had been prescribed the same medications earlier, but only knew them by the brand names. So the man incorrectly thought he was supposed to take 20 medications instead of 10.
"Having a pharmacist intervene at that critical moment at discharge to make sure the patient is on track when self-administering medication is hugely important," Schommer says.
"We find that when you have a pharmacist provide comprehensive medication management services, it really does lead to a desired outcome," Schommer explains.
"It's expensive because just using phone calls and letters isn't as effective," he adds. "You can do some [MTM] over the web or telephone, but face-to-face works best."
MTM services provided by pharmacists are on the rise, at least in Minnesota, where nearly one-third of pharmacies provide medication management services, Schommer says.1
While it's important to have pharmacists involved with MTM, this shouldn't take away from the pharmacist's traditional role in the drug distribution process, Schommer says.
"Our argument is you need a certain number of expert pharmacists to maintain that control and understanding of the drug distribution process," he says. "However when we start looking at the percentage of time devoted to drug distribution, only 50% of the hours pharmacists devote to their work is related to drug distribution."
About 30% of their time is spent in patient care, and 20% is used in business management, education, research, etc., he adds.
This is a recent phenomenon, as pharmacists' time spent in distribution has decreased over the years, Schommer notes.
"We've been tracking this trend for a number of years, and the hours spent dispensing and controlling medications is going down," he says. "We have more PharmD-trained pharmacists, and more pharmacists move to residencies and advanced training."
It's likely that the future will see this trend continue, he adds.
"Pharmacists will devote more and more of their time to direct patient care and also to indirect patient care, which is removed from the medication itself," Schommer says.
There might even be a future trend of outsourcing the distribution work so pharmacists can spend more time in patient care.
"We have made a grant proposal to see how pharmacists can work face-to-face with patients in a clinic or pharmacy and outsource their behind-the-scenes work," Schommer says.
Some pharmacists will work in indirect patient care, reviewing patient's medical records and making recommendations. But then they'll work with a primary practitioner, who also is a pharmacist, and who will meet with the patient, he suggests.
"Our model is to have the [support] pharmacist work out of his or her home and collaborate with other pharmacists, using secure Internet access or software," Schommer explains. "The pharmacist is working behind the scenes."
This is a way to provide value-added service to pharmacy practice by having clinical pharmacists focus more on patient-centered care and outsourcing behind-the-scenes work.
It might also be a way to mitigate pharmacist shortage issues that have made it difficult for hospitals to find trained pharmacists for MTM and other clinical work when they begin new programs.
"The colleges of pharmacy have expanded from 80 some colleges to now over 110, and they're moving toward 120 in the near future," Schommer says. "They have expanded class sizes so the number of graduates has increased, and it's helping with the shortage."
However, the evidence suggests a pharmacist shortage remains, he adds.
So hospital pharmacies will need to provide the best MTM they can within their given resources.
Reference
- Schommer JC, Planas LG, Johnson KA, et al. Pharmacist-provided medication therapy management (Part 1): Provider perspectives in 2007. J Am Pharm Assoc 2008;48:354-363.
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