Nontraditional or noncentralized models of diabetes care: Medication therapy management services

,

Article

Nontraditional or noncentralized models of diabetes care: Medication therapy management services

November 2011 · Vol. 60, No. 11 Suppl: S12-S18

By

Sweta Chawla, PharmD, MS, CDE

References

1. Biola H, Green LA, Phillips RL, et al. The U.S. primary care physician workforce: minimal growth 1980–1999. Am Fam Physician. 2003;68(8):1483.-

2. Council on Credentialing in Pharmacy. Scope of contemporary pharmacy practice: roles, responsibilities, and functions of pharmacists and pharmacy technicians. J Am Pharm Assoc (2003). 2010;50(2):e35-e69.

3. Drab S. Translating clinical guidelines into clinical practice. Role of the pharmacist in type 2 diabetes management. J Am Pharm Assoc (2003). 2009;49(6):e152-e162.

4. Posey LM, Tanzi MG. Diabetes care: Model for the future of primary care. J Am Pharm Assoc (2003). 2010;50(5):623-626.

5. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533-543.

6. Malloy MJ, DeBellis R. Collaborative drug therapy management, medication treatment management, and Medicare Part D: What do they have in common? Harvard Health Policy Review. 2006;7(1):186-188.

7. McGivney MS, Meyer SM, Duncan-Hewitt W, Hall DL, Goode JV, Smith RB. Medication therapy management: its relationship to patient counseling, disease management, and pharmaceutical care. J Am Pharm Assoc (2003). 2007;47(5):620-628.

8. Funnell MM, Brown TL, Childs BP, et al. National standards for diabetes self-management education. Diabetes Care. 2011;34(suppl 1):S89-S96.

9. Daly A, Kulkarni K, Boucher J. The new credential: advanced diabetes management. J Am Diet Assoc. 2001;101(8):940-943.

10. Alliance for Pharmaceutical Care. Collaborative Drug Therapy Management: A Coordinated Approach to Patient Care. http://www.ashp.org/s_ashp/docs/files/about/CDTM.doc. Accessed February 3, 2011.

11. Roberts S, Gainsbrugh R. Medication therapy management and collaborative drug therapy management [letter]. J Managed Care Pharm. 2010;16(1):67-68.

12. Martin CM, McSpadden CS. Dispelling the myths about medication therapy management services. Consult Pharm. 2008;23(11):866-872, 875.

13. American Pharmacists Association. Delivering Medication Therapy Management Services in the Community. http://www.pharmacist.com/ctp/mtm. Published March 1, 2009. Accessed February 1, 2011.

14. American Society of Consultant Pharmacists. Delivering Medication Therapy Management Services in The Community—Updated for 2010. https://www.ascp.com/articles/professional-development/delivering-medication-therapy-management-services-community-update. Accessed February 1, 2011.

15. Pellegrino AN, Martin MT, Tilton JJ, Touchette DR. Medication therapy management services: definitions and outcomes. Drugs. 2009;69(4):393-406.

16. Bluml BM. Definition of medication therapy management: development of professionwide consensus. J Am Pharm Assoc (2003). 2005;45(5):566-572.

17. Centers for Medicare and Medicaid Services. 2010 Medicare Part D Medication Therapy Management Programs. https://www.cms.gov/PrescriptionDrugCovContra/Downloads/MTMFactSheet_2010_06_2010_final.pdf. Published June 8, 2010. Accessed February 1, 2011.

18. American Pharmacists Association; 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):341-353.

19. American Pharmacists Association. Medication Therapy Management Digest. Perspectives on 2009: A Year of Changing Opportunities. http://www.pharmacist.com/AM/Template.cfm?Section=Home2&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=22674. Published March 2010. Accessed February 1, 2011.

20. Abt Associates. Exploratory Research on Medication Therapy Management. Final report. http://www.cms.hhs.gov/Reports/downloads/blackwell.pdf. Published July 8, 2008. Accessed February 1, 2011.

