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

• Published in: Implementation science : IS Vol. 14; no. 1; p. 99
• Main Authors: Hohmeier, Kenneth C, Wheeler, James S, Turner, Kea, Vick, Jarrod S, Marchetti, Merrill L, Crain, Jeremy, Brookhart, Andrea
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27.11.2019; BioMed Central; BMC
• Subjects: Adaptability; Adaptation; Attitude of Health Personnel; CFIR; CMM; Community Pharmacy Services - organization & administration; Drug therapy; Education; Health Plan Implementation - methods; Humans; Implementation science; Intelligence gathering; Intervention; Interviews as Topic; Medication therapy management; Medication Therapy Management - organization & administration; MTM; Patient compliance; Patients; Pharmacists; Pharmacy; Prescription drug plans; Prospective Studies; Quality Improvement; Researchers; Studies; Success; Supermarkets; United States; United States; United States > US; CMM; CFIR; Community Pharmacy; Adaptability; Implementation science; MTM; Medication therapy management; TMR; CMR; Community Pharmacist
• ISSN: 1748-5908; 1748-5908
• DOI: 10.1186/s13012-019-0946-7

(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. 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. 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). 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.