The impact of care coordination on community pharmacist-delivered medication therapy management.

摘要

Background: Care coordination is imperative to successful patient outcomes. However, community pharmacists are commonly excluded from health information exchange during care coordination. One of the ways pharmacists deliver care, through medication therapy management (MTM), could be optimized if pharmacists engaged in care coordination through review of unedited patient medical records in preparation for a section of the MTM, the comprehensive medication review (CMR).;Methods: This was a non-blinded randomized controlled trial undertaken within the Medication Safety Research network of Indiana, also known as RxSafeNet. RxSafeNet is a community pharmacy practice based research network. Pharmacists were randomized to deliver CMR's to adult patients under usual care, or with a care coordination intervention. The intervention consisted of soliciting the patient-identified primary care provider-held medical records of the last six months. Medication related problems (MRPs) identified and omissions in preventative care identified were recorded for each CMR delivered. Additionally, pharmacists were surveyed over their thoughts and opinions regarding utilizing medical records.;Results: Thirty seven patients were seen for CMR appointments. Intervention pharmacists identified more MRP's than usual care pharmacists. The intervention, while controlling for predictor variables included in a multiple linear regression model, had an adjusted R2= 0.511; p=0.05. Intervention pharmacists identified more omissions in preventative care (adjusted R2= 0.136; p=0.027).;Intervention pharmacists were more likely to agree they were confident they identified all of the patient's MRPs (47.1% vs. 15.8%), but neither group was more likely than the other to believe they had resolved all MRPs (41.2% vs. 42.1%). Lastly, intervention pharmacists agreed 100% of the time that the patient's health history helped them complete a better CMR as compared with only 69% of usual care pharmacists.;Conclusion: Community pharmacists identify more MRPs and omissions in preventative care when they engage in care coordination by reviewing the patient's PCP's unedited medical record in preparation for a CMR.