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Implementation Science
Published in: Implementation Science 1/2019

Open Access 01-12-2019 | Research

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

Authors: Kenneth C. Hohmeier, James S. Wheeler, Kea Turner, Jarrod S. Vick, Merrill L. Marchetti, Jeremy Crain, Andrea Brookhart

Published in: Implementation Science | Issue 1/2019

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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.
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Literature
1.
2.
3.
Theising KM, Fritschle TL, Scholfield AM, et al. Implementation and clinical outcomes of an employer-sponsored, pharmacist-provided medication therapy management program. Pharmacotherapy. 2015;35(11):e159–63.PubMedCrossRef
4.
Tsuyuki RT, Johnson JA, Teo KK, et al. A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Arch Intern Med. 2002;162(10):1149–55.PubMedCrossRef
5.
Carter BL, Barnette DJ, Chrischilles E, et al. Evaluation of hypertensive patients after care provided by community pharmacists in a rural setting. Pharmacotherapy. 1997;17(6):1274–85.PubMed
6.
Chabot I, Moisan J, Grégoire J-P, et al. Pharmacist intervention program for control of hypertension. Ann Pharmacother. 2003;37(9):1186–93.PubMedCrossRef
7.
Cheema E, Sutcliffe P, Singer DRJ. The impact of interventions by pharmacists in community pharmacies on control of hypertension: a systematic review and meta-analysis of randomized controlled trials. Br J Clin Pharmacol. 2014;78(6):1238–47.PubMedPubMedCentralCrossRef
8.
Santschi V, Chiolero A, Colosimo AL, et al. Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials. J Am Heart Ass. 2014;3(2):e000718.
9.
Ryan R, Santesso N, Lowe D, et al. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev. 2014;4:CD007768.
10.
11.
Bulajev A, Labberton L, Leikola S, et al. Medication review practices in European countries. Res Social Adm Pharm. 2014;10(5):731–40.CrossRef
12.
American Pharmacists Association and the National Association of Chain Drug Stores Foundation. Medication therapy management in pharmacy practice: Core elements of an MTM service model (version 2.0). J Am Pharm Assoc (2003). 2008;(48):3.
13.
14.
Viswanathan M, Kahwati L, Golin C, et al. Medication therapy management interventions in outpatient settings. JAMA Intern Med. 2015;175(1):76–87.PubMedCrossRef
15.
16.
17.
Hohmeier KC, Spivey C, Collier C, et al. Qualitatively exploring student perceptions of the pharmacist's approach across the varying levels of medication therapy management services. Am J Pharm Educ. 2018;82(1):Article 6190.PubMedCrossRef
18.
McGrath SH, Snyder ME, Dueñas GG, et al. Physician perceptions of pharmacist-provided medication therapy management: qualitative analysis. J Am Pharm Assoc (2003). 2010;50(1):67–5.CrossRef
19.
20.
McBane SE, Dopp AL, Abe A, et al. Collaborative drug therapy management and comprehensive medication management. Pharmacotherapy. 2015;35(4):e39–50.PubMedCrossRef
21.
McGivney MS, Meyer SM, Duncan–Hewitt W, et al. Medication therapy management: its relationship to patient counseling, disease management, and pharmaceutical care. J Am Pharm Assoc (2003). 2007;47(5):620–8.CrossRef
22.
Aarons GA, Green AE, Palinkas LA, et al. Dynamic adaptation process to implement an evidence-based child maltreatment intervention. Implement Sci. 2012;7(1):32.PubMedPubMedCentralCrossRef
23.
Lee SJ, Altschul I, Mowbray CT. Using planned adaptation to implement evidence-based programs with new populations. Am J Community Psychol. 2009;41(3-4):290–303.CrossRef
24.
Wingood GM, DiClemente RJ. The ADAPT-ITT model: a novel method of adapting evidence-based HIV Interventions. J Acquir Immune Defic Syndr. 2008;47:S40–6.PubMedCrossRef
25.
Backer T. Finding the balance: program fidelity and adaptation in substance abuse prevention: a state-of-the-art review. Center for Substance Abuse Prevention. Rockville: Substance Abuse and Mental Health Services Administration; 2002.
26.
McKleroy VS, Galbraith JS, Cummings B, et al. Adapting evidence-based behavioral interventions for new settings and target populations. AIDS Educ Prev. 2006;18:59–73.CrossRef
27.
Barrera M, Castro FG. A heuristic framework for the cultural adaptation of interventions. Clin Psychol Sci Pract. 2006;13:311–6.CrossRef
28.
Rogers E. Diffusion of innovations. 5th ed. New York: Free Press; 2003.
29.
Bartholomew Eldredge L, Highfield L, et al. Using intervention mapping to adapt evidence-based interventions. In: Planning health promotion programs: an intervention mapping approach. San Franscisco: John Wiley & Sons; 2016. p. 596–649.
