Awareness of and Readiness for Medication Therapy Management Among Community Pharmacists in New York City : Results from a Focus Group

For pharmacist-provided Medication Therapy Management (MTM) services to operate effectively and efficiently, pharmacists must understand the process of MTM delivery, assess the barriers and challenges in creating a sustainable MTM program, and realize the willingness and readiness of their colleagues to deliver such services. In order to assess feasibility of such services among high-risk neighborhoods in New York City (NYC), a focus group design was used to qualitatively assess pharmacists’ perceptions of MTM. Findings showed that reimbursement and allocation of resources were the most discussed challenges/barriers to the provision of pharmacist-provided MTM services. Overall, pharmacists were willing, but not yet ready, to provide MTM services on a large scale. Lack of understanding of MTM structure/process, reimbursement challenges, and the need for collaboration between providers were key components to pharmacists’ willingness to provide services. Additional training opportunities were deemed necessary for them to feel confident to conduct clinical services. Although pharmacists discussed several issues regarding MTM, they were still interested in participating and seeing how MTM would impact their community practice settings. Understanding these perceptions of pharmacists on MTM allowed us to better understand and assess ways for continuous quality improvement of services that will enhance patient care. Introduction In 2010, the U.S. health care system was transformed with the passage of the Patient Protection and Affordable Care Act (PPACA). The underlying force behind the health care reform legislation was improving quality of care while decreasing health care costs. With this new legislation, pharmacists may have an opportunity to be part of the effort to help improve patient outcomes and reduce costs by utilizing their expertise in medication management. In particular, emphasis was placed on health care delivery with team-based care acting as a driving force for quality improvement, cost containment, Corresponding Author: Vibhuti Arya, PharmD 8000 Utopia Parkway, St. Albert Hall, Room 114 Queens, NY 11439, Phone: 347-396-4320 Cell: 347-837-4734, Fax: 718-990-1986 Email: [email protected] and outcomes assessment. 1 An explicit team-based model of care is the patient-centered medical home (PCMH). PCMH is a delivery system wherein patients obtain care from a variety of providers based on their individualized needs, with an emphasis on the primary care team focusing on care coordination and quality improvement. 2 Studies have demonstrated that pharmacists participating in team-based care in acute care or outpatient clinic settings have made positive contributions to patient care quality and safe medication use. 3 The PCMH movement provides an opportunity for pharmacists to affect the delivery of primary care through the utilization of medication therapy management (MTM). Additionally, in light of recent changes within the New York State Medicaid Redesign Team 4 to reduce costs and improve care, the New York State Department of Health introduced the concept of Health Homes. 5 While not identical to PCMHs, Original Research PHARMACY PRACTICE http://z.umn.edu/INNOVATIONS 2013, Vol. 4, No. 2, Article 116 INNOVATIONS in pharmacy 2 Health Homes also strive to accomplish the goals of improving care while reducing costs. In an environment where change in care delivery models is being examined, pharmacists have an increased opportunity to play a role in improving public health. When providing MTM services, pharmacists often perform comprehensive therapy reviews of prescribed and self-care medications, resolve medication-related problems, optimize complex regimens, design adherence programs, and recommend cost-effective therapies. 6 MTM services encompass care beyond traditional medication counseling, and are designed to maximize the benefits of prescribed medication regimens, increase medication adherence, and reduce the risk of adverse drug events and drug interactions. 6-8 Additionally, MTM services are designed to improve collaboration among pharmacists, physicians, and other health care professionals, enhance communication between patients and their health care team, and optimize medication use for improved patient outcomes. 10 Research has shown that pharmacist-provided MTM services have improved patients’ clinical, economic, and humanistic outcomes. 11-14 These services can occur in various locations, such as primary-care offices, outpatient clinics, patient homes, work-site health programs, senior centers, hospitals, and community pharmacies. 