The Ohio State University College of Pharmacy, 500 West 12th Ave, Columbus, OH 43210. Email:
Professional Data Analysts, Inc, Minneapolis, Minnesota.
Prev Chronic Dis. 2019 Nov 21;16:E153. doi: 10.5888/pcd16.190163.
Pharmacists are underused in the care of chronic disease. The primary objectives of this project were to 1) describe the factors that influence initiation of and sustainability for pharmacist-provided medication therapy management (MTM) in federally qualified health centers (FQHCs), with secondary objectives to report the number of patients receiving MTM by a pharmacist who achieve 2) hemoglobin A1c (HbA) control (≤9%) and 3) blood pressure control (<140/90 mm Hg).
We evaluated MTM provided by pharmacists in 10 FQHCs in Ohio through qualitative thematic analysis of semi-structured interviews with pharmacists and FQHC leadership and aggregate reporting of clinical markers.
Facilitators of MTM included relationship building with clinicians, staff, and patients; regular verbal or electronic communication with care team members; and alignment with quality goals. Common MTM model elements included MTM provided distinct from dispensing medications, clinician referrals, and electronic health record access. Financial compensation strategies were inadequate and varied; they included 340B revenue, incident-to billing, grants, and shared positions with academic institutions. Of 1,692 enrolled patients, 60% (n = 693 of 1,153) achieved HbA ≤9%, and 79% (n = 758 of 959) achieved blood pressure <140/90 mm Hg.
Through this statewide collaborative, access for patients in FQHCs to MTM by pharmacists increased. The factors we identified that facilitate MTM practice models can be used to enhance the models to achieve clinical goals. Collaboration among clinic staff and community partners can improve models of care and improve chronic disease outcomes.
药剂师在慢性病护理中的作用未得到充分发挥。本项目的主要目标是：1）描述影响药剂师在联邦合格健康中心（FQHC）提供药物治疗管理（MTM）的启动和持续进行的因素，次要目标是报告接受药剂师提供的 MTM 的患者数量，这些患者达到 2）糖化血红蛋白（HbA）控制（≤9%）和 3）血压控制（<140/90mmHg）。
我们通过对俄亥俄州 10 家 FQHC 的药剂师进行半结构化访谈的定性主题分析，评估了药剂师提供的 MTM，并对临床指标进行了汇总报告。
MTM 的促进因素包括与临床医生、员工和患者建立关系；与护理团队成员进行定期的口头或电子沟通；以及与质量目标保持一致。常见的 MTM 模型要素包括与配药分开提供的 MTM、临床医生转诊和电子健康记录访问。财务补偿策略不足且各不相同；包括 340B 收入、附带计费、赠款以及与学术机构的共享职位。在 1692 名入组患者中，60%（n=1153 例中的 693 例）达到 HbA≤9%，79%（n=959 例中的 758 例）达到血压<140/90mmHg。
通过全州范围的合作，FQHC 患者获得药剂师提供的 MTM 的机会增加了。我们确定的促进 MTM 实践模式的因素可用于增强这些模式以实现临床目标。诊所工作人员和社区合作伙伴之间的合作可以改善护理模式并改善慢性病结局。