21. Buffington DE. Future of medication therapy management services in delivering patient-centered care. Am J Health Syst Pharm. 2007;64(15 suppl 10):S10-S12; quiz S21–S23.

22. Law AV, Okamoto MP, Brock K. Ready, willing, and able to provide MTM services?: A survey of community pharmacists in the USA. Res Social Adm Pharm. 2009;5(4):376-381.

23. Lounsbery JL, Green CG, Bennett MS, Pedersen CA. Evaluation of pharmacists’ barriers to the implementation of medication therapy management services. J Am Pharm Assoc (2003). 2009;49(1):51-58.

24. Freeman JS. Insulin analog therapy: improving the match with physiologic insulin secretion. J Am Osteopath Assoc. 2009;109(1):26-36.

25. Davies MJ, Derezinski T, Pedersen CB, Clauson P. Reduced weight gain with insulin detemir compared to NPH insulin is not explained by a reduction in hypoglycemia. Diabetes Technol Ther. 2008;10(4):273-277.

26. Fajardo Montanana C, Hernandez Herrero C, Rivas Fernandez M. Less weight gain and hypoglycaemia with once-daily insulin detemir than NPH insulin in intensification of insulin therapy in overweight Type 2 diabetes patients: the PREDICTIVE BMI clinical trial. Diabet Med. 2008;25(8):916-923.

27. Mandosi E, Fallarino M, Rossetti M, Gatti A, Morano S. Waist circumference reduction after insulin detemir therapy in type 2 diabetes patients previously treated with NPH. Diabetes Res Clin Pract. 2009;84(2):e18-e20.

28. Korytkowski M, Bell D, Jacobsen C, Suwannasari R. A multicenter, randomized, open-label, comparative, two-period crossover trial of preference, efficacy, and safety profiles of a prefilled, disposable pen and conventional vial/syringe for insulin injection in patients with type 1 or 2 diabetes mellitus. Clin Ther. 2003;25(11):2836-2848.

29. Molife C, Lee LJ, Shi L, Sawhney M, Lenox SM. Assessment of patient-reported outcomes of insulin pen devices versus conventional vial and syringe. Diabetes Technol Ther. 2009;11(8):529-538.

30. Jankovec Z, Cechurova D, Krcma M, Lacigova S, Zourek M, Rusavy Z. The influence of insulin pump treatment on metabolic syndrome parameters in type 2 diabetes mellitus. Wien Klin Wochenschr. 2009;121(13-14):459-463.

31. Machado M, Bajcar J, Guzzo GC, Einarson TR. Sensitivity of patient outcomes to pharmacist interventions. Part I: systematic review and meta analysis in diabetes management. Ann Pharmacother. 2007;41(10):1569-1582.

32. Wubben DP, Vivian EM. Effects of pharmacist outpatient interventions on adults with diabetes mellitus: a systematic review. Pharmacotherapy. 2008;28(4):421-436.

33. Rochester CD, Leon N, Dombrowski R, Haines ST. Collaborative drug therapy management for initiating and adjusting insulin therapy in patients with type 2 diabetes mellitus. Am J Health Syst Pharm. 2010;67(1):42-48.

34. Cranor CW, Bunting BA, Christensen DB. The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc (Wash). 2003;43(2):173-184.

35. Fera T, Bluml BM, Ellis WM. Diabetes Ten City Challenge: Final economic and clinical results. J Am Pharm Assoc (2003). 2009;49(3):383-391.

