A while back, we compared medication therapy management (MTM) and comprehensive medication management (CMM) in this blog post, noting that there are distinct differences between each program's approach and components.
This piece concluded with a helpful table that outlined key differences — and some similarities — between the two. Now let's delve into some of these points further, focusing on a pharmacist's role in performing drug therapy review in these programs.
Key Comprehensive Medication Management Differentiators
Here are six of the ways a pharmacist's responsibilities differ between medication therapy management and comprehensive medication management, more specifically exploring the role of pharmacists in CMM.
1. Comprehensive medication management must be delivered by a clinical pharmacist
One of the most noteworthy differences between MTM and CMM is that MTM can be provided by retail pharmacists. As we note in this blog post that examines the concept and shortcomings of medication therapy management, retail pharmacists "typically lack the clinical context necessary to effectively and accurately assess whether a medication and its dosage is appropriate for a patient given their underlying condition(s) and clinical course."
On the other hand, comprehensive medication management, by definition, must be performed by residency-trained clinical pharmacists. Why is this valuable? Such clinical pharmacists possess another level of expertise and experience that supports efforts to further optimize a patient's medication regimen. A clinical pharmacist with access to all the information gathered during the CMM process means they will also be in a stronger position to effectively assess and, if necessary, revise a medication list rather than working off a list that is assumed to be accurate and already optimized (or at least close to it).
2. Pharmacists conduct clinical assessments of patients and their records in CMM
An integral component of comprehensive medication management is the active role a clinical pharmacist takes in assessing — i.e., performing a clinical assessment of — a patient's clinical status, needs, and any applicable records, such as lab results, problem lists, clinical notes, vital signs, and X-rays. The assessment performed during medication therapy management typically sees a pharmacist focusing on a patient's medication history in the e-Prescribing (eRx) module of an electronic health record (EHR) system.
What is included in a CMM clinical assessment of a patient? The College of Psychiatric and Neurologic Pharmacists put together a comprehensive medication management checklist for use by pharmacists during a patient visit. Among the matters covered, in addition to medications:
- Device use (e.g., oxygen machine, wheelchair)
- Social history (e.g., smoking, alcohol, exercise)
- Family history
- Medication adherence (an example of an enhanced medication service)
3. CMM considers pharmacists an integral part of the patient care team
This component is a significant reason why proponents of CMM believe comprehensive medication management 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."
Research on pharmacist-performed CMM as part of an interdisciplinary care team at an accountable care organization's primary care offices, published in The American Journal of Accountable Care, found that this approach resulted in positive patient and provider satisfaction, among other benefits.
4. CMM gives pharmacists direct access to patient records in the EHR
In addition, clinical pharmacists can also edit a patient's medical record. This access and capability are pivotal to helping pharmacists make the most educated decisions for their patients and better ensuring those decisions and recommendations travel with the patient as they continue their care journey.
A Centers for Medicare & Medicaid Services (CMS) demonstration project in Connecticut saw participating pharmacists granted complete access to the EHR, including data in patients' medical and lab records. A Health Affairs report on the project 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."
5. CMM has pharmacists assess medications at admission and discharge
Studies have demonstrated 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 supported a substantial reduction in medication errors within the first 24 hours of hospitalization.
Meanwhile, an article published in the American Journal of Health-System Pharmacy discussed a quality improvement project that pilot tested a medication reconciliation post-discharge (MRP) service managed by pharmacists and supported by telepharmacy. The article notes the pilot revealed that the pharmacist-managed MRP service improved the final discharge lists and documentation received by patients. During the testing period, more than 6,400 comprehensive reconciled discharge medication lists were prepared. The reconciliation service detected more than 600 documented discrepancies or medication errors.
6. CMM allows for collaborative practice agreements between pharmacists and physicians
Throughout the country, CMM programs are getting a boost from collaborative practice agreements (CPAs) between pharmacists and physicians as well as physician organizations and accountable care organizations. A Cureatr blog post about collaborative practice agreements shared a few reasons why CMM programs benefit from these formal arrangements.
As American Academy of Family Physicians report notes, all states except Delaware currently have CPA legislation or regulations related to pharmacist practice which allow physicians and pharmacists to enter into voluntary written agreements to manage the drug therapy of a patient or group of patients. While CPAs certainly have value, we're a proponent of going behind collaborative practice agreements to securing national provider status for pharmacists. We've explained why provider status is so important in a number of posts, including this piece that explores the value of provider status for pharmacists following the pandemic.
Going Even Further With Tech-Enabled CMM
Comprehensive medication management goes well beyond medication therapy management by empowering clinical pharmacists to take a more active role in supporting patients. Such support contributes to better optimization of medication regimens, decreased costs, and reduced readmissions and adverse drug events, among other benefits.
For organizations looking to elevate their CMM performance further, there is now technology-enabled comprehensive medication management. This CMM service from Cureatr pairs real-time patient medication histories with clinical context and advanced technology that helps expedite the assessment and understanding of the data. The results: more personalized and effective medication plans, stronger relationships with patients, and many other benefits. You can learn more about the service by scheduling a call with one of our specialists.