Medication Therapy Management: Current Challenges

Medication therapy management (MTM) services have evolved as a means for pharmacists and other providers to assist patients and caregivers in improving therapeutic outcomes and reducing health care expenditures. More than a decade has passed since the Medicare Modernization Act of 2003 provided pharmacists with the opportunity to deliver MTM services to Medicare beneficiaries. MTM continues to offer pharmacists the opportunity to use their knowledge; yet, pharmacists have reported challenges with service delivery. Identifying the challenges that affect MTM services in pharmacy practice is necessary in order to seek improvement to MTM delivery. This narrative review explores the current challenges pharmacists face with MTM delivery, summarizes potential solutions for addressing challenges, and seeks to incite further debate, service reconfiguration, and ultimately service improvement of pharmacist-provided MTM services.

Assessment of pharmacy students' patient care skills using case scenarios with a SOAP note grading rubric and standardized patient feedback

BACKGROUND AND PURPOSE

To determine if the patient care and documentation skills of pharmacy students improve in the third professional (P3) year using a subjective, objective, assessment, plan (SOAP) note grading rubric and a standardized patient (SP) checklist rubric with SPs taking the role as evaluator during a sequential system of case scenarios.

EDUCATIONAL ACTIVITY AND SETTING

During a required skills laboratory course in the P3 year at the University of Mississippi School of Pharmacy, students were evaluated with a SOAP note grading rubric and an SP checklist rubric during three consecutive SP case scenarios (hypertension, diabetes, asthma).

FINDINGS

Overall, scores for the sequential case scenarios improved across all three scenarios through the use of SOAP notes (F = 96.89, p < 0.0001). For the SP evaluations, total score improved for the second and third case scenarios versus the first (F = 27.48, p < 0.0001).

SUMMARY

Patient care skills of P3 pharmacy students improved during a sequential system of case scenarios using a SOAP note grading rubric and an SP checklist rubric as objectively developed evaluation tools, with SPs taking the role as evaluator.

Positioning pharmacists' roles in primary health care: a discourse analysis of the compensation plan in Alberta, Canada

BACKGROUND

A comprehensive Compensation Plan for pharmacy services delivered by community pharmacists was implemented in Alberta, Canada in July 2012. Services covered by the Compensation Plan include care planning services, prescribing services such as adapting prescriptions, and administering a drug or publicly-funded vaccine by injection. Understanding how the Compensation Plan was framed and communicated provides insight into the roles of pharmacists and the potential influence of language on the implementation of services covered by the Compensation Plan by Albertan pharmacists. The objective of this study is to examine the positioning of pharmacists' roles in documents used to communicate the Compensation Plan to Albertan pharmacists and other audiences.

METHODS

Publicly available documents related to the Compensation Plan, such as news releases or reports, published between January 2012 and December 2015 were obtained from websites such as the Government of Alberta, Alberta Blue Cross, the Alberta College of Pharmacists, the Alberta Pharmacists' Association, and the Blueprint for Pharmacy. Searches of the Canadian Newsstand database and Google identified additional documents. Discourse analysis was performed using social positioning theory to explore how pharmacists' roles were constructed in communications about the Compensation Plan.

RESULTS

In total, 65 publicly available documents were included in the analysis. The Compensation Plan was put forward as a framework for payment for professional services and formal legitimization of pharmacists' changing professional roles. The discourse associated with the Compensation Plan positioned pharmacists' roles as: (1) expanding to include services such as medication management for chronic diseases, (2) contributing to primary health care by providing access to services such as prescription renewals and immunizations, and (3) collaborating with other health care team members. Pharmacists' changing roles were positioned in alignment with the aims of primary health care.

CONCLUSIONS

Social positioning theory provides a useful lens to examine the dynamic and evolving roles of pharmacists. This study provides insight into how communications regarding the Compensation Plan in Alberta, Canada positioned pharmacists' changing roles in the broader context of changes to primary health care delivery. Our findings may be useful for other jurisdictions considering implementation of remunerated clinical services provided by pharmacists.

Development and implementation of the compensation plan for pharmacy services in Alberta, Canada

OBJECTIVE

To describe experiences with development and implementation of a compensation plan for pharmacy services delivered by pharmacists in community pharmacies.

SETTING

Community pharmacy practice in Alberta, Canada.

PRACTICE DESCRIPTION

Pharmacists in Alberta have one of the most progressive scopes of practice in North America. They have authority to prescribe drugs independently, administer drugs by injection, access electronic health records, and order laboratory tests.

PRACTICE INNOVATION

A publicly funded compensation plan for pharmacy services was implemented in 2012. Principles that guided development of the compensation plan aimed to 1) ensure payment for pharmacy services, 2) support pharmacists in using their full scope of practice, 3) enable the development of long-term relationships with patients, 4) facilitate expansion of services delivered by pharmacists, and 5) provide access to pharmacy services for all eligible Albertans. Services covered by the compensation plan include care planning, prescribing, and administering drugs by injection.

EVALUATION

The guiding principles were used to evaluate experiences with the compensation plan.

RESULTS

Claims for pharmacy services covered by the compensation plan increased from 30,000 per month in July 2012 to 170,000 per month in March 2016. From September 2015 to August 2016, 1226 pharmacies submitted claims for services provided by 3901 pharmacists. The number of pharmacists with authorization to prescribe and administer injections continued to increase following implementation of the plan.

CONCLUSION

Alberta's experiences with the development and implementation of the compensation plan will be of interest to jurisdictions considering implementation of remunerated pharmacy services. The potential impact of the plan on health and economic outcomes, in addition to the value of the services as perceived by the public, patients, pharmacists, and other health care providers, should also be explored.