Patient satisfaction with a pharmacist-provided telephone medication therapy management program

doi:10.1016/j.sapharm.2010.03.005

Research in Social and Administrative Pharmacy

Volume 6, Issue 2, June 2010, Pages 143-154

https://doi.org/10.1016/j.sapharm.2010.03.005 Get rights and content

Abstract

Background

Patient satisfaction with medication therapy management (MTM), a required component of the Medicare Part D benefit, is an important outcome to consider when evaluating MTM programs.

Objective

To measure patient satisfaction with a pharmacist-provided telephone MTM program.

Methods

The study design was nonexperimental and cross sectional. A survey was mailed to Scott & White Health Plan Medicare Part D beneficiaries (n = 60) who received telephone MTM in 2007. The survey was composed of 15 Likert-scaled questions (1 = strongly disagree to 5 = strongly agree) that assessed satisfaction with MTM. Descriptive statistics were used for quantitative data analysis. A qualitative content analysis of patients' responses to 3 open-ended questions was also conducted.

Results

The response rate for the survey was 80% (47 of 59). Study participants were 70.8 (±7.9) years old, and most were white (84.1%) and female (54.3%). The alpha coefficient for the satisfaction scale was 0.88. Overall mean satisfaction score was 4.0 (±0.6), with items ranging from 3.6 to 4.3. The highest level of agreement (mean = 4.3) was with the following statements: (1) I can easily contact my pharmacist when I have questions or concerns; (2) My pharmacist adequately answers my questions; and (3) I am content receiving MTM over the telephone. The patients agreed least (mean = 3.6) with the following statements: (1) When necessary, my pharmacist has encouraged me to receive preventive health care services; and (2) When needed, my pharmacist refers me to other health care providers.

Conclusions

Most of the beneficiaries were satisfied with their MTM care. The positive response to telephone MTM is important because Medicare Part D plans are using the telephone as a method of MTM delivery. Education regarding the pharmacist's role in preventive care and pharmacist follow-up with non-pharmacist health care providers may lead to greater satisfaction levels.

Introduction

Patient satisfaction has become a key component of evaluating the quality of health services provided by all health care providers, including pharmacists and payers.1, 2, 3, 4, 5, 6, 7, 8, 9, 10 Because pharmacists pursue medication therapy management (MTM) provider recognition by Medicare Part D plans, measuring patient satisfaction with pharmacist MTM services is important to provide support for the value of pharmacist services. In fact, 1 survey of MTM providers and payers reported that patient satisfaction was perceived to be a significant factor in determining the value of MTM,¹¹ and an MTM consensus document listed patient satisfaction as a measure that can support the overall effectiveness of an MTM program.¹² Furthermore, the Centers for Medicare and Medicaid Services (CMS) 2010 Call Letter listed satisfaction as an outcome that may become a requirement for Part D MTM Programs to collect and report to CMS in the future.¹³ Currently, MTM best practices are not established and there is much variability in the design and delivery of MTM services among Part D plans. MTM eligibility differs by beneficiaries' number of chronic diseases, number of Part D medications, and total Part D medication costs, and MTM is delivered via face-to-face or telephone consultations or by educational mailings.¹⁴ Therefore, measuring satisfaction with MTM services is essential to help inform MTM design and delivery as best practices evolve.

Few studies have measured satisfaction with pharmacist-provided telephone services.15, 16, 17 Kaiser Permanente of Colorado conducted a survey of patient satisfaction with a telephone/mail Clinical Pharmacy Cardiac Risk Reduction Service (CPCRS),¹⁵ and patient satisfaction was also assessed in a pharmacist-managed lipid clinic that was conducted via the telephone in a Veterans Affairs medical center.¹⁶ These studies reported that patients had a high level of satisfaction with pharmacist telephone services. There is little data regarding pharmacist-provided telephone MTM to Part D beneficiaries. However, 1 recent study reported that MTM participants perceived telephone consultations to be helpful and convenient.¹⁷ It is important to continue to examine patient satisfaction, as the role of the pharmacist expands to include more direct patient care activities, such as MTM, with various types of service delivery. In particular, evaluating patient satisfaction with MTM services can help contribute to the development of patient-centered MTM best practices and provide support for Part D plans and other payers to recognize pharmacists as MTM providers. This descriptive study examined patient satisfaction with a telephone MTM program provided by Scott & White Health Plan (SWHP), a regional Part D health care plan.

