Medication therapy management, generally called medicine use review in the United Kingdom, is a service provided typically by

pharmacists A pharmacist, also known as a chemist ( Commonwealth English) or a druggist (North American and, archaically, Commonwealth English), is a healthcare professional who prepares, controls and distributes medicines and provides advice and instru ...

that aims to improve outcomes by helping people to better understand their health conditions and the medications used to manage them. This includes providing education on the disease state and medications used to treat the disease state, ensuring that medicines are taken correctly, reducing waste due to unused medicines, looking for any side effects, and providing education on how to manage any side effects. The process that can be broken down into five steps: medication therapy review, personal medication record, medication-related action plan, intervention and or referral, and documentation and follow-up. The medication therapy review has the pharmacist review all of the prescribed medications, any over the counter medications, and all dietary supplements an individual is taking. This allows the pharmacist to look for any duplications or dangerous

drug interactions Drug interactions occur when a drug's mechanism of action is disturbed by the concomitant administration of substances such as foods, beverages, or other drugs. The cause is often the inhibition of the specific receptors available to the drug, ...

. This service can be especially valuable for people who are older, have several

chronic conditions A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term ''chronic'' is often applied when the course of the disease lasts for more than three mo ...

, take multiple medications, or are seen by multiple doctors.

United States

In 2014, the US Centers for Medicare and Medicaid Services required Part D plans to include an MTM program, which led to an expansion of services offered. MTM services are provided free to eligible patients enrolled in a plan. As of 2019, to be eligible a patient must have at least two (or three, for some plans) chronic conditions, take multiple drugs covered by Part D, and are predicted to exceed a preset amount in annual out of pocket costs for their covered Part D drugs (set at $3,967 in 2018 and $4,044 in 2019). Plans are permitted to expand MTM eligibility to patients not meeting the minimum required criteria if they so choose.

Comprehensive medication review

As part of the minimum required services, plans must provide for a comprehensive medication review (CMR) once per year, usually conducted by a pharmacist. Per CMS guidance, the goal of the CMR is to "improve patients’ knowledge of their prescriptions, over-the-counter (OTC) medications, herbal therapies and dietary supplements, identify and address problems or concerns that patients may have, and empower patients to self manage their medications and their health conditions." The CMR is conducted in an interactive manner either in person or through

telehealth Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, mon ...

. A pharmacist or other provider conducting a CMR will use information from various sources, such as the pharmacy fill records, the patient's pill bottles, a patient interview, and/or discussion with caregivers to identify potential improvements that can be made in the patient's therapy. The pharmacist will then make any appropriate recommendations to the patient's doctor, as well as document their findings in a format similar to a

SOAP note The SOAP note (an acronym for subjective, objective, assessment, and plan) is a method of documentation employed by healthcare providers to write out notes in a patient's chart, along with other common formats, such as the admission note. Documenti ...

. The patient must be provided a medication action plan with a list of their medications, directions, and any steps they need to take to improve their therapy (such as using reminders, organizing, stopping old medications, etc). Most comprehensive medication reviews result in pharmacist intervention to recommend changes to therapy to a doctor, and/or recommendations to the patient to improve adherence/efficacy of their medications.

Targeted medication review

A targeted medication review (TMR, also called targeted intervention program or TIP) is a required service for eligible patients that focuses on a specific medication or disease state and is conducted once every three months. The goal of a TMR program is to improve adherence to medication and identify and fix drug therapy problems common in chronic diseases such as nonadherence, duplicate therapy, or sub-optimal therapy. The pharmacist or provider will contact the patient to ensure adherence, identify potential problems with the therapy, and make any appropriate recommendations to the prescriber. The provision of TMR services to patients with chronic diseases has been shown to decrease the number of inpatient admissions per 1000 patients by about 50 admissions per 1000 patients.

United Kingdom

A medicine use review (MUR) is an advanced service offered by

pharmacies Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links healt ...

in the

United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the European mainland, continental mainland. It comprises England, Scotlan ...

. It is part of the current contract pharmacies hold with the

National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...

(NHS). An MUR is an opportunity for patients to discuss their medicines with a qualified pharmacist. An MUR is a free NHS service that is held in a private consultation room at a local pharmacy. It is not meant to replace the role of the general practitioner but rather provide: *A review of all medicines to see if there is any overlapping or interactions *Give extra information on what medicines are for *Discuss side effects of medicines *Identify problems associated with medicines Pharmacies in the United kingdom are paid £28 for each Medicines Use Review undertaken, up to a maximum of 400 per pharmacy, per year. At least 70% of patients must be in one of the four target groups: * taking certain high risk medicines on the national list * recently discharged from hospital with changes to their prescribed medicine * with a respiratory condition such as

asthma Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, co ...

chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...

* with cardiovascular disease or risk factors, who are prescribed four or more regular medicines. The introduction of pharmacists into GP surgeries means that the practice pharmacists can do more to ensure that reviews are carried out where necessary.

Abuse of system

There have been concerns over abuse of the system, whereby multiple pharmacies are using the system to charge the £28 fee for each 10- to 15-minute MUR, and pressuring pharmacists to meet targets for the number carried out, with the review more of a tick-box exercise than a benefit for the patient. There have also been cases of falsification of figures.

References