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KEY POINTS

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  • Medication therapy management (MTM) practice models should strive to be safe, timely, efficient, effective, equitable, and patient centric.

  • The Chronic Care Model provides a comprehensive view of the provision of care that is applicable to MTM.

  • There are many different models of MTM and little evidence supporting a best way to provide MTM.

  • The various MTM practice settings have differing MTM practice models.

  • The successful provision of MTM will require the definition of the roles and responsibilities of the various people involved.

  • Barriers to the provision of MTM vary by the entity involved, eg, a payer faces different barriers than a pharmacist.

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INTRODUCTION

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Chronic Care Model

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The measurement of quality in providing care is expanding rapidly throughout the United States health-care system. The 2001 Institute of Medicine Report Crossing the Quality Chasm: A New Health System for the 21st Century defines quality as the degree to which health services for indi-viduals as well as populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.1 The report targets for improvement of 6 fundamental attributes of effective healthcare:1

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  1. Safety: Care should be helping the patient should not cause injury.

  2. Effectiveness: Care and services should be based on the current accepted scientific knowledge.

  3. Patient-centeredness: Care should be responsive and provided in a respectful manner.

  4. Timeliness: Prevent harmful delays in receiving and providing care.

  5. Efficiency: Prevent waste.

  6. Equitable patient care: Care received should not vary in quality based on geographic location or patient characteristics such as socioeconomic status, race, or ethnicity.

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With a rapidly aging population and the increasing longevity of people with chronic conditions, there is a significant push to improve not only the quality of care but also how that care is delivered. Data shows that more than 145 million people, almost 50% of the American population, live with chronic illnesses that require ongoing management and interaction with a healthcare team.2 Among those, almost half have multiple conditions that are not being effectively managed. Various deficiencies hindering the treatment of these patients include increased demands and time constraints on practitioners, which affect their ability to follow established practice guidelines; lack of coordination among healthcare teams; lack of active as well as ongoing follow-up with patients to ensure optimal outcomes; and patients who are inadequately trained to manage their conditions.

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The fundamental problem at the root of these challenges is the design of the total healthcare system, which has been focused mostly on reacting to the acute needs of a patient versus being proactive about the prevention of such problems in the first place. Thus, a multidimensional solution for changing the system was defined by the Group Health Research Institute called the Chronic Care Model (CCM), which identifies 6 essential elements (Table 3-1, Figure 3-1) necessary for high-quality chronic disease care.3,...

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