社区药剂师提供的药物治疗管理服务：来自医疗保险D部分受益人的全国样本的见解。
Medication Therapy Management Delivery by Community Pharmacists: Insights from a National Sample of Medicare Part D Beneficiaries.
作者信息
Adeoye Omolola A, Farley Joel F, Coe Antoinette B, Pestka Deborah L, Farris Karen B, Zillich Alan J, Snyder Margie E
机构信息
Purdue University College of Pharmacy, Indianapolis, IN.
University of Minnesota College of Pharmacy, Minneapolis, MN.
出版信息
J Am Coll Clin Pharm. 2019 Aug;2(4):373-382. doi: 10.1002/jac5.1160. Epub 2019 Jun 29.
INTRODUCTION
The Medicare Part D medication therapy management (MTM) program positions pharmacists to optimize beneficiaries' medications and improve care. Little is known regarding Part D MTM delivery by community pharmacists and other pharmacist provider types.
OBJECTIVES
To (1) characterize Medicare Part D MTM delivery by community pharmacists, (2) compare MTM delivery by community pharmacists to other pharmacists, and (3) generate hypotheses for future research.
METHODS
A descriptive cross-sectional study using merged data from a 20% random sample of Medicare beneficiary enrollment data with a 100% sample of recently available 2014 Part D MTM files was conducted. Andersen's Behavioral Model was applied to describe MTM delivery across beneficiary characteristics. Descriptive and bivariate statistics were used to compare delivery of MTM between community and other pharmacist providers.
RESULTS
Among beneficiaries sampled, community pharmacists provided comprehensive medication reviews (CMRs) to 22% (n=26,337) of beneficiaries receiving at least one CMR. Almost half (49.4%) were provided face-to-face. Across pharmacist cohorts, median days to CMR offer of post-MTM program enrollment were within the 60-day policy requirement. The community pharmacist cohort had fewer days from CMR offer to receipt (median 47 days). Community pharmacists provided more medication therapy problem (MTP) recommendations (mean [SD] of 1.8 [3.5]; p<0.001), but resolved less MTPs (0.2 [0.7]; p<0.001), and most commonly served beneficiaries that were in the south but less in the west/northeast. Additionally, community pharmacists served a smaller proportion of black beneficiaries, yet a larger proportion of Hispanic beneficiaries (p<0.001).
CONCLUSION
Community pharmacists provided approximately one in five CMRs for MTM eligible beneficiaries in 2014, with CMRs occurring more quickly, resulting in more MTP recommendations, but resolving less MTPs than those provided by non-community pharmacists. Future research should explore geographic/racial-ethnic disparities in beneficiaries served and strategies to increase negligible MTP resolution by community pharmacists.
引言
医疗保险D部分药物治疗管理（MTM）计划使药剂师能够优化受益人的药物治疗并改善护理。关于社区药剂师和其他药剂师提供者类型提供D部分MTM的情况，我们了解得很少。
目的
（1）描述社区药剂师提供医疗保险D部分MTM的情况，（2）将社区药剂师提供的MTM与其他药剂师进行比较，（3）为未来研究提出假设。
方法
进行了一项描述性横断面研究，使用了来自医疗保险受益人登记数据20%随机样本与2014年最新可用D部分MTM文件100%样本的合并数据。应用安德森行为模型来描述不同受益人特征下的MTM提供情况。使用描述性和双变量统计来比较社区药剂师和其他药剂师提供者之间MTM的提供情况。
结果
在抽样的受益人中，社区药剂师为至少接受过一次全面药物审查（CMR）的受益人中的22%（n = 26,337）提供了CMR。近一半（49.4%）是面对面提供的。在所有药剂师群体中，MTM计划注册后提供CMR的中位数天数在60天政策要求范围内。社区药剂师群体从提供CMR到接收的天数较少（中位数为47天）。社区药剂师提供了更多的药物治疗问题（MTP）建议（平均[标准差]为1.8[3.5]；p < 0.001），但解决的MTP较少（0.2[0.7]；p < 0.001），并且最常服务的受益人在南部，但在西部/东北部较少。此外，社区药剂师服务的黑人受益人比例较小，但西班牙裔受益人比例较大（p < 0.001）。
结论
2014年，社区药剂师为符合MTM条件的受益人提供了约五分之一的CMR，CMR出现得更快，导致更多的MTP建议，但与非社区药剂师相比，解决的MTP较少。未来的研究应探索所服务受益人中的地理/种族差异，以及增加社区药剂师对可忽略不计的MTP解决率的策略。
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