Targeting adaptability to improve Medication Therapy Management (MTM) implementation in community pharmacy

Kenneth C Hohmeier; James S Wheeler; Kea Turner; Jarrod S Vick; Merrill L Marchetti; Jeremy Crain; Andrea Brookhart

doi:10.1186/s13012-019-0946-7

Targeting adaptability to improve Medication Therapy Management (MTM) implementation in community pharmacy

Implement Sci. 2019 Nov 27;14(1):99. doi: 10.1186/s13012-019-0946-7.

Authors

Kenneth C Hohmeier¹, James S Wheeler², Kea Turner³, Jarrod S Vick⁴, Merrill L Marchetti⁵, Jeremy Crain⁵, Andrea Brookhart⁶

Affiliations

¹ Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, 310 S Perimeter Park Drive, Suite 220, Nashville, TN, 37211, USA. khohmeie@uthsc.edu.
² Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, 310 S Perimeter Park Drive, Suite 220, Nashville, TN, 37211, USA.
³ Department of Health Services Research, Management & Policy, College of Public Health & Health Professions, University of Florida, Gainesville, USA.
⁴ College of Pharmacy, University of Tennessee Health Science Center, Nashville, USA.
⁵ Kroger Nashville Division, Nashville, TN, USA.
⁶ Kroger Pharmacy General Office, Cincinnati, OH, USA.

Abstract

Objectives: (1) To develop an adaptation framework for MTM delivery for pharmacists (the MTM Adaptability Framework), (2) to examine the impact of an educational intervention informed by the MTM Adaptability Framework on MTM completion rates over a 2-year period, and (3) to explore pharmacists' perceptions regarding knowledge and beliefs about MTM and MTM implementation self-efficacy pre- and post-intervention.

Methods: This study is a prospective, mixed-methods research study including a quasi-experimental, one-group pretest-posttest quantitative study with a sequential explanatory qualitative study arm featuring semi-structured key informant interviews. US supermarket pharmacy chain setting included 93 community pharmacy sites located in Tennessee, Kentucky, and Alabama. MTM completion rates are reported as percentage of completed comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) and pharmacist perceptions.

Results: An 11.4% absolute increase in MTM completion rates was seen after the educational intervention targeting adaptation of MTM in the community pharmacy setting. This was found to be significant (46.92% vs. 58.3%; p < 0.001). Responses to the semi-structured interviews were mapped against CFIR and included themes: "knowledge and beliefs about MTM (pre-intervention)," "self-efficacy for MTM implementation (pre-intervention)," "knowledge and beliefs about MTM (post-intervention)," and "self-efficacy for MTM implementation (post-intervention)." Data convergence was found across these methodologies and suggested that targeting adaptability of MTM delivery increases MTM completion rates (quantitative data) and positively changes perceptions of MTM feasibility and self-efficacy (interviews).

Conclusion: The use of an educational intervention about adaptation of MTM to influence adaptation of MTM to a chain community pharmacy setting part of an implementation strategy improved MTM completion rates significantly. Future research should investigate combined implementation strategies and their impact on MTM implementation success.

Keywords: Adaptability; CFIR; CMM; CMR; Community Pharmacist; Community Pharmacy; Implementation science; MTM; Medication therapy management; TMR.

MeSH terms

Attitude of Health Personnel
Community Pharmacy Services / organization & administration*
Health Plan Implementation / methods*
Humans
Interviews as Topic
Medication Therapy Management / organization & administration*
Pharmacists
Prospective Studies
Quality Improvement*
United States