30.
Smith E, Caldwell L. Adapting evidence-based programs to new contexts: what needs to be changed? J Rural Health. 2007;23(Suppl):37–41.PubMedCrossRef
31.
Dusenbury L, Brannigan R, Falco M, et al. A review of research on fidelity of implementation: implications for drug abuse prevention in school settings. Health Educ Res. 2003;18(2):237–56.PubMedCrossRef
32.
Moore JE, Bumbarger BK, Cooper BR. Examining adaptations of evidence-based programs in natural contexts. J Prim Prev. 2013;34:147–61.PubMedCrossRef
33.
34.
Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50.PubMedPubMedCentralCrossRef
35.
Stirman SW, Miller CJ, Toder K, Calloway A. Development of a framework and coding system for modifications and adaptations of evidence-based interventions. Implement Sci. 2013;8:65.PubMedPubMedCentralCrossRef
36.
Lounsbery JL, Green CG, Bennett MS, et al. Evaluation of pharmacists’ barriers to the implementation of medication therapy management services. J Am Pharm Assoc (2003). 2009;49(1):51–8.CrossRef
37.
Blake KB, Madhavan SS. Perceived barriers to provision of medication therapy management services (MTMS) and the likelihood of a pharmacist to work in a pharmacy that provides MTMS. Ann Pharmacother. 2010;44(3):424–31.PubMedCrossRef
38.
Stafford R, Thomas J, Payakachat N, et al. Using an array of implementation strategies to improve success rates of pharmacist-initiated medication therapy management services in community pharmacies. Res Social Adm Pharm. 2017;13(5):938–46.PubMedCrossRef
39.
Shoemaker SJ, Curran GM, Swan H, et al. Application of the Consolidated Framework for Implementation Research to community pharmacy: A framework for implementation research on pharmacy services. Res Social Adm Pharm. 2017;13(5):905–13.PubMedCrossRef
40.
Moullin JC, Sabater-Hernandez D, Benrimoj SI. Qualitative study on the implementation of professional pharmacy services in Australian community pharmacies using framework analysis. BMC Health Serv Res. 2016;16:439.PubMedPubMedCentralCrossRef
41.
Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation science. 2012;7(1):37.PubMedCrossRef
42.
Klein KJ, Conn AB, Sorra JS. Implementing computerized technology: an organizational analysis. J Appl Psychol. 2001;86:811–24.PubMedCrossRef
43.
Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191–215.PubMedCrossRef
44.
Herbert KE, Urmie JM, Newland BA, et al. Prediction of pharmacist intention to provide Medicare medication therapy management services using the theory of planned behavior. Res Soc Adm Pharm. 2006;2(3):299e314.CrossRef
45.
Burgess AM, Chang J, Nakamura BJ, et al. Evidence-based practice implementation within a theory of planned behavior framework. J Behav Health Serv Res. 2017;44(4):647–65.PubMedCrossRef
46.
47.
48.
Escoffery C, Lebow-Skelley E, Haardoerfer R, et al. A systematic review of adaptations of evidence-based public health interventions globally. Implement Sci. 2018;13(1):125.PubMedPubMedCentralCrossRef
49.
Tofade T, Duggan C, Rouse M, et al. The responsibility of advancing continuing professional development and continuing education globally. Am J Pharm Educ. 2015;79(2):16.PubMedPubMedCentralCrossRef
50.
Powell BJ, Waltz TJ, Chinman MJ, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science. 2015;10(1):21.PubMedCrossRef
51.
Powell BJ, McMillen JC, Proctor EK, et al. A compilation of strategies for implementing clinical innovations in health and mental health. Med Care Res Rev. 2012;69(2):123–57.PubMedCrossRef
52.
53.
Gray M, Joy E, Plath D, et al. What supports and impedes evidence-based practice implementation? A survey of Australian social workers. Br J Soc Work. 2013;45(2):667–84.CrossRef
54.
Dietz J, Antonakis J, Hoffrage U, et al. Teaching evidence-based management with a focus on producing local evidence. Acad Manage Learn Educ. 2014;13(3):397–414.CrossRef
55.
56.
Bennett M, Goode JV. Recognition of community-based pharmacist practitioners: essential health care providers. J Am Pharm Assoc (2003). 2016;56(5):580–3.CrossRef
Metadata
Title
Targeting adaptability to improve Medication Therapy Management (MTM) implementation in community pharmacy
Authors
Kenneth C. Hohmeier
James S. Wheeler
Kea Turner
Jarrod S. Vick
Merrill L. Marchetti
Jeremy Crain
Andrea Brookhart
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2019
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-019-0946-7

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