Community pharmacists' lack of access to health records and its impact on targeted MTM interventions

Abstract

Objectives: To describe the adequacy of health record information available to community pharmacists when completing medication therapy management (MTM) interventions and to quantify the time spent on interventions that are ultimately revealed as invalid.

Methods: This prospective cross-sectional study analyzed cases of high-risk medication use in the elderly and statin use in persons with diabetes identified by 3 MTM platforms across 15 grocery chain pharmacies. MTM interventions were completed by phone and fax following a usual care protocol. Collected data included case validity (defined as the case truly requiring a pharmacist's involvement), case success (defined as achieving the targeted goal of the intervention), time spent on the intervention, and a determination of whether information from an electronic health record (EHR) could have eliminated patient or prescriber contact.

Results: Among 163 cases analyzed, 54% were found to be valid and 30% successful. The most common reasons for invalidity were allergy or contraindication, patient already taking a statin, and patient not having the targeted condition. Overall, 14% of cases were valid and successful, 40% valid and unsuccessful, 17% invalid and successful, and 29% invalid and unsuccessful. Valid successful cases averaged 15.3 minutes per case, valid unsuccessful cases averaged 9.2 minutes, invalid successful cases averaged 4.2 minutes, and invalid unsuccessful cases averaged 5.1 minutes. Based on the case-by-case determination of the researchers, EHR information would have completed 39% of cases without patient or prescriber contact. The average time spent on cases needing EHR access was 5.5 minutes, compared with 9.5 minutes for cases in which EHR access would not have helped.

Conclusion: Community pharmacists performing MTM interventions are hindered by lack of access to patient health information, imprecise patient targeting by MTM platforms, and cumbersome communication between pharmacists and prescribers.