Community Based Medication Therapy Management Program
Community Based Medication Therapy Management Program
Aging is closely linked to a broad array of risk factors that are associated with chronic disease and declining health. With increasing age, most individuals will have a growing and sustained need for a variety of prescription drug therapies. In a survey of noninstitutionalized adults, 94% of women age 65 years or older had taken at least one medication in the preceding week, and 57% took at least five. In many cases, therapies are complex and costly and involve the services of multiple health care providers. Factors such as these enhance the potential for the occurrence of drug-related problems, including adverse drug events, drug interactions, and poor adherence to treatment plans.
While the majority of older adults receive health care in ambulatory care settings, outpatient providers typically lack structured programs to accommodate geriatric needs and assist seniors with managing their medication regimens. Hence, it is not surprising that drug-related problems are frequent among older adults receiving outpatient care. Gurwitz et al. examined the frequency of adverse drug events among 27,617 Medicare beneficiaries receiving ambulatory care services and found the incidence was 50.1 adverse drug events per 1000 person-years of observation; 27.6% of these were classified as preventable. The results of the study suggest that new approaches are needed to improve the quality of care and health outcomes of older adults, especially in ambulatory care settings.
The need of the elderly for drug therapy also places an increasing burden on seniors to continuously garner the resources needed to access medications over extended periods. Despite this need, it is estimated that 25% or more of seniors do not have prescription drug coverage. The recent enactment of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) is an important national milestone that holds potential to increase seniors' access to medications and improve their quality of care. Beginning in January 2006, MMA expands the Medicare entitlement program to offer seniors and people living with disabilities the option of purchasing a prescription drug plan (PDP) through a benefit designated as Part D or as part of the Medicare Advantage program in Part C (MA-PD). An important provision of MMA is that PDPs and MA-PDs establish a medication therapy management (MTM) program that may be furnished by a pharmacist and that is designed to ensure, with respect to targeted beneficiaries, that covered drugs are appropriately used to optimize therapeutic outcomes and reduce the risk of adverse events.
Nevertheless, MMA broadly defines MTM and does not currently mandate the involvement of pharmacists. Consequently, there is an important need to identify successful models of MTM that are practical in the community settings where most Medicare beneficiaries reside. We evaluated the effects of a novel, comprehensive, community-based program that integrates MTM services by pharmacists with prescription drug assistance for seniors with limited incomes. Although the program was developed prior to the enactment of MMA, it serves as a potential model for delivering effective MTM services in community settings. The objectives of this evaluation were to assess (1) whether a model of providing medication payment assistance, MTM, and tailored community referral improves health outcomes for seniors with limited incomes and (2) the sustained effects of enrollment after 24 months in the program.
Aging is closely linked to a broad array of risk factors that are associated with chronic disease and declining health. With increasing age, most individuals will have a growing and sustained need for a variety of prescription drug therapies. In a survey of noninstitutionalized adults, 94% of women age 65 years or older had taken at least one medication in the preceding week, and 57% took at least five. In many cases, therapies are complex and costly and involve the services of multiple health care providers. Factors such as these enhance the potential for the occurrence of drug-related problems, including adverse drug events, drug interactions, and poor adherence to treatment plans.
While the majority of older adults receive health care in ambulatory care settings, outpatient providers typically lack structured programs to accommodate geriatric needs and assist seniors with managing their medication regimens. Hence, it is not surprising that drug-related problems are frequent among older adults receiving outpatient care. Gurwitz et al. examined the frequency of adverse drug events among 27,617 Medicare beneficiaries receiving ambulatory care services and found the incidence was 50.1 adverse drug events per 1000 person-years of observation; 27.6% of these were classified as preventable. The results of the study suggest that new approaches are needed to improve the quality of care and health outcomes of older adults, especially in ambulatory care settings.
The need of the elderly for drug therapy also places an increasing burden on seniors to continuously garner the resources needed to access medications over extended periods. Despite this need, it is estimated that 25% or more of seniors do not have prescription drug coverage. The recent enactment of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) is an important national milestone that holds potential to increase seniors' access to medications and improve their quality of care. Beginning in January 2006, MMA expands the Medicare entitlement program to offer seniors and people living with disabilities the option of purchasing a prescription drug plan (PDP) through a benefit designated as Part D or as part of the Medicare Advantage program in Part C (MA-PD). An important provision of MMA is that PDPs and MA-PDs establish a medication therapy management (MTM) program that may be furnished by a pharmacist and that is designed to ensure, with respect to targeted beneficiaries, that covered drugs are appropriately used to optimize therapeutic outcomes and reduce the risk of adverse events.
Nevertheless, MMA broadly defines MTM and does not currently mandate the involvement of pharmacists. Consequently, there is an important need to identify successful models of MTM that are practical in the community settings where most Medicare beneficiaries reside. We evaluated the effects of a novel, comprehensive, community-based program that integrates MTM services by pharmacists with prescription drug assistance for seniors with limited incomes. Although the program was developed prior to the enactment of MMA, it serves as a potential model for delivering effective MTM services in community settings. The objectives of this evaluation were to assess (1) whether a model of providing medication payment assistance, MTM, and tailored community referral improves health outcomes for seniors with limited incomes and (2) the sustained effects of enrollment after 24 months in the program.
Source...