Face-to-Face and Telephonic MTM: A Comparison

Cincinnati—With an estimated 3.5 billion prescriptions written each year, the need for a medication management process is evident, according to a Contemporary Issues session at the AMCP meeting. Linda Strand, PharmD, PhD, Thomas Albers, BS, and Alisa Thomas, PharmD, BCPS, spoke at a session titled Optimizing the Patient Outcome of Telephonic and Face-to-Face [Medication Therapy Management] MTM Services. Dr. Strand and Mr. Albers are affiliated with Medication Management Systems, Inc., and Dr. Thomas with VRx Pharmacy Services.

At present, 80% of all medical treatments involve medication, the speakers said. Adherence to drug therapy averages approximately 50% and problems with drug therapies are common. Costs associated with drug morbidity and mortality exceed $200 billion each year.

On average, Medicare beneficiaries have 13 different physicians, are given 50 different prescriptions a year, account for 76% of all hospital admissions, and are 100 times more likely to have preventable hospitalization than patients who do not have chronic disease.

Medication management is defined as a standard of care that ensures each patient’s medications are appropriate, effective, safe, and able to be taken as intended. It is a process that includes identifying the medication experience of each patient, performing a comprehensive assessment medication history, identifying any problems with drug therapy, creating a care plan, and completing a follow-up evaluation. Finally, it is a continuum of care with measurable goals and outcomes that reflect a positive return-on-investment (ROI).

There are 2 basic types of medication management systems: (1) a face-to-face process and (2) a process conducted telephonically. Face-to-face management occurs where there is time, space, and patient access and it can be integrated with the total care of the patient. A face-to-face system can provide an increased opportunity for practitioners to establish a therapeutic relationship and offers proximity to other patient care providers.

For patients who are immobile or who have limited access to transportation, face-to-face services may not be possible. In addition, there are limited resources to support face-to-face management, the speakers noted.

An alternative to face-to-face MTM is a telephone-based management system. Telephonic services can be delivered to patients who are incapable of meeting face-to-face, who do not have access to a face-to-face provider, who prefer to meet telephonically, or who are in need of a follow-up contact after a comprehensive medication review (CMR).

Strengths of telephonic MTM systems include the ability to reach patients regardless of location, and a longer uninterrupted time with the patient. Challenges include accuracy of phone numbers in the database and a limit to the clinical information that can be obtained for or from the patient.

The session continued with an overview of the CMR process. A CMR is designed to ensure that each medication is appropriate, effective, and safe and results in a medication action/care plan that is individualized for each patient and helps achieve the intended goals of therapy.

The medication action plan is developed to address identified drug therapy problems and suggested resolutions, empower the patient to have an educated discussion with the physician, refresh the patients’ memory about what was discussed, and keep the physician informed regarding any changes or issues related to the medication regimen.

The speakers then introduced data related to drug therapy problems (DTPs) identified through the 2 types of MTM systems. Types of DTPs found during telephonic contact compared with face-to-face contact are unnecessary drugs (5.5% vs 5%), need for additional drugs (64% vs 34%), ineffective drugs (9% vs 8%), dose too low (20% vs 23%), adverse reactions (25% vs 11%), dose too high (6% vs 5%), and lack of adherence (44% vs 14%).

The economic impact of the systems was identified using ROI. According to the speakers, telephonic contact has an ROI of 4.5:1 compared with an ROI that varies from 2:1 to 12:1 for face-to-face contact (average, 3:1).