Table of Contents

Introduction

Traditional or centralized models of diabetes care: The multidisciplinary diabetes team approach

Nontraditional or noncentralized models of diabetes care: Medication therapy management services

Nontraditional or noncentralized models of diabetes care: Boutique medicine

Nontraditional or noncentralized models of diabetes care: Models in which other HCPs take on a leading role in managing patients’ diabetes

TAKE-HOME POINTS

Medication therapy management (MTM) services were introduced in the mid-2000s as part of Medicare Part D—the prescription drug benefit
Key goals of MTM services are to:

– Counsel patients to improve understanding of their medications
– Improve medication adherence
– Detect adverse drug reactions and patterns of improper drug use

MTM services are becoming well established in pharmacy practice
Pharmacists can help improve outcomes by:

– Following patient progress between physician visits
– Utilizing their clinical expertise to monitor and manage diabetes medication plans
– Educating patients on disease, lifestyle, and adherence issues

Although referral by a physician/health care professional (HCP) is not required for MTM provided by a pharmacist, the physician/ HCP needs to be contacted for anything that requires a change in management

Introduction

Patients with type 2 diabetes mellitus (T2DM) have a large unmet medical need for appropriate treatment and continuity of care. Treatment of T2DM requires a complex, stepped approach combining behavioral modifications and multiple medications, as well as close monitoring of the effects of these interventions. In addition, these patients often require treatment for diabetes-related complications and comorbid medical conditions. Problems may arise from the complex medication regimens that T2DM patients often require. The primary care physician (PCP) has been the traditional provider or coordinator of care for T2DM. However, recent trends have imposed limits on access to the full scope of primary care needed by the growing number of patients affected by this and other chronic illnesses. The pool of PCPs is shrinking, physicians lack the time needed for complex patient interactions, and planners are discussing the shifting of primary care responsibilities to other types of health care professionals (HCPs), such as nurse practitioners, physician assistants, and pharmacists.^1-4

The pharmacist’s role in managing chronic diseases

Pharmacists are a professional group with sufficient education and skills to take a leading role in the primary care of patients with T2DM and other patients with complex needs. Pharmacists are the third-largest group of health professionals in the United States (US).² The emphasis of professional pharmacy practice has been shifting from a product-oriented, medication-dispensing role, to a patient-centered role, in which the pharmacist provides cognitive services and patient management. Provision of time-consuming primary care for T2DM is made more feasible not only by this growing supply of practicing pharmacists—expected to reach 300,000 by 2020—but also by 2 trends that should increase the availability of their time: the automation of pharmacy practice and the growth of certified pharmacy technicians to a number about equal to that of pharmacists.⁴

The “pharmaceutical care” philosophy was first articulated 2 decades ago as a call for pharmacists to assume a wider scope of professional responsibility in improving the outcomes of drug therapy, preventing medication-related morbidity and mortality, and improving patients’ quality of life.⁵ Falling within this paradigm are diabetes self-management education or training (DSME/DSMT), disease management, and collaborative drug therapy management (CDTM), all of which are models that have been applied to pharmacy care in recent decades.^6,7 DSME/DSMT programs aim to educate patients on all aspects of diabetes control, including nutrition and exercise, blood glucose control, medication management, and prevention of complications. DSME is taught in an individual or classroom format by certified diabetes educator (CDE) nurses, dietitians, pharmacists, or other professionals. The CDE credential, administered by the National Certification Board of Diabetes Educators, is the national credential for health professionals who provide diabetes patient education and counseling.⁸

Disease management programs, widely adopted in the 1990s, may be delivered by physicians, pharmacists, or other HCPs or teams. These programs are disease-specific and focus on conditions that require a considerable degree of patient self-management. They provide a wider range of services than just patient education, and may include drug and nondrug therapy. However, they do not usually encompass the needs of patients with multiple chronic illnesses. Some pharmacists are now specializing in management of specific diseases, such as diabetes, and the Board Certified-Advanced Diabetes Management (BC-ADM) credential has been introduced for pharmacists, nurses, and dietitians.⁹ This credential was originally introduced in 2000, but is currently being reviewed by the American Association of Diabetes Educators. The BC-ADM certifies expertise in patient evaluation and clinical management, as well as patient education. However, because the responsibilities for disease management are often shared among members of a team, pharmacists who provide disease management services may have difficulty obtaining compensation for their contribution.⁷