Medication Therapy Management (MTM) services: A potential tool for improving quality of care in patients with complex chronic diseases

Objectives: Pharmacists play an integral role in resolving drug related problems through Medication Therapy Management (MTM). MTM, acknowledged in the Drug Improvement and Modernization Act (MMA) of 2003, represents an innovative chronic disease management practice that will play a role in aligning therapy goals to overall patient management quality measures. This study estimates the relationship between MTM and achievement of Optimal Diabetes Care benchmarks in patients with complicated diabetes.

Study Design: An outpatient pharmacy database was used to identify patients with diabetes who received MTM services during a 2007 demonstration project (n= 121) and a control group invited to receive MTM services during that same year but opted out (n= 103). Baseline characteristics were compared between groups using t-tests for continuous variables and chi-square tests for categorical variables. Rates of optimal diabetes care for both groups were compared using McNemar's test based on Minnesota Community Measurement (MNCM) criteria for 2006, 2007 and 2008. Linear and non-linear multivariate difference-in-differences (DID) estimation was used to evaluate the impact of one-year exposure to MTM on each care component individually.

Principal Findings: MTM patients were sicker at baseline (higher Charlson scores, more complex diabetes and cholesterol lowering medication regimens, and a higher percentage of diabetes with complications (p-value <0.05)). In 2007, the percent of MTM patients optimally managed (HbA1c <7; LDL <100mg/dl; blood pressure <140/90 mmHg; tobacco free and daily aspirin use) was significantly higher compared to their rates in 2006 (21.49% vs. 45.45%, p-value<0.01). The percent of patients meeting HbA1c, LDL and tobacco abstinence goals significantly increased (43.8% vs.73.55%, p-value <0.01; 63.64% vs. 83.47%, p-value <0.001; 85.95% vs.91.74%, p-value<0.05 respectively). Non-linear DID models showed that MTM patients were more likely to meet the HbA1c criterion in 2007 (OR: 2.48, 95% CI: 1.04-5.85, p=0.038). Linear DID models for HbA1c showed a mean reduction of 0.54% (95% CI: 0.091%-0.98%, p=0.018) for MTM patients. In 2008, achievement rates for HbA1c declined significantly compared to 2007 rates (p-value <0.01) nearing baseline values (42.15%). The 2008 rates for LDL goals and tobacco abstinence did not decline significantly compared to 2007 values (79.34% vs.83.47, and 91.74% vs.91.74% respectively; p-value>0.3 for both).

Conclusion: Despite greater complexity, optimal control of diabetes was improved significantly when patients were receiving MTM. Lower rates of optimal HbA1c levels one year after the project ended highlight the need to receive MTM services on a regular basis to maintain the beneficial clinical control of hyperglycemia.