Implementation of a Medication Therapy Management Program in a Hospital-Based Outpatient Pharmacy

Purpose To describe the integration of a medication therapy management (MTM) service in a hospital-based outpatient pharmacy, including adapting Medicare-based screening criteria to target a primarily non-Medicare population, integrating data into the medical center's electronic medical record, and designing a method to track identified drug-related problems (DRPs). Methods The hospital-based outpatient pharmacy at the University of Pittsburgh Medical Center (UPMC) established an MTM service to enhance patient medication safety. Identification criteria were developed in accordance with the Medicare Modernization Act of 2003 and institutional practices: older than 65 years, more than 5 chronic medications, more than 3 chronic disease states, presence of diabetes, tobacco use, or possible adverse drug event (ADE). As this was a proof of concept pilot, both Medicare and non-Medicare patients were included. Additionally, an intervention tracking form was developed to use in conjunction with the medical center's electronic medical record. Results During an 18-month period, 319 patients met the criteria upon random screening. Sixty-eight patients enrolled in the MTM program, resulting in 234 patient visits. One hundred and seventy DRPs were identified, with 2.5 DRP per patient. The most common problems found were the need for additional drug therapy and nonadherence. The overall physician acceptance rate for recommendations was 69%. Conclusion MTM programs are adaptable to a hospital-based outpatient pharmacy utilizing Medicare-based screening criteria in a primarily non-Medicare population resulting in identification of DRPs.