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KEY POINTS

KEY POINTS

  • 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 practice for providing MTM services.

  • The various MTM practice settings have differing MTM models.

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

  • Barriers to the provision of MTM exist and vary by the entity involved.

INTRODUCTION

Chronic Care Model

The measurement of quality in providing care is expanding rapidly throughout the US healthcare 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 individuals as well as populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. The report targets for improvement of six fundamental attributes of effective healthcare:1

  1. Safety: Care should be directed toward helping the patient and 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: The healthcare provider should ensure that the patient receives care without harmful delays.

  5. Efficiency: The healthcare provider should ensure that the patient receives care without waste.

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

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 projections indicate that by 2020 more than 157 million people, over 50% of the American population, are expected to be living with a chronic condition that requires ongoing management and interaction with a healthcare team.2 Among those, almost half have multiple conditions that are not being effectively managed.2,3 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; the data-sharing paradox; lack of ongoing follow-up with patients to ensure optimal outcomes; and inadequately trained patients to self-manage their own conditions.

The fundamental problem at the root of these challenges is the design of the total healthcare system, which has focused mostly on reacting to the acute needs of the 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 ...

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