Risk stratification-based tiered medication therapy management for outpatients with asthma: a practical prospective...

This study aims to explore a new model of tiered medication therapy management (MTM) services for outpatients with bronchial asthma and evaluate its effectiveness.

A new model of tiered MTM services for outpatients with asthma (referred to as the T-MTM model) was established based on the triangle risk stratification model, and its multidimensional value was evaluated using the ECHO model. A single-center, prospective, randomized controlled, open-label study was conducted. A total of 126 asthma patients who visited the Medication Therapy Clinic at Hebei Provincial People's Hospital from January 2024 to December 2024 were selected and randomly divided into an observation group and a control group, with 63 patients in each group. Patients in the observation group received T-MTM services, while those in the control group received traditional MTM services. The differences in values across the three dimensions-economic, clinical, and humanistic-were compared between the two groups before and after the intervention.

Before the intervention, there were no statistically significant differences in any indicators between the two groups (p > 0.05). After the intervention, the patients in the observation group who received T-MTM services demonstrated superior outcomes in economic, clinical, and humanistic values than in those in the control group, with statistically significant differences (p < 0.05). The mean difference in the cost-utility ratio is as follows: MD = -7.54 (95% CI, -9.38 to -5.70), whereas that in the ACT score is given as MD = 2.25 (95% CI, 1.41-3.09). The improvement in the observation group was 5.05 points, exceeding the minimum clinically important difference (MCID) threshold of 3 points (MARS-A adherence score: MD = 0.44 [95% CI, 0.25-0.63]). The average duration of a single service per pharmacist was reduced by 18.92 min, representing an efficiency improvement of approximately 35%.

Risk-stratified tiered MTM services enable pharmacists to rapidly identify high-risk asthma patients, significantly improve work efficiency and service volume, and simultaneously enhance patients' self-management capabilities. This approach provides evidence-based guidance for optimizing and tiering outpatient asthma pharmacy service resources and represents a modified pharmacy service model worthy of promotion.