Exploring Medication Problems and Strategies for Future Medication Therapy Management in an Outpatient Psychiatric Center

Medication therapy management (MTM) for Medicare Part D beneficiaries offers new practice opportunities for pharmacists and insight in designing new modes of pharmaceutical care delivery for all patients. The authors' goal was to identify medication-related problems in an outpatient behavioral health care center, and other important considerations in designing a reimbursable, collaborative, pharmacist-coordinated MTM program. Nine months of medication use evaluation data obtained from medical record review, medication inventory audits, transcription records, patient, and staff were examined for variances from organizational standard of care. Of the 592 documented variances, a majority of them were in the areas of medication prescribing and transcription (508; 85%), patient self-administration (46; 8%), and dispensing (38; 6%). Medication-related problems were identified that could be addressed with pharmacist MTM. MTM design should include elements of pharmacotherapy effectiveness and program quality. Important considerations for reimbursement are the priorities of health care organizational stakeholders, promotion of the nondispensing role of pharmacists, capacity to integrate the workflow processes and billing codes of pharmacists and other health professionals, and newly emerging trends and service demands in health care. Although these experiences occurred in an outpatient psychiatric setting, they are generally applicable to future MTM program design.