Moczygemba Leticia R, Barner Jamie C, Lawson Kenneth A, Brown Carolyn M, Gabrillo Evelyn R, Godley Paul, Johnsrud Michael
Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia 23298-0533, USA.
Am J Geriatr Pharmacother. 2011 Oct;9(5):328-38. doi: 10.1016/j.amjopharm.2011.08.001. Epub 2011 Aug 24.
The Medicare Modernization Act of 2003 mandated the provision of medication therapy management (MTM) to eligible Part D beneficiaries to improve medication-related outcomes. As MTM programs evolve, evaluation is necessary to help inform MTM best practices.
The objective of this study was to determine the impact of pharmacist-provided telephone MTM on: (1) medication and health-related problems (MHRPs); (2) medication adherence; and (3) Part D drug costs.
This quasi-experimental study included Part D beneficiaries from a Texas health plan. Andersen's Behavioral Model of Health Services Use served as the study framework. MTM utilization was the health behavior. Age, gender, and race were predisposing factors, and number of medications, chronic diseases, and medication regimen complexity were need factors. Outcomes were pre-to-post changes in: (1) MHRPs; (2) medication adherence, using the medication possession ratio (MPR); and (3) total drug costs. Multiple regression was used to analyze group differences while controlling for predisposing and need factors.
At baseline, the intervention (n = 60) and control (n = 60) groups were not statistically different regarding predisposing and need factors, with the exception of gender. The intervention group had significantly (P = 0.009) more men compared with the control group (51.7% vs 28.3%). There were 4.8 (2.7) and 9.2 (2.9) MHRPs identified at baseline and 2.5 (2.0) and 7.9 (3.0) MHRPs remained at the 6-month follow up in the intervention and control groups, respectively. The intervention group (vs control) had significantly more MHRPs resolved (P = 0.0003). There were no significant predictors of change in MPR or total drug costs from baseline to follow up, although total drug costs decreased by $158 in the intervention group compared with a $118 increase in the control group.
A telephone MTM program resolved significantly more MHRPs compared with a control group, but there were no significant changes in adherence and total drug costs.
2003年的《医疗保险现代化法案》规定，要为符合条件的D部分受益人提供药物治疗管理（MTM），以改善与药物相关的结果。随着MTM项目的发展，有必要进行评估，以帮助形成MTM的最佳实践。
本研究的目的是确定药剂师提供的电话MTM对以下方面的影响：（1）药物和健康相关问题（MHRP）；（2）药物依从性；（3）D部分药物费用。
这项准实验研究纳入了得克萨斯州一个健康计划的D部分受益人。安德森的卫生服务利用行为模型作为研究框架。MTM的使用是健康行为。年龄、性别和种族是诱发因素，药物数量、慢性病和药物治疗方案复杂性是需求因素。结果是以下方面从基线到随访后的变化：（1）MHRP；（2）药物依从性，采用药物持有率（MPR）；（3）总药物费用。在控制诱发因素和需求因素的同时，使用多元回归分析组间差异。
在基线时，干预组（n = 60）和对照组（n = 60）在诱发因素和需求因素方面无统计学差异，但性别除外。与对照组相比，干预组男性显著更多（P = 0.009）（51.7%对28.3%）。在基线时，干预组和对照组分别识别出4.8（2.7）个和9.2（2.9）个MHRP，在6个月随访时，干预组和对照组分别仍有2.5（2.0）个和7.9（3.0）个MHRP。干预组（与对照组相比）解决的MHRP显著更多（P = 0.0003）。从基线到随访，MPR或总药物费用变化没有显著预测因素，尽管干预组总药物费用减少了158美元，而对照组增加了118美元。
与对照组相比，电话MTM项目解决的MHRP显著更多，但依从性和总药物费用没有显著变化。
