Medication Therapy Management and the Role of Rural Pharmacists

– RHAC Issue Brief/Fall 2012

RHAC Priority 5. Pharmacy: Medication Therapy Management and Rural Pharmacists

Problem statement Although elders make up 12% of the population, they consume 33%
of all medicines. This is especially significant in older rural areas.
Medication Therapy Management (MTM) and other pharmacist
services are underutilized in rural areas, despite their proven potential
to reduce costs and improve outcomes. MTM has shown success in
avoiding readmission in the first thirty days, which is especially
important with cardiac patients. With mentally ill patients, including
dementia and delirium in the elderly, MTM helps keep people stable.
Rural question/angle How can MTM be used more widely to meet rural workforce, quality
and system reform goals? Are there specific populations in rural areas
that could be targeted for maximum benefit from MTM? How can
telehealth applications for MTM can be best utilized in rural areas?
RHAC approach RHAC will analyze the role of rural pharmacists and potential for
broader application of MTM in rural sub-populations:
 Elder care and MTM (issue brief)
 Telehealth applications for MTM (issue brief)
 MTM diabetes model at Fond du Lac (presentation)

TOPICS ADDRESSED IN THIS ISSUE BRIEF

1. MEDICATION THERAPY MANAGEMENT: SAFETY ISSUES

• Medication-related problems and medication mismanagement are massive public health

problems in the US.
• 1.5 million preventable adverse events occur each year that result in $177 billion in injury
and death. 1

“The most critical MTM-related components: MTM or elimination of

polypharmacy, disease management, lab testing or POC testing services, and
implementation of wellness programs and the provision of immunizations.”
–Patient Care Services in Rural Minnesota Community Pharmacies

A 2010 UMN College of Pharmacy biennial pharmacy workforce survey reported:

• Greater percent of rural pharmacies reported providing MTM services than urban.
o Attributed to the geographic isolation in some rural areas of Minnesota and the
demand for services that may be difficult to find otherwise.

1
American Pharmacists Association, APhA MTM Central, http://www.pharmacist.com/mtm
 o Providing MTM services may be more critical for rural compared with urban
pharmacies because rural residents may rely more heavily on their pharmacy for
medication-related needs as a result of limited access to physician services.
• Rural pharmacies were more likely to provide a drug information than urban pharmacies.
o This may be attributed to a relative lack of other drug information sources
available to rural patients and providers compared with urban dwellers, such as
high-speed Internet connections being less available in rural than urban
communities.

2. MAJOR PROBLEMS FACING ELDERLY POPULATION

• Non compliance
• Adverse drug reactions (more than any other age group)
• On average, elderly are on 5 medications 2
• ¼ of all hospital admissions in elderly persons are drug related

Elderly patients frequently do not follow their prescribed regimens, which may be attributed to
lack of understanding, forgetfulness, inability to manage multiple medications & lack of access.

Previous studies suggested that up to 51% of medications for elderly patients might be overused
and that up to 90% might be misused. Lack of knowledge and lack of timely access to patient
information are considered root causes of prescribing errors. 3

3. BARRIERS TO THE DELIVERY OF PHARMACY SERVICES IN RURAL AREAS

• 21% of Americans live in rural, while only 12% of pharmacists practice in rural areas 4
• There were 126 one pharmacy towns (of 5,000 or fewer residents) in MN in 2005
o Many rural pharmacy owners plan to sell their business within 10 years
• Aging pharmacy workforce - 22.5% of MN pharmacists in rural counties were older than
55 years in the late 1990s, but just 14.1% of MN pharmacists in urban counties were
older than 55 years at that time. 5

4. TELEPHARMACY

• Usually involves having a larger hospital with round the clock pharmacist staffing review
medication orders sent electronically or via fax from one or more smaller rural hospitals
in the same system.
• Rural hospital telepharmacy models normally involve sharing the services of pharmacists
among hospitals in the same health care system.
• Some CAHs reported that Medicare cost-based reimbursement was helping them pay for
telepharmacy.
2
Rural Community Pharmacy Assistance Program (Cenla Medication Access Program)
3
Improving Primary Care in Rural Alabama with a Pharmacy Initiative
4
Patient care services in rural Minnesota community pharmacies
5
Student Pharmacist Perspectives of Rural Pharmacy Practice (2005)