Sneed Gregory, Kappeler Karl, Gilmore Travis, Kuhn Catherine
J Am Pharm Assoc (2003). 2018 Jul-Aug;58(4S):S114-S119. doi: 10.1016/j.japh.2018.04.021. Epub 2018 Jun 2.
To describe the implementation of a medication therapy management (MTM) collaborative within a pediatric health system to ensure the safe use of medication.
Outpatient pharmacies and clinics within a pediatric health system in Central Ohio.
The outpatient pharmacies conducted the daily operations of a community pharmacy following a standard, 4-point workflow. The ambulatory clinical pharmacists served on interdisciplinary teams within outpatient clinics to ensure the appropriate use of medication.
A collaborative model was developed to offer MTM services to patients within outpatient pharmacies and clinics throughout the health system. The pharmacist responsibilities varied, with outpatient pharmacists focused on targeted medication reviews (TMRs) and ambulatory clinical pharmacists focused on comprehensive medication reviews (CMRs) and TMRs.
The use of multiple plan-do-study-act cycles allowed for program improvements throughout implementation. Data collection included a pharmacy staff perception survey, mapping of MTM opportunities, and a quantitative report on the number, type, and intervention rate of all MTM activities.
Four hundred nine MTM interventions, 349 TMRs (70 clinic based and 279 pharmacy based) and 60 CMRs, were completed throughout the first 6 months. Two hundred thirty-eight of the TMRs were pharmacist-initiated interventions that allowed pharmacists to provide medication counseling and follow-up with patients beginning new therapy. Ambulatory clinical pharmacists identified and resolved drug-related problems in greater than one-half of the CMRs completed. The intervention rates were 39% for CMRs and 44% for TMRs.
The implementation of a collaborative MTM model provided an opportunity to address drug-related problems to ensure the appropriate use of medication. The model consisted of pharmacy staff members within 2 different patient care environments working together to complete MTM services for patients throughout the health system. The key elements of the program included the use of training sessions tailored to the pharmacy staff member's role in MTM, incorporation of technician champions, and creation of pharmacist-initiated interventions.
描述在儿科医疗系统内实施药物治疗管理（MTM）协作项目以确保药物安全使用的情况。
俄亥俄州中部儿科医疗系统内的门诊药房和诊所。
门诊药房按照标准的四点工作流程开展社区药房的日常运营。门诊临床药师在门诊诊所的跨学科团队中工作，以确保药物的合理使用。
开发了一种协作模式，为整个医疗系统门诊药房和诊所的患者提供MTM服务。药剂师的职责各不相同，门诊药剂师专注于目标药物审查（TMR），门诊临床药师专注于全面药物审查（CMR）和TMR。
在整个实施过程中，通过多个计划 - 执行 - 研究 - 行动循环对项目进行改进。数据收集包括药房工作人员认知调查、MTM机会映射，以及关于所有MTM活动的数量、类型和干预率的定量报告。
在最初的6个月内共完成了409项MTM干预，其中349项TMR（70项基于诊所，279项基于药房）和60项CMR。238项TMR是由药剂师发起的干预措施，使药剂师能够为开始新治疗的患者提供用药咨询和随访。门诊临床药师在超过一半的已完成CMR中识别并解决了与药物相关的问题。CMR的干预率为39%，TMR的干预率为44%。
协作性MTM模式的实施为解决与药物相关的问题提供了机会，以确保药物的合理使用。该模式由两个不同患者护理环境中的药房工作人员共同合作，为整个医疗系统的患者完成MTM服务。该项目的关键要素包括针对药房工作人员在MTM中的角色开展培训课程、引入技术骨干以及创建由药剂师发起的干预措施。