6 In order for pharmacist-provided MTM services to operate effectively and efficiently, pharmacists must understand the process of MTM delivery, assess the barriers and challenges in creating a sustainable MTM program, and realize the willingness and readiness of their colleagues to deliver such services. Though MTM has been introduced in many states across the U.S., New York offers a unique environment that is not representative of other states (see Discussion). In order to assess feasibility of pharmacist-led MTM services among high-risk neighborhoods in New York City (NYC), a look at pharmacists’ perceptions of MTM is warranted, a topic that is explored by very few qualitative studies in the existing literature. We are only aware of one study done specifically in NYC where participants of a continuing education program were surveyed regarding their extent of MTM provision and attitudes, interest, and challenges related to delivering MTM services; 15 In order to appropriately assess feasibility of scaling up MTM in NYC, we felt further knowledge was needed through a method that would allow for detailed questions to gather more in-depth information. As such, we used a semi-structured focus group that allowed us to assess the immediate awareness and readiness of MTM among pharmacists. Background on our project As experience from other states demonstrates, implementing, scaling‐up and sustaining Medication Therapy Management (MTM) services to meaningfully impact public health will require supportive policies and alignment of stakeholder interests, including effective communication linkages between primary providers and community pharmacists. 3,9 The current policy environment remains favorable with MTM being a key area of interest as the State of New York (NYS) works to redesign Medicaid to improve both efficiency and quality. 10 Preparedness, planning and stakeholder involvement are the vital next steps to enable effective MTM to succeed. 11‐13 The Fund for Public Health in New York on behalf of the New York City Department of Health and Mental Hygiene (NYC DOHMH) received funding to develop a project that supports building the framework to introduce pharmacist-led Medication Therapy Management to high risk communities. Collaborating with a large network of primary care providers and pharmacists, this project aims to identify and convene champions and early adopters, and further engage them in assessing and improving readiness for MTM provision in NYC. To explore the feasibility of providing such services to NYC residents and to inform our work currently under development, the Bureau of Primary Care Information Project (PCIP) at the NYC DOHMH hosted focus groups. Researchers met with the Physician Advisory Board (PAB; comprised of champion physicians within NYC) and a group of community pharmacist leaders in the NYC area to learn about awareness of MTM and readiness to deliver these services to NYC residents. Findings from the PAB focus group are beyond the scope of this report. The findings from the focus groups provided key information to be considered in developing an MTM model in NYC and advised our efforts in working with NYS Managed Care organizations to create and implement an effective program to improve public health. Objective The goal of this exploratory study was to assess pharmacists’ perceptions of MTM services using qualitative methods. Our five objectives to address this goal were to assess: (1) The awareness of MTM services among champion community pharmacists in NYC; (2) Scope of current MTM services in NYC; (3) Willingness of pharmacists to deliver MTM services in NYC; (4) Readiness of community pharmacists to deliver MTM services to NYC residents; and (5) Pharmacists’ description of an ideal MTM model. Original Research PHARMACY PRACTICE http://z.umn.edu/INNOVATIONS 2013, Vol. 4, No. 2, Article 116 INNOVATIONS in pharmacy 3 Methods Study Design A focus group design was used to qualitatively study the awareness and readiness of pharmacist-led medication therapy management (MTM) among pharmacists from the state of New York. Researchers from the NYC DOHMH conducted the focus group. Study Subjects Participants from this study included community pharmacists who are active members of the New York City Pharmacists Society (NYCPS), a member organization of independent pharmacists that accounts for about 40% of independent pharmacists within the NYC area. These pharmacists were selected based on their interest in MTM and are considered leaders in the pharmacy profession in New York. Pharmacists were recruited by invitation over email and responded based on their availability on the given focus group dates. Pharmacists who confirmed their attendance were then sent information on the purpose of the meeting. This included the APhA Promotional flyer for Pharmacists on MTM and a copy of the letter of support from the Surgeon General in response to Improving Patient and Health System Outcomes through advanced Pharmacy Practice.