RESUMO
OBJECTIVES: To describe the implementation of a medication therapy management (MTM) collaborative within a pediatric health system to ensure the safe use of medication. SETTING: Outpatient pharmacies and clinics within a pediatric health system in Central Ohio. PRACTICE DESCRIPTION: The outpatient pharmacies conducted the daily operations of a community pharmacy following a standard, 4-point workflow. The ambulatory clinical pharmacists served on interdisciplinary teams within outpatient clinics to ensure the appropriate use of medication. PRACTICE INNOVATION: A collaborative model was developed to offer MTM services to patients within outpatient pharmacies and clinics throughout the health system. The pharmacist responsibilities varied, with outpatient pharmacists focused on targeted medication reviews (TMRs) and ambulatory clinical pharmacists focused on comprehensive medication reviews (CMRs) and TMRs. EVALUATION: The use of multiple plan-do-study-act cycles allowed for program improvements throughout implementation. Data collection included a pharmacy staff perception survey, mapping of MTM opportunities, and a quantitative report on the number, type, and intervention rate of all MTM activities. RESULTS: Four hundred nine MTM interventions, 349 TMRs (70 clinic based and 279 pharmacy based) and 60 CMRs, were completed throughout the first 6 months. Two hundred thirty-eight of the TMRs were pharmacist-initiated interventions that allowed pharmacists to provide medication counseling and follow-up with patients beginning new therapy. Ambulatory clinical pharmacists identified and resolved drug-related problems in greater than one-half of the CMRs completed. The intervention rates were 39% for CMRs and 44% for TMRs. CONCLUSION: The implementation of a collaborative MTM model provided an opportunity to address drug-related problems to ensure the appropriate use of medication. The model consisted of pharmacy staff members within 2 different patient care environments working together to complete MTM services for patients throughout the health system. The key elements of the program included the use of training sessions tailored to the pharmacy staff member's role in MTM, incorporation of technician champions, and creation of pharmacist-initiated interventions.
