Medication Therapy Management

Medication therapy management (MTM) is a structured service in which a pharmacist comprehensively reviews all of a patient's medicines, identifies and resolves drug therapy problems, and produces a documented care plan and follow-up. It packages the philosophy of pharmaceutical care into a defined, often reimbursable set of activities, especially for patients with multiple medicines or chronic conditions.

Definition

Medication therapy management is a distinct service or group of services that optimize therapeutic outcomes for individual patients through a comprehensive medication review, the identification and resolution of drug therapy problems, a personal medication record, a documented care plan, and scheduled follow-up.

Scope

The entry covers what MTM is, its characteristic components, how it differs from a single counseling encounter, and the kinds of outcomes researchers have examined. It is a reference description of the service model, not a protocol for managing an individual patient's therapy.

Core questions

• What distinguishes MTM from ordinary dispensing and from a single counseling session?
• What are the standard components of an MTM encounter?
• What clinical and economic outcomes have been associated with MTM services?
• How does MTM operationalize the pharmaceutical care philosophy?

Key concepts

• Comprehensive medication review
• Drug therapy problems
• Personal medication record
• Medication action plan
• Targeted intervention and follow-up
• Documentation and billing of services
• Patients with polypharmacy and chronic disease

Mechanisms

MTM converts the open-ended responsibility of pharmaceutical care into a repeatable workflow. The pharmacist assembles a complete medication list, conducts a comprehensive review to detect drug therapy problems (such as untreated indications, ineffective or unsafe therapy, dosing issues, and non-adherence), agrees a medication action plan with the patient, documents the encounter, and schedules follow-up. Because the service is defined and documented, it can be evaluated and, in some systems, reimbursed, which distinguishes it from informal advice at the counter.

Clinical relevance

MTM describes how pharmacists deliver comprehensive medication review as a defined service and how that service is studied. The entry is reference-educational and provides no dosing or individualized treatment recommendations.

Epidemiology

MTM is targeted at patients most likely to benefit, typically those taking several medicines or managing chronic conditions, where the burden of drug therapy problems and non-adherence is concentrated. Outcomes research such as the Minnesota experience reported by Isetts et al. (2008) examined clinical and economic effects of delivering the service at scale.

History

MTM emerged as a formalization of pharmaceutical care and gained prominence in the United States after Medicare Part D (enacted 2003) required MTM programs for eligible beneficiaries, prompting professional bodies to define a consensus set of core elements. Research programs, including the long-running Minnesota work, then evaluated the service's effects on outcomes and cost.

Debates

How robust is the evidence for MTM's clinical and economic value?

Studies report favorable clinical and economic outcomes, but much of the early evidence is observational and program-specific, so the generalizability and the magnitude of benefit across settings remain subjects of ongoing evaluation.

Key figures

• Brian J. Isetts
• Robert J. Cipolle
• Linda M. Strand
• Charles D. Hepler

Seminal works

• hepler-strand-1990
• isetts-2008

Frequently asked questions

Who typically receives MTM?

MTM is usually targeted at patients with multiple medications or chronic conditions, where comprehensive review is most likely to uncover and resolve drug therapy problems.

What is a comprehensive medication review?

It is the central MTM activity: a systematic look at all of a patient's medicines, prescription and otherwise, to identify drug therapy problems and to build a documented action plan with follow-up.