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Australian Journal of Pharmacy : September 2005
medication management in review Being paid to manage medications—it’s becoming popular both here and abroad Australia’s unique position of government-funded medication management reviews is no longer the case as other countries follow suit and look to secure the health outcomes to be gained from services of this type. In this and subsequent articles,AACP CEO, BILL KELLY, looks at some recent international trends and sees what lessons we could learn from them in ices in residential aged care facilities some eight years ago and the more recent extension of this to the domicil- liary setting, Australia held a somewhat unique position in the international pharmacy world. This is no longer the case as a number of overseas countries have implemented or plan to implement a variety of medication management services involving the pharmacist at an integral level and for which the pharma- cist receives payment other than for sup- ply of medication. The US model sched- uled to come into effect from 1 January 2006 has some interesting features that Australia could well consider in future reviews of our medication management review (MMR) program. W US medication therapy management services The Medicare Modernization Act of 2003 created a specific pharmacy benefit for US Medicare patients. A key element in this benefit is the provision of medica- tion therapy management (MTM) services for targeted beneficiaries. As was the case in Australia with the introduction of remunerated medication review services, the introduction of MTM and the recog- nition of the pharmacist as the provider of these services provides an excellent opportunity for pharmacists to enhance patient care and address the universally recognised need to identify and resolve medication therapy problems, brought to ITH the introduction of remu- nerated medication reviews serv- prominence by Bootman and Johnson1 their 1995 seminal article on drug–related morbidity and mortality. The US model differs from, but still has a lot of common features with, the Aus- tralian model, not the least being the over- all aim of the MTM services to enhance patient’s understanding of appropriate drug use, to increase their compliance with medication therapy, to improve the detection of adverse drug effects and to achieve greater collaboration between pharmacists and prescribers. Last year, 11 US national pharmacy organisations achieved consensus on the definition of what a MTM should be, namely a distinct service or group of serv- ices that optimise therapeutic outcomes for individual patients and that can occur independent of or in conjunction with the provision of a medication product. In some situations, MTM services may be provided to the caregiver or other persons involved in the care of the patient.2 Patient eligibility, service initiation and payment Patients can be recruited for MTM serv- ices through health plan identification, GP referral and identification by the phar- macist. Eligibility criteria are naturally not too dissimilar from those in the Aus- tralian MMR documents, with the excep- tion of a pre-determined monthly med- ication cost critera (for example, US$200–300). Enabling legislation addressing funding issues and extent of remuneration is still 706 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 SEPTEMBER 2005 Flexible models Building on the definition, and while the ultimate goal is improved patient out- comes, there is some degree of flexibility available in how the services are provided, ensuring availability across the board regardless of the setting in which the tar- geted beneficiary resides. That is, there is no distinction between those who are ambulatory and, for example, aged care patients who reside in institutional set- tings. Hence, the various pharmacy organisations have identified models that best suit their constituents’ needs and meet the overall aims of the program. A community pharmacy-based model The American Pharmacists Association (APhA) in conjunction with the National Association of Chain Drug Stores (NACDS) Foundation have developed a model framework for implementing effec- tive MTM services across the spectrum of community pharmacy.3 Ideally, under this model, patients or caregivers would receive their MTM service, like our HMR model, through their regular community pharmacy where they have an ongoing relationship. The five core components of the model are: • an annual medication therapy review (MTR); • a personal medication record (PMR); being worked on and a number of mod- els including direct pharmacist remuner- ation and through Prescription Drug Plans are under consideration.