Academic-Community Partnership to Implement Medication Therapy Management (MTM) Services in Rural Communities to Improve Adherence to Preventative Health Guidelines for Patients with Diabetes and/or Hypertension Rebecca Jastrzab, PharmD, MPH Clinical Pharmacist The University of Arizona College of Pharmacy
Research Team Rose Martin, PharmD (Principal Investigator) Director, University of Arizona Medication Management Center (UAMMC) Terri Warholak, PhD, RPh, FAPhA Associate Professor, Pharmacy Practice and Science Melissa Johnson, PharmD Clinical Pharmacist Kate Johnson, RN, BSN Interprofessional Care Coordinator Elizabeth Hall-Lipsy, JD, MPH Assistant Professor and Program Manager for Health Disparities Initiatives & Community Outreach Ann Taylor, MPH, MCHES Program Manager
Introduction UAMMC awarded funding for pilot program Funding provided by Arizona Department of Health Services (ADHS) Bureau of Tobacco and Chronic Disease (BTCD) Goal to provide medication therapy management (MTM) services to rural Arizonans
Background What is MEDICATION THERAPY MANAGEMENT (MTM)?
Background MTM services are designed to improve collaboration among pharmacists, physicians, and other healthcare professionals; enhance communication between patients and their healthcare team; and optimize medication use for improved patient outcomes -American Pharmacists Association
Background MTM and public health? Medication Management Center MTM is a comprehensive service provided by pharmacists that shifts the focus from a product to the patient Problem Medication-related problems (MRPs) are a significant public health issue Almost 1/2 of patients fail to adhere to their medication regimen This results in $100 billion dollars spent on avoidable hospitalizations each year
Background (Potential) solution - Provide MTM services to high-risk patients to reduce MRPs and increase adherence
Introduction Requirements Serve 600 patients with chronic condition(s) Identify high-risk patients Medication Management Center Meet monthly & quarterly for updates and a final review Collaborative relationships Academic: UAMMC, Health Outcomes and PharmacoEconomic Research (HOPE Center) and Rural Health Professions Program Community pharmacists Patients Providers
Program Overview Site selection and training Medication Management Center Sites with established relationships with The University of Arizona College of Pharmacy Community partners selected to implement program: Targeting socio-economically underserved areas Addressing health disparities as defined by the Centers for Disease Control (CDC) Patient Recruitment Community Pharmacists assist UAMMC in patient recruitment MTM Review and Interprofessional coordination
Methods MTM review by UAMMC clinical staff including: Medication Reconciliation Evaluation of medication regimen Patient Education Recommendation(s) for patient, provider and/or community partner Follow-up schedule Quarterly or more frequently as needed with patients Routinely with providers and community pharmacists Program Evaluation
Results Sample Population N = 517 patient participants Patient demographics Median Age: 65 70 years of age 2:1 ratio female to male Ethnicity and race varied per site Medical conditions Average of 2 per patient Primary chronic conditions: Type 2 diabetes and hypertension Secondary chronic conditions: cardiovascular disease and asthma
Results Medication Management Center
Results Laboratory Results and Self-Monitoring Patients showed positive trends in laboratory values and self-monitoring of chronic disease (* = p <0.05) Pre-Intervention Post-Intervention Hemoglobin A1c (%) 7.45 7.37 Fasting Blood Glucose (mg/dl)* 131 123 Post Prandial Glucose (mg/dl)* 167 154 Systolic and Diastolic Blood Pressure (mmhg)* 132/76 128/73
Results Guideline Adherence Overall, 75% or higher compliance rate for: Statin, beta blocker, rescue inhaler and inhaled corticosteroids High-Risk medication in the elderly (BEERs Criteria) N = 242 (46.8% of patients) were 65 years and older Of these, a total of 56 patients (23.1%) were prescribed high-risk medication(s) 67 high-risk medications were identified Two most common high-risk medications Frist-generation antihistamines Benzodiazepines
Results Guideline Adherence Medication Management Center
Results Guideline Adherence Medication Management Center
Results Guideline Adherence Medication Management Center
Results Guideline Adherence Medication Management Center
Results Health Promotion 1,103 health promotion interventions completed Average of two interventions per patient Of the 517 participating patients 44% missing preventative screening 29% missing flu vaccine 49% not up to date on their pneumonia vaccination 46% not up to date on their shingles vaccination Approximately 10% of patients were referred to seek programs within their community health center
Discussion The majority of participants had multiple chronic conditions and were far from meeting recommended preventative health screenings and immunizations The program had a positive impact in this patient population regarding: Improved patient health outcomes Increased participation in health promotion activities
Discussion Impact of collaboration across academic institution and community Logistic support Academic Community Continuity of care at the local level Central care coordination Established relationship with patient Clinical expertise Local resource Capacity and personnel to provide service to community based patients
Study Limitations Self-selection bias Potential positively skewed results if patients who were more motivated to make changes chose to participate compared to those choosing not to do so Statistical power of sites varied Ongoing enrollment of program
Conclusion Community-academic MTM relationships can help improve adherence to preventative health guidelines for patients with chronic conditions in rural Arizona CHW, interprofessional care coordinator (RN) More research is needed to determine whether a program such as this is effective in producing similar results in diverse populations
My colleagues and I want to Thank You for attending this session!
Questions Medication Management Center