Rosenthal Meagen, Holmes Erin, Banahan Benjamin
The University of Mississippi, School of Pharmacy, Faser Hall Room 223A, University, MS 38677, USA.
The University of Mississippi, School of Pharmacy, University, MS 38677, USA; Associate, Applied Pharmacy Solutions, Sacramento, CA, USA.
Res Social Adm Pharm. 2016 May-Jun;12(3):523-8. doi: 10.1016/j.sapharm.2015.07.006. Epub 2015 Jul 30.
Although the literature has demonstrated positive patient outcomes from medication therapy management (MTM), implementing it in community pharmacy continues to be met with significant barriers. To make MTM implementation more attainable, scalable, and sustainable in community pharmacies, this paper puts out a call for the need to identify the proportion of patients who clinically qualify for various levels of intensity of MTM services. This paper presents three proposed levels of MTM: adherence management (lowest level of MTM intensity), interventions on drug-related problems (mid-level MTM intensity), and disease state management (highest level of intensity). It is hypothesized that the lowest levels of MTM intensity would be sufficient to address medication problems in the vast majority of patients and require fewer MTM skills and resources, while the highest levels of MTM intensity (requiring the most skills and resources) would address medication problems in the smallest number of patients whose medication problems could not resolved with lower-intensity MTM. Future research in this area will involve testing previously designed instruments to determine why patients are not adhering to their medication regimen, following patients who have already had their adherence managed with medication synchronization, and tracking patients who will require higher levels of pharmacy services.
尽管文献表明药物治疗管理（MTM）能给患者带来积极的治疗效果，但在社区药房实施MTM仍面临重大障碍。为了使MTM在社区药房的实施更具可行性、可扩展性和可持续性，本文呼吁有必要确定临床上符合不同强度MTM服务水平的患者比例。本文提出了MTM的三个建议水平：依从性管理（MTM强度最低水平）、药物相关问题干预（MTM中等强度水平）和疾病状态管理（最高强度水平）。据推测，最低强度的MTM足以解决绝大多数患者的用药问题，所需的MTM技能和资源较少，而最高强度的MTM（需要最多的技能和资源）将解决用药问题最复杂、低强度MTM无法解决的少数患者的用药问题。该领域未来的研究将包括测试先前设计的工具，以确定患者不遵守药物治疗方案的原因，跟踪那些已经通过药物同步化管理了依从性的患者，并跟踪那些需要更高水平药房服务的患者。