Section snippets

SWHP's MTM program

In 2007, the SWHP Part D plan administered an opt-in, pharmacist-provided, telephone MTM program to eligible beneficiaries (ie, beneficiaries with ≥2 medications, ≥2 chronic diseases, and Part D medication costs of at least $1000 per quarter). Eligible beneficiaries were mailed a brochure that described the MTM program and invited them to participate. Interested beneficiaries called SWHP to schedule an MTM appointment. About 18,000 beneficiaries were enrolled in the SWHP Part D plan, and 1999

Results

A total of 60 surveys were mailed and 1 survey was returned as undeliverable. Additionally, 1 survey was returned without any responses to the survey questions. This was considered to be a nonresponse to the survey. Forty-seven completed surveys were received to yield a response rate of 80% (47 of 59). Most of the study participants were white (84.1%), female (54.3%), and had been a SWHP member for 5 or more years (65%). The study participants were 70.8 (±7.9) years old, were taking 12.8 (±3.4)

Discussion

Most of the patients who participated in this study were satisfied with their MTM care. In addition, they indicated satisfaction with receiving MTM over the telephone. These findings parallel those of another Part D MTM program patient satisfaction study, whereby patients overwhelmingly (93%, n = 147) agreed that it was convenient to talk to the pharmacist on the telephone and better understand drug treatment.²¹ Similarly, 86.7% (n = 491) of the patients in the Kaiser Permanente telephone/mail

Limitations

An unanticipated technical problem with the SWHP's MTM database occurred during the study period, which resulted in a 6-week delay in mailing the written MAP for about 15 study participants. The delay may have influenced these patients' response to the timeliness item in the questionnaire. Also, the delay may have impacted written feedback to the open-ended questions. It is also possible that selection bias occurred in this study. SWHP Medicare beneficiaries that opted-in to the MTM program

Conclusions

Overall, patients were satisfied with the telephone MTM program, which is important because Part D plans are using the telephone as a method of MTM delivery. Furthermore, these results suggest that for some patients MTM can be delivered via the telephone without compromising patient satisfaction. Although patients reported being satisfied with the current level of services, it is important to continue to obtain patient feedback to learn how to best engage patients in pharmacist-provided

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There is ample variability in practices employed at different MMCs to provide MTM services, which has led to assessment of patient needs and factors affecting satisfaction in the literature over the past several years.41,42 Previous studies have found positive outcomes related to patient satisfaction with MTM, particularly given that it is a component of the Medicare Part D benefit.41-43 Consideration of motivation factors related to MMC personnel performance may also be directly or indirectly related to patient satisfaction.
Telephonic medication management centers (MMCs) provide medication therapy management services to help alleviate medication-related issues and improve health outcomes. Motivation factors driving the performance of MMC personnel are key components in achieving these goals. Yet, published literature is limited on how motivation affects MMC personnel performance.
To assess validity and reliability of the employee motivation questionnaire (EMQ), a 19-item measure of barriers and facilitators to motivation associated with MMC employees’ work performance.
Pharmacist, nurse, pharmacy technician, and intern employees (N = 534) from 5 telephonic-based U.S. MMCs were invited to complete the electronic EMQ. Rasch analysis was conducted in Winsteps software using a rating scale model. Construct and content validity and reliability were analyzed with employee and item separation index (SI) and reliability coefficient (RC). Linear regression was conducted to test the association of employee characteristics with individual work performance motivation.
A total of 319 employees completed the EMQ, 59.7% response rate. Principal components analysis suggested a unidimensional construct. Employee and item infit and outfit mean squared values met recommended fit criteria (0.5–1.5), suggesting that the data fit the model. An item-person map identified items that were easiest (joy of helping patients) and most difficult (motivated to work harder if incentives were tied to goal achievements) to agree with. Mismatch of employee motivation and item difficulty level on the measurement continuum (−1 to 0.92 logits) indicated a need for additional items that employees perceive as more difficult to agