How the Medication Therapy Management Pharmacist's Role Differs in CMM

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A recent Cureatr blog post compared medication therapy management (MTM) and comprehensive medication management (CMM), noting that there are distinct differences between each program's approach and components.

The piece concluded with a helpful table that outlined key differences (and some similarities) between the two. This article will delve into some of these points further, focusing on how drug therapy review differs between medication therapy management and comprehensive medication management.

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Key Comprehensive Medication Management Differentiators

Here are five of the ways a pharmacist's responsibilities differ when conducting CMM versus MTM.

1. Pharmacists conduct clinical assessments of the patient and patient records in CMM

One of the most significant differences is the active role a pharmacist takes in assessing a patient's clinical status, needs, and any applicable records (e.g., lab results, problem lists, clinical notes, vital signs, X-rays etc) while performing CMM as opposed to solely focusing on the medication history in the eRx module.

What is included in a CMM clinical assessment? The College of Psychiatric and Neurologic Pharmacists put together a CMM checklist for use by pharmacists during a patient visit. Among the matters covered, in addition to medications:

  • Allergies
  • Labs
  • Device use (e.g., oxygen machine, wheelchair)
  • Social history (e.g., smoking, alcohol, exercise)
  • Family history
  • Medication adherence
  • Immunizations

2. CMM considers pharmacists as a part of the patient care team

This component is a significant reason why proponents of CMM believe it is so effective. As an American College of Clinical Pharmacy report notes, "Clinical pharmacists work in collaboration with other providers to deliver CMM that optimizes patient outcomes. Care is coordinated among providers and across systems of care as patients transition in and out of various settings. … Physicians and other care team members benefit when clinical pharmacists apply their pharmacotherapeutic expertise in a collaborative process to help manage complex drug therapies."

3. CMM gives pharmacist direct access to patient records in an electronic health record (EHR) system

Pharmacists can also edit a patient's medical record. This access is pivotal to helping pharmacists make the most educated decisions for their patients. The findings from a Centers for Medicare & Medicaid Services demonstration project in Connecticut, published in HealthAffairs, note that pharmacists participating in the project were given complete access to the patients' EHR, including the data in their medical and lab records.

The report describes the importance of EHR access for these pharmacists: "The EHR provided diagnoses, medical history, medications, laboratory results, progress notes, and reports from specialists or consultants. … The pharmacists reconciled discrepancies using information from the EHR, pharmacy claims, and encounters with patients. … The pharmacists identified possible safety issues that stemmed from disparate medication lists in EHRs and prescription claims. Many were attributable to discontinuations of medication that were not recorded in medical records or known to the provider."

4. CMM has pharmacists assess medications at hospital admission and discharge

Studies have shown the tremendous value of engaging pharmacists to help perform medication assessments upon hospital admission, at discharge, and post-discharge.

The results of a study published in the Journal of Clinical Pharmacy and Therapeutics indicated that pharmacist involvement in medication management planning upon admission helped drive a dramatic reduction in medication errors within the first 24 hours of hospitalization.

An article published in the American Journal of Health-System Pharmacy discussed a quality improvement project that pilot tested a discharge medication reconciliation service managed by pharmacists and supported by telepharmacy. As the article notes, "Hospitals' efforts to prepare legible, complete, and accurate medication lists to patients prior to discharge continue to be complicated by staffing and time constraints and suboptimal information technology."

During the testing period, more than 6,400 comprehensive reconciled discharge medication lists were prepared. The pharmacist-managed medication reconciliation service detected more than 600 documented discrepancies or medication errors.

Concerning post-discharge medication review, a Cureatr blog on CMM in pharmacy practice discussing how Novant Health established "guidelines for discharge nurses to refer patients to a pharmacist and integrate clinical pharmacists into the medication review and follow up of high-risk patients after discharge from the hospital and emergency room" noted that this effort resulted in a significant reduction in readmissions.

5. CMM allows for collaborative agreements between pharmacists and physicians

Throughout the country, CMM programs are getting a boost from collaborative practice agreements (CPAs) between pharmacists and physicians, physician organizations, and accountable care organizations. A recent Cureatr blog about collaborative practice agreements shared a few reasons why CMM programs benefit from CPAs.

In arguing for collaborative practice legislation, the Florida Society of Health-System Pharmacists' message to legislators, according to a news release from the American Society of Health-System Pharmacists, is that "… pharmacists operating under a CPA with a physician can promote better health outcomes, reduce healthcare costs, and increase patients' access to care by supporting optimal use of pharmacists' expertise. In addition, pharmacists can reduce physicians' administrative burden by obtaining prior authorizations, managing formulary issues, and monitoring drug therapy."

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