Analysis of Pharmacist-Provided Medication Therapy Management (MTM) Services in Community Pharmacies Over 7 Years
Analysis of Pharmacist-Provided Medication Therapy Management (MTM) Services in Community Pharmacies Over 7 Years
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DOI：
10.18553/jmcp.2009.15.1.18
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发表时间：
2009-01-01
影响因子：
--
通讯作者：
Perry, Paul J.
中科院分区：
文献类型：
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作者：
Barnett, Mitchell J.;Frank, Jessica;Perry, Paul J.
背景技术背景：虽然社区药剂师在历史上主要是支付药物分配和配药服务，药物治疗管理（MTM）服务在20世纪90年代演变为药剂师和其他供应商协助医生和患者管理药物治疗的临床，服务和成本结果的一种手段。2003年的《医疗保险处方药、改进和现代化法案》（MMA 2003）以及随后于2006年1月为参加D部分福利的2000多万医疗保险受益人实施的医疗保险D部分，正式为一部分高成本患者提供MTM服务。虽然医疗保险第0部分提供了一个新的机会来定义药师提供的MTM服务在医疗保健系统中的价值，但几乎没有出版物可以量化药师提供的MTM服务随时间的变化。（a）描述7年来的变化-通过MTM管理服务与药物计划申办者签订合同的社区药房提供的主要类型的MTM服务公司，和（B）量化潜在的MTM相关的成本节约的基础上，药剂师的自我评估的可能影响，他们的干预措施对卫生保健utilization.METHODS：药物治疗管理索赔从一个多州的MTM行政服务公司进行了分析，从2000年1月1日至2006年12月31日，在7年的时间。从每个MTM索赔中提取的数据包括患者人口统计学（例如，年龄和性别），触发干预的药物和类型（例如，药物治疗类别和治疗类型为急性、间歇或慢性），以及关于所提供服务的具体信息（例如，原因、行动、结果和估计成本避免[ECA]）。ECA值来自平均国家卫生保健利用成本，这是适用于药剂师自我评估的“合理和可预见的”干预结果。ECA值每年更新的医疗保健inflation.RESULTS：从近100，000 MTM索赔的数据库中，选择了50个计划赞助商的方便样本。在排除了数据缺失或可能重复的索赔后，47个州的社区药房MTM提供者为23，798名患者提出了76，148项索赔。在2000年1月1日至2006年12月31日的7年期间，平均（[SO]中位数）药房报销为每次MTM服务8.44美元（[5.19美元] 7.00美元），平均（[SD]中位数）ECA为93.78美元（[1，022.23美元] 5.00美元）。在7年期间，药剂师提供的MTM干预措施从主要的教育和监测新的或改变的处方疗法转变为关于成本效益管理的处方者咨询（Pearson卡方P
BACKGROUND: Although community pharmacists have historically been paid primarily for drug distribution and dispensing services, medication therapy management (MTM) services evolved in the 1990s as a means for pharmacists and other providers to assist physicians and patients in managing clinical, service, and cost outcomes of drug therapy. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA 2003) and the subsequent implementation of Medicare Part D in January 2006 for the more than 20 million Medicare beneficiaries enrolled in the Part D benefit formalized MTM services for a subset of high-cost patients. Although Medicare Part 0 has provided a new opportunity for defining the value of pharmacist-provided MTM services in the health care system, few publications exist which quantify changes in the provision of pharmacist-provided MTM services over time.OBJECTIVES: To (a) describe the changes over a 7-year period in the primary types of MTM services provided by community pharmacies that have contracted with drug plan sponsors through an MTM administrative services company, and (b) quantify potential MTM-related cost savings based on pharmacists' self-assessments of the likely effects of their interventions on health care utilization.METHODS: Medication therapy management claims from a multistate MTM administrative services company were analyzed over the 7-year period from January 1, 2000, through December 31, 2006. Data extracted from each MTM claim included patient demographics (e.g., age and gender), the drug and type that triggered the intervention (e.g., drug therapeutic class and therapy type as either acute, intermittent, or chronic), and specific information about the service provided (e.g., Reason, Action, Result, and Estimated Cost Avoidance [ECA]). ECA values are derived from average national health care utilization costs, which are applied to pharmacist self-assessment of the "reasonable and foreseeable" outcome of the intervention. ECA values are updated annually for medical care inflation.RESULTS: From a database of nearly 100,000 MTM claims, a convenience sample of 50 plan sponsors was selected. After exclusion of claims with missing or potentially duplicate data, there were 76,148 claims for 23,798 patients from community pharmacy MTM providers in 47 states. Over the 7-year period from January 1, 2000, through December 31, 2006, the mean ([SO] median) pharmacy reimbursement was $8.44 ([$5.19] $7.00) per MTM service, and the mean ([SD] median) ECA was $93.78 ([$1,022.23] $5.00). During the 7-year period, pharmacist-provided MTM interventions changed from primarily education and monitoring for new or changed prescription therapies to prescriber consultations regarding cost-efficacy management (Pearson chi-square P