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Future Pharmacy

Medical Therapy Management (MTM): The Future of Pharmacy

The pharmacy profession has evolved and changed dramatically in the century and a quarter since Ohio Northern University founded its pharmacy school. As one of the nation’s oldest and premier pharmacy schools, the Raabe College of Pharmacy has strived to stay ahead of the curve, continually adapting its curriculum to prepare students to be leaders in the profession.

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Today, medication therapy management (MTM) represents the new direction of pharmacy in the 21st century. ONU professors and alumni find themselves once again at the forefront of change. They are shaping the profession by creating, delivering and promoting MTM services. They are equipping current and future pharmacists with the skills and knowledge they need for this exciting new role on the health care team.

MTM is defined as a patient-centered service that leads to a better medication outcome and improved health. MTM services include medication reviews, pharmacotherapy consults, anticoagulation management, immunizations, health and wellness services, and much more.

The U.S. Congress coined the term “medication therapy management” in the Medicare Modernization Act of 2003, a bill that recognized the advantages of providing MTM services to elderly people with multiple chronic conditions. But MTM services can benefit more than just the elderly population. According to the American Pharmacists Association, “medication-related problems and medication mismanagement are a massive public health problem in the United States.” Each year, 1.5 million preventable drug adverse events occur, costing approximately $177 billion in injury and death.

Dr. Scott Hall

Dr. Michael Rush, PharmD ’05, views MTM as the natural evolution of the profession. “Historically, pharmacists formulated medications from raw materials. Eventually, we moved to dispensing medications manufactured in factories. We are now shifting our focus from the product to the patient and taking more responsibility for the outcomes related to the medications we provide,” he says. Rush, director of ONU HealthWise, a disease state and MTM clinic, trains ONU pharmacy students in the delivery of MTM services.

“With MTM, we’re working more with our minds and voices and less with our hands,” says Scott Hall, BSPh ’81, MTM Lead for Kmart’s North Division. “I describe MTM as pharmacy done right.” Hall was featured in the December 2010 issue of Pharmacy Today as a leading expert on MTM. In addition to his MTM role at Kmart, Hall practices pharmacy part-time at Akron General Medical Center.

“I see pharmacists as equal partners in medication therapeutics,” Hall adds. “At my hospital job, our pharmacotherapy specialists are deeply involved in most of the medication-prescribing decisions. Ten years from now, I see this as the norm for our profession, in both institutional and community practice.”

Pharmacists are poised to make a big impact as the health care system becomes increasingly cost-conscious and overloaded, says Catherine (Paik) Kuhn, PharmD ’06, an MTM coordinator at Kroger. She oversees MTM services in 121 stores in three states, training and supporting pharmacists, residents and student pharmacists as they learn how to meet patient needs. She won the American Pharmacists Association’s “Distinguished New Practitioner Award” in 2011, after earning the admiration of her colleagues and patients for her dedication and innovation in the MTM field.

MTM and the Raabe College of Pharmacy

The Raabe College of Pharmacy is taking steps to prepare its pharmacy students for the future of MTM. “The current curriculum is centered on patient care,” says Dr. Michael Rush, PharmD ’05. “That is the beauty of it. Students graduate with a better understanding of MTM than many practicing pharmacists because of the exposure they get here.”

ONU HealthWise Clinic. Pharmacy students receive real-world experience providing MTM services to ONU employees, retirees and their families at this disease state and MTM clinic. Students provide preventative health services and monitoring of chronic conditions such as hypertension, diabetes mellitus, dyslipidemia, and tobacco abuse.

Faculty certification. Several ONU faculty members are certified in MTM and incorporate MTM into their therapeutic models. Students learn the concepts of the disease as well as how to care for a patient with the condition.

Student certification. Pharmacy students can take an elective certification course in MTM. The college’s goal is for all ONU pharmacy students to graduate certified in MTM

Labs/Computer Simulation. Pharmacy students hone their clinical skills by using cutting-edge MTM software simulation programs and role-playing. In labs, students provide MTM services to faculty members pretending to be patients – an activity that generates great enthusiasm and intense preparation.

Kuhn explains that, by providing MTM services, pharmacists can help to reduce costs, relieve the burden on physicians and improve the patient experience. “Pharmacists (and MTM) have shown that they can help reduce medical costs by addressing drug-related problems,” she says. “Patients are able to use pharmacists as another health care resource to prevent and address medication-related issues. And physicians are able to utilize pharmacists as an extender of their services, helping to alleviate their workload.”

Pharmacists must develop exceptional listening skills and rapport with patients to be successful at MTM. Pharmacists not only are some of the most accessible health care practitioners, but also have the distinct advantage of seeing the bigger picture. Patients often speak more openly with their pharmacist than they do with their physician. While patients may see several specialists for different medical conditions, they usually patronize just one pharmacy.

Hall treats each patient with the same care and concern he would show his parents or children. “My job requires me to talk a lot, but I learn a lot more when I am listening,” he says. Often, he’s surprised by what he’s discovered about patients he thought he knew well. “It’s essential that both the patient and myself understand the indication for each med, verify the effectiveness of each med for that indication, that each is dosed appropriately, and that the patient can comply with the therapy and tolerate any adverse effects,” he adds.

While MTM has a proven track record, pharmacists still face obstacles as they try to implement MTM on a wider scale. The biggest hurdles appear to be time, compensation, skill set and acceptance within the wider medical community.

According to Rush, many pharmacists are already overworked, so freeing up time for new tasks can be difficult. “The solution may be to re-examine our work flow and allow pharmacy technicians and interns to help where they are qualified,” he says.

Dr. Catherine Kuhn

“There is no doubt that MTM, done right, involves a time commitment,” agrees Hall. “Sometimes this is a hurdle, but I’ve found that probably 75 percent of the time I spend on an MTM case, scheduling or documenting the service, can be performed by a well-trained technician or student.” Rush and Kuhn also believe that pharmacists need to prove their worth to physicians, nurses and patients. “We need to demonstrate that we are competent and capable providers, so physicians and others see us as a valuable part of the health care team,” says Rush.

“Pharmacists should not be afraid to showcase their abilities,” says Kuhn. “We are often good at letting each other know what we can do, but we can’t be afraid to step out from behind the counter and show patients what we know.”

Hall has faith in the adaptability of the pharmacy profession. Ultimately, he says, pharmacists will overcome the challenges. “Our colleges are training new professionals that have the skills and the will to do MTM. Our profession has always shown the ability to work smarter. It’ll get done.”

Photos courtesy of Jenny Whitney, Robert Mullenix and Pharmacy Today.