Telephonic MTM can benefit lower risk Medicare patients after hospital discharge

Dr Zillich

Low-risk Medicare patients entering home healthcare and receiving a telephonic medication therapy management (MTM) consultation by a pharmacist were 3 times less likely to be hospitalized within the next 2 months, while those at greater risk saw no benefit, according to a study in Health Services Research.

A team of Purdue University researchers collaborated with Amedisys Inc., a home healthcare organization, and pharmacists from Curant Health (formerly HealthStat Rx) provided the MTM intervention. Amedisys Inc. funded the research.

In the randomized, controlled trial researchers followed 895 Medicare patients from 40 Amedisys home healthcare centers throughout the United States; 415 patients received the intervention. The intervention consisted of an initial phone call by a pharmacy technician to verify active medications, a pharmacist-provided medication regimen review to identify and resolve medication problems, and follow-up phone calls from a pharmacist 7 days later and as needed for 30 days.

The results showed no overall significant difference in the 60-day probability of hospitalization for those who received telephonic MTM versus those who did not. However, when the patients were evaluated based on their risk profiles, those in the lowest-risk group who received the MTM service were 3 times more likely to remain out of the hospital 60 days after entering into home healthcare. Data were collected from in-home nursing assessments using the “Outcome and Assessment Information Set” (OASIS-C).

“Clinical services regarding medication management provided by pharmacists during the transition of care to home health can reduce hospitalization,” study leader Alan J. Zillich, PharmD, associate professor, Purdue University College of Pharmacy, told FormularyWatch. “Targeting the pharmacy service to patients who are most likely to benefit is important. The modality of service delivery-telephone, face-to-face, videoconference, in-home-that will optimize outcomes requires further study.”

The study helped determine which patients benefit most from telephonic MTM and a way to identify them through a standardized risk score, said Zillich.

According to Zillich, the most common types of medication-related errors are identified soon after transitions of care take place and the first days are the most important.

"Most elderly patients requiring home healthcare are dealing with multiple chronic conditions and taking multiple medications," he said in a press release. "When we say ‘low-risk’ patients in this context, we are talking about the least sick of a very sick group of patients. I'm not sure why they benefited so much from this intervention while the other groups did not. One theory is that they are better able to receive and retain guidance from a pharmacist over the phone and perhaps face-to-face medication therapy management would better help the higher-risk patients."