Implementing services into the community pharmacy workflow presents challenges
Areas for improvement include the business model, healthcare team buy-in, patient engagement, and technology.
The Medicare Prescribing, Drugs, Improvement, and Modernization Act of 2003 established requirements under Part D to provide medication therapy management (MTM) services to eligible Medicare beneficiaries.1
This paved the way for an expanded role for pharmacists in patient care. In 2018, approximately 65% of plans reported using community pharmacists through supplier contracts.2.3 However, challenges exist with implementing MTM services into the community pharmacy workflow.
Overcome the obstacles
Results of a cross-sectional study from a random sample of Medicare beneficiary enrollment data evaluating the 2014 Part D MTM files showed that community pharmacists provided more medication treatment problem recommendations (MTP ) (P 2. Evidence shows that the following challenges are associated with implementing TMD services in community practice: barriers to the business model, integration of programs within the health care team, integration into the pharmacy workflow, lack of patient engagement, and difficulties in adapting technology (Figure2-5).
Challenges in integrating MTM services into the pharmacy workflow include difficulty in training staff, insufficient dedicated physical space to perform consultations, and lack of time.2.3 Busy pharmacy chains may have difficulty integrating MTM services due to the many responsibilities of pharmacists, including administering vaccines and dispensing medications. Evidence shows that access to technology is essential for MTM services, especially for reviewing electronic medical records.3.4 Typically, MTM providers use web-based software for documentation and billing, so onboarding qualified pharmacy technicians for this task is essential. Findings from another study identified barriers and implementation strategies for integrating a web-based medication management application into community pharmacies.4 Additionally, study results showed that clinical training, computer literacy, and leadership training facilitated the implementation of an online program into practice.4 However, staff opposition to change and providers’ reluctance to share data were seen as barriers to implementing the technology.4
Lack of patient interest in MTM services is also a barrier.3 Additionally, many patients are unaware that clinical training for pharmacists goes beyond dispensing medications.3 Pharmacists can develop a standardized approach to providing MTM services and explain their roles to patients. Pharmacists and physicians can also work together successfully through collaborative medication therapy management to improve communication and patient care services.3 Results from a third study showed that there was an increase in MTM completion rates after the implementation of an educational intervention in community pharmacies (P 5
According to the results of a Health2 Resources report, more than 600 practicing pharmacists and program managers who responded to the survey believed that comprehensive medication management (CMM) services enable healthcare organizations to achieve patient satisfaction. clinicians, cost savings, better outcomes and patient satisfaction. .6
The CMM approach focuses on clinical, patient and personal goals to improve health outcomes.6 Goodrich Pharmacy, an independent pharmacy in Anoka, Minnesota, and HealthPartners successfully completed the CMM.6 HealthPartners began paying for CMM services in 2006.6 At press time, Goodrich Pharmacy employed 18 pharmacists at 7 sites and they used CMM with approximately 900 patients.6
About the Author
Jennifer Gershman, PharmD, CPh, PACSis a drug information pharmacist and Pharmacy Times® contributor who lives in South Florida.
1. Medicare Prescription Drug, Improvement, and Modernization Act of 2003, HR 1, 108th Cong (2003). Accessed April 7, 2022. https://www.congress.gov/bill/108th-congress/house-bill/1
2. Adeoye OA, Farley JF, Coe AB, et al. Provision of medication therapy management by community pharmacists: insight from a national sample of Medicare Part D beneficiaries. J Am Coll Clin Pharm. 2019;2(4):373-382. doi:10.1002/jac5.1160
3. Ferreri SP, Hughes TD, Snyder ME. Management of drug therapy: current challenges. Integr Pharm Res Practice. 2020;9:71-81. doi:10.2147/IPRP.S179628
4. Turner K, Renfro C, Ferreri S, Roberts K, Pfeiffenberger T, Shea CM. Support community pharmacies with the implementation of a web-based medication management application. Appl Clin Inform. 2018;9(2):391-402. doi:10.1055/s-0038-1651488
5. Hohmeier KC, Wheeler JS, Brookhart A, et al. Targeting adaptability to improve implementation of medication therapy management (MTM) in community pharmacy. Implement Sci. 2019;14(1):99. doi:10.1186/s13012-019-0946-7
6. GTMRx Institute. The Get the Medications iight report: a national overview of expert practices – Comprehensive medication management in outpatient/community pharmacies. May 2016. Accessed April 8, 2022. https://gtmr.org/the-gtmr-report/