Isetts Brian
Department of Pharmaceutical Care & Health Systems, University of Minnesota College of Pharmacy, 308 Harvard St., SE Minneapolis, MN 55455, USA.
Pharmacy (Basel). 2017 Oct 16;5(4):56. doi: 10.3390/pharmacy5040056.
(1) Background: As the U.S. healthcare system evolves from fee-for-service financing to global population-based payments designed to be accountable for both quality and total cost of care, the effective and safe use of medications is gaining increased importance. The purpose of this project was to determine the feasibility of integrating medication therapy management (MTM) services provided by community pharmacists into the clinical care teams and the health information technology (HIT) infrastructure for Minnesota Medicaid recipients of a 12-county community-based accountable care organization (ACO). (2) Methods: The continuous quality improvement evaluation methodology employed in this project was the context + mechanism = outcome (CMO) model to account for the fact that programs only work insofar as they introduce promising ideas, solutions and opportunities in the appropriate social and cultural contexts. Collaborations between a 12-county ACO and 15 community pharmacies in Southwest Minnesota served as the social context for this feasibility study of MTM referrals to community pharmacists. (3) Results: All 15 community pharmacy sites were integrated into the HIT infrastructure through Direct Secure Messaging, and there were 32 recipients who received MTM services subsequent to referrals from the ACO at 5 of the 15 community pharmacies over a 1-year implementation phase. (4) Conclusion: At the conclusion of this project, an effective electronic communication and MTM referral system was activated, and consideration was given to community pharmacists providing MTM in future ACO shared savings agreements.
(1) 背景：随着美国医疗保健系统从按服务收费融资模式向旨在对医疗质量和总成本负责的基于全球人口的支付模式转变，药物的有效和安全使用变得越来越重要。本项目的目的是确定将社区药剂师提供的药物治疗管理（MTM）服务整合到明尼苏达州一个基于社区的12县责任医疗组织（ACO）的明尼苏达医疗补助受助人的临床护理团队和健康信息技术（HIT）基础设施中的可行性。(2) 方法：本项目采用的持续质量改进评估方法是情境+机制=结果（CMO）模型，以考虑到项目只有在适当的社会和文化背景下引入有前景的想法、解决方案和机会时才会发挥作用。明尼苏达州西南部一个12县的ACO与15家社区药房之间的合作是对社区药剂师进行MTM转诊可行性研究的社会背景。(3) 结果：在为期1年的实施阶段，所有15个社区药房站点都通过直接安全消息传递整合到了HIT基础设施中，在15家社区药房中的5家，有32名受助人在ACO转诊后接受了MTM服务。(4) 结论：在本项目结束时，一个有效的电子通信和MTM转诊系统启动，并且考虑了社区药剂师在未来ACO共享节约协议中提供MTM服务的可能性。
