Medication therapy management
|Medication therapy management|
Medication therapy management (MTM) is a distinct service or group of services that optimizes drug therapy with the intent of improved therapeutic outcomes for individual patients. Eleven national pharmacy organizations adopted this definition in 2004. Medication therapy management includes a broad range of professional activities, including but not limited to performing patient assessment and/or a comprehensive medication review, formulating a medication treatment plan, monitoring efficacy and safety of medication therapy, enhancing medication adherence through patient empowerment and education, and documenting and communicating MTM services to prescribers in order to maintain comprehensive patient care.
Medication therapy management includes five core components: a medication therapy review (MTR), personal medication record (PMR), medication-related action plan (MAP), intervention and/or referral, and documentation and follow-up. A MTR is a systematic process of collecting patient and medication-related information which occurs during the pharmacist-patient encounter. In addition, the MTR assists in the identification and prioritization of medication-related problems. During the MTM encounter, the pharmacist develops a PMR for use by the patient. The PMR includes all prescription and nonprescription products and requires updating as necessary. After assessing and identifying medication-related problems, the pharmacist develops a patient-specific MAP. The MAP is a list of self-management actions necessary to achieve the patient’s specific health goals. In addition, the patient and pharmacist utilize the MAP to record actions and track progress towards health goals. During the MTM session, the pharmacist identifies medication-related problem(s) and determines appropriate intervention(s) for resolution. Often, the pharmacist collaborates with other health care professionals to resolve the identified problem(s). Following the patient encounter and/or intervention, the pharmacist must document his/her encounter and determine appropriate patient follow-up. 
Hepler and Strand define pharmaceutical care as the provision of drug therapy in order to achieve definite outcomes that improve a patient’s quality of life. Outcomes include cure of a disease, elimination or reduction of a patient’s symptomatology, arresting or slowing of a disease process, and preventing a disease or symptomatology. The process includes pharmacist collaboration with other health care professionals in designing, implementing, and monitoring a therapeutic plan for a patient. Pharmaceutical care focuses on the pharmacist’s role in achieving therapeutic goals to improve the patient’s quality of life. 
The Medicare Modernization Act of 2003, requires Medicare Part D prescription drug plans to include medication therapy management services delivered by a qualified healthcare professional, including pharmacists, beginning in 2006. MTM services target beneficiaries who have multiple chronic conditions (such as diabetes, asthma, hypertension, hyperlipidemia, and congestive heart failure), take multiple medications, or are likely to incur annual costs above a predetermined level.  Medication therapy management is a unique niche for the pharmacy profession, allowing pharmacists to apply their extensive medication knowledge as “medication experts” with the intent of improving patient outcomes.
- Medication therapy Management in Pharmacy Practice. Core Elements of an MTM Service Model. Version 2.0. American Pharmacists Association and National Association of Chain Drug Stores Foundation. March 2008. https://www.accp.com/docs/positions/misc/CoreElements.pdf
- Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm.1990;47:533-43
- Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Public Law 108-173. http://www.medicare.gov/medicarereform/108s1013.htm
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