Chang Alice C, Lincoln Jutieh, Lantaff Wendy M, Gernant Stephanie A, Jaynes Heather A, Doucette William, Snyder Margie E
J Am Pharm Assoc (2003). 2018 Jan-Feb;58(1):61-66.e7. doi: 10.1016/j.japh.2017.09.059. Epub 2017 Nov 9.
To characterize actions performed by pharmacists and support staff during provision of medication therapy management (MTM) and to compare actions performed according to practice characteristics.
A purposeful sample of 7 MTM practices (2 call centers and 5 community practices) was identified and visited by investigators. Pharmacists and support staff were observed during their routine provision of MTM. Investigators characterized "major" (e.g., preparation for a comprehensive medication review) and "minor" (i.e., specific steps in overarching major action) actions with the use of a time-and-motion approach.
A total of 32 major and 469 minor actions were observed. Practices were characterized as Later Maturity Level or Early Maturity Level on the basis of their self-reported MTM appointment volume, self-assessment of the extent of integration of chronic care model principles, and payer mix. Later Maturity Level practices were more likely to deliver follow-up medication therapy reviews and comprehensive medication reviews (CMRs) as opposed to targeted medication reviews (TMRs) and to receive physician referrals for MTM. Later Maturity Level practices were also more likely to use paid interns than pharmacy rotation students. CMR activities observed at Later Maturity Level practices lasted a median of 30.8 minutes versus 20.3 minutes for CMR activities at Early Maturity Level practices. Similarly, TMR activities observed at Later Maturity Level practices were longer: a median of 31.0 minutes versus 12.3 minutes. At Later Maturity Level practices, pharmacists spent a greater proportion of time providing patient education, while support staff spent a greater proportion of time on tasks such as capturing demographics and introducing or explaining MTM.
MTM activities were longer at Later Maturity Level practices, and these practices were more likely to use paid pharmacy interns and to receive physician referrals for MTM. This work provides a foundation for future research.
描述药剂师和辅助人员在提供药物治疗管理（MTM）期间所执行的操作，并根据实践特征比较所执行的操作。
通过有目的抽样确定了7个MTM实践机构（2个呼叫中心和5个社区实践机构），研究人员对其进行了走访。在药剂师和辅助人员常规提供MTM服务期间进行观察。研究人员采用时间动作研究方法对“主要”操作（如为全面药物评估做准备）和“次要”操作（即总体主要操作中的具体步骤）进行了描述。
共观察到32项主要操作和469项次要操作。根据自我报告的MTM预约量、慢性护理模式原则整合程度的自我评估以及付款人组合，将实践机构分为成熟度较高水平或成熟度较低水平。成熟度较高水平的实践机构更有可能提供后续药物治疗评估和全面药物评估（CMR），而非针对性药物评估（TMR），并且更有可能获得医生的MTM转诊。成熟度较高水平的实践机构也比药学实习生更有可能使用带薪实习生。在成熟度较高水平的实践机构中观察到的CMR活动持续时间中位数为30.8分钟，而在成熟度较低水平的实践机构中为20.3分钟。同样，在成熟度较高水平的实践机构中观察到的TMR活动持续时间更长：中位数为31.0分钟，而在成熟度较低水平的实践机构中为12.3分钟。在成熟度较高水平的实践机构中，药剂师花费更多时间提供患者教育，而辅助人员则花费更多时间处理诸如收集人口统计学信息以及介绍或解释MTM等任务。
成熟度较高水平的实践机构中的MTM活动持续时间更长，并且这些实践机构更有可能使用带薪药学实习生并获得医生的MTM转诊。这项工作为未来的研究奠定了基础。
