Evaluation of an Academic-Community Partnership to Implement MTM Services in Rural Communities to Improve Pharmaceutical Care for Patients with Diabetes and/or Hypertension

摘要

BACKGROUND: Although the current methods of medication therapy management (MTM) delivery have demonstrably improved therapeutic, safety, economic, and humanistic health outcomes, patient- and prescriber-level barriers persist, limiting its reach and effectiveness. OBJECTIVE: To assess telephonic- and community-based clinical pharmacy services in improving health indicators for rural, underserved patients. METHODS: In 2014, an established MTM provider created a novel, collaborative pilot program with independent retail and community health center pharmacies to provide comprehensive, telephonic MTM services to rural Arizonans. This pilot program used a combined telephonic- and community-based pharmacist approach in the provision of MTM services for rural, underserved Arizona populations. Adults with diabetes mellitus and/or hypertension, seen by a prescriber or who filled prescriptions at a contracted, rural facility in 2014, were eligible to participate. Initial MTM telephonic consultations were conducted, and recommendations were communicated to patients’ prescribers and/or pharmacists. Patients received a follow-up telephone call at standard intervals, depending on risk severity. RESULTS: A total of 517 patients participated, and 237 medication-related and 1,102 health promotion interventions were completed. Positive trends were observed in fasting blood glucose, postprandial glucose, and diastolic blood pressure. Broad variation in prescriber acceptance of pharmacist recommendations was observed (27%-60%). CONCLUSIONS: Study results provide initial evidence to support the efficacy of collaborative efforts in the provision of MTM services for improving health indicators and safety measures while potentially reducing health care disparities. While the results are encouraging, future research is warranted in more diverse populations and settings. DISCLOSURES: This work was supported in part by funding from the Centers for Disease Control and Prevention via a multiyear, interagency grant from the Arizona Department of Health Services. The findings and conclusions presented in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention nor the Arizona Department of Health Services. Study concept and design were contributed by M. Johnson, Jastrzab, Hall-Lipsy, Martin, and Warholak. M. Johnson took the lead in data collection, along with K. Johnson, Martin, Jastrzab, and Hall-Lipsy. Data interpretation was performed by Jastrzab, Warholak, and Taylor. The manuscript was written by K. Johnson, M. Johnson, and Jastrzab, along with the other authors, and revised by M. Johnson, Tate, and Taylor, along with Jastrzab, K. Johnson, and Hall-Lipsy. The data from this manuscript were previously presented in poster and podium format by Jastrzab and Johnson at the American Public Health Annual Meeting; Chicago, Illinois; October 31-November 4, 2015.