Asheville Medication Project

Two studies conducted separately in Asheville, North Carolina, to observe the long-term clinical, humanistic, and economic outcomes of a community-based medication therapy management for asthma, and hypertension and dyslipidemia have been described here.

Bunting and Cranor observed 207 adult patients with asthma for 5 years to evaluate various outcomes of a community-based medication therapy management (MTM) program. They performed a quasi-experimental, longitudinal pre and post interventional study. The participants included patients with asthma covered by twp self insured health plans, one professional educator at Mission Hospital, 18 certificate trained community and hospital pharmacists. The range of interventions included education for patients; initial check up and long-term follow-up visits by pharmacists including consultations, monitoring, and recommendations to concerned physicians. The outcome was estimated through factors like forced expiratory volume in 1 second (FEV1), asthma symptoms and related emergency hospital visits.

The results concluded that education and long-term MTM caused significant improvements for the patients and reduction of asthma related costs.

The Asheville study by Bunting, Smith and Sutherland to determine the effects long-term MTM program for hypertension and dyslipidemia resulted in sustained clinical improvements for 6 years, increase of proper CV medication use, and decrease in adverse drug events and medical costs.

Most of the studies involved patients who participated voluntarily due to either self-interest or motivation from employers. Most of them were beneficiaries of Medicare prescription drug benefit. Of the participants, women outnumbered men, which was 72% and 28% respectively in one of the Asheville project. Moreover, almost all the patients in the listed studies were using multiple medications for multiple chronic diseases. This was almost a prime requirement for selection into the study, as comparison would be needed on multiple drug use and effects during the course of the studies.

The initial ambiguity over MTM owing to insufficient standards and performance measures to evaluate MTMPs was later overcome by flexibility given from Centers for Medicare and Medicaid Services (CMS) in implementing plans for MTMPs.

The program provides opportunities for pharmacists and other related health care providers to identify patients requiring MTM services along with standard payment for services as per contemporary provider payment rates based on time, clinical intensity and resources used for the service. Nonetheless, pharmacists need to render efficient services while maintaining compliance with private sector markets and federal policies. Also, though MTM activities were relatively new approaches, patients showed favorable attitudes and satisfaction towards pharmacist-provided training and MTM services in various surveys.

A successful MTM program requires a comprehensive team including physicians, pharmacists, nurses and others. For, all the involved parties will have benefits from MTM. To be precise, Clinical institutions can evaluate whether or not the patient expectations for pharmacy services are being met, give emphasis to patients on the importance of keeping scheduled appointments. Instead of simply confining to delivery of prescribed medicines, pharmacists can have the chance to enhance patient care, and work towards identifying and resolving medication therapy problems. Coming to the patients, a study showed that drug cost savings were reported to be nearly $0.57 per member per month for new prescriptions and $1.07 for all prescriptions. Moreover, considering the fact that MTM programs result in reduced drug expenses and hospitalizations, governments and third party payment agencies should promote MTM to realize cost savings.

All in all, MTM services have been proved to be effective in clinical, social and financial dimensions. Moreover, the increased awareness of public and governments over the lack of public guidance for reducing improper drug use and adverse drug effects makes the MTM program as a best alternative to address major concerns.