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Purpose: To provide pilot data on intervention operations and patient outcomes for a larger, ongoing multi-site evaluation of the impact of a telephonic medication therapy management (MTM) service on 60-day hospitalizations and emergency department (ED) visits in a predominately Medicare home health population.
Methods: Patients in three randomly selected, geographically diverse home health care centers were randomized to the intervention or usual care control. The MTM program consisted of the following: 1) initial phone call by a pharmacy technician to verify an active medication list, 2) pharmacist-completed medication therapy review by telephone, and 3) follow-up pharmacist phone calls at days 7 and 30. Patients also received a medication action plan and personal medication record. Pharmacists intervened with prescribers and patients/caregivers to resolve identified drug therapy problems.
Results: Sixty eight (intervention n= 32, control n= 37) of a targeted 84 patients were enrolled with no significant differences in baseline demographics. A smaller proportion of patients in the intervention group were hospitalized within 60 days compared to the control (12.5% vs. 19%: p=0.53); while 3.1% of intervention patients visited the ED compared to 19% of control patients (p=0.05). Opportunities for improvement of the intervention operations included the need for additional home health clinician education about the MTM intervention, clinician discomfort with the informed consent process, the importance of timely data transfer from home health care centers to the MTM providers, and timely initiation of the medication therapy review.
Conclusion: Pilot testing of the MTM program provided lessons learned that informed implementation of the larger, ongoing study. Pilot findings suggest that this program may result in a reduction in hospitalization and ED utilization; however results of the ongoing study are pending.