Woeppel Jacqueline, Clark Renee, Underwood Lora, Gatwood Justin, Turner Kea, Renfro Chelsea, Hohmeier Kenneth C
TennCare Pharmacy Division, Nashville, TN, USA.
University of Tennessee College of Pharmacy, Memphis, TN, USA.
Res Social Adm Pharm. 2020 Mar;16(3):315-320. doi: 10.1016/j.sapharm.2019.05.018. Epub 2019 May 24.
Pharmacist-led medication therapy management (MTM) programs are considered evidence-based and have clearly defined core components. Despite this, MTM programs are often implemented without fidelity due to notable implementation barriers, such as physician-pharmacist relationships and pharmacist access to patient medical records. To improve MTM implementation, the Tennessee Medicaid program developed a MTM intervention that incorporates implementation strategies to address some of the known barriers to implementation (e.g., formalizing pharmacist-physician relationships through collaborative practice agreements, ensuring pharmacists' access to medical records).
The purpose of this hybrid type 2 effectiveness-implementation study is to (1) assess the effectiveness of the MTM pilot program in Tennessee (e.g., medication adherence, healthcare utilization, quality and cost of care) and (2) assess the implementation of the MTM pilot program (e.g., feasibility, appropriateness, acceptability, penetration).
The Tennessee MTM pilot program is being assessed as a hybrid type 2 effectiveness-implementation study with a quasi-experimental design. A mixed methods approach (QUAN + QUAL) for the purpose of complementarity (e.g., answering related research questions). Data will include surveys, interviews, MTM platform encounter information, and medical and pharmacy claims. Initial analyses will include data between January 2018 and December 2019.
The study will further add to the evidence base of MTM interventions by testing an intervention that addresses known barriers to implementation and simultaneously collecting data on effectiveness and implementation to speed up MTM translation. The Tennessee MTM program is expected to serve as a guide to other states seeking to expand pharmacist-delivered clinical services to their Medicaid members, particularly those intending to incorporate MTM into programs seeking to improve primary care delivery. Further, by improving the implementation of MTM, the pilot program is expected to improve the reliability of MTM program benefits including healthcare quality and cost and patient outcomes.
由药剂师主导的药物治疗管理（MTM）项目被认为是基于证据的，并且具有明确界定的核心组成部分。尽管如此，由于存在显著的实施障碍，如医师与药剂师的关系以及药剂师获取患者病历的途径，MTM项目在实施时往往缺乏保真度。为了改进MTM的实施，田纳西州医疗补助计划制定了一项MTM干预措施，该措施纳入了实施策略以解决一些已知的实施障碍（例如，通过合作实践协议使药剂师与医师的关系正规化，确保药剂师能够获取病历）。
这项混合型2类有效性 - 实施研究的目的是：（1）评估田纳西州MTM试点项目的有效性（例如，药物依从性、医疗保健利用情况、护理质量和成本）；（2）评估MTM试点项目的实施情况（例如，可行性、适宜性、可接受性、渗透率）。
田纳西州MTM试点项目作为一项具有准实验设计的混合型2类有效性 - 实施研究进行评估。采用混合方法（定量+定性）以实现互补（例如，回答相关研究问题）。数据将包括调查、访谈、MTM平台接触信息以及医疗和药房报销数据。初步分析将包括2018年1月至2019年12月期间的数据。
该研究将通过测试一项解决已知实施障碍的干预措施，并同时收集有效性和实施方面的数据以加速MTM的转化，进一步增加MTM干预措施的证据基础。田纳西州MTM项目有望为其他寻求向其医疗补助成员扩展药剂师提供的临床服务的州提供指导，特别是那些打算将MTM纳入旨在改善初级保健服务的项目的州。此外，通过改进MTM的实施，试点项目有望提高MTM项目效益的可靠性，包括医疗质量、成本和患者结局。
