Making MTM implementable and sustainable in community pharmacy: Is it time for a different game plan?

Although the literature has demonstrated positive patient outcomes from medication therapy management (MTM), implementing it in community pharmacy continues to be met with significant barriers. To make MTM implementation more attainable, scalable, and sustainable in community pharmacies, this paper puts out a call for the need to identify the proportion of patients who clinically qualify for various levels of intensity of MTM services. This paper presents three proposed levels of MTM: adherence management (lowest level of MTM intensity), interventions on drug-related problems (mid-level MTM intensity), and disease state management (highest level of intensity). It is hypothesized that the lowest levels of MTM intensity would be sufficient to address medication problems in the vast majority of patients and require fewer MTM skills and resources, while the highest levels of MTM intensity (requiring the most skills and resources) would address medication problems in the smallest number of patients whose medication problems could not resolved with lower-intensity MTM. Future research in this area will involve testing previously designed instruments to determine why patients are not adhering to their medication regimen, following patients who have already had their adherence managed with medication synchronization, and tracking patients who will require higher levels of pharmacy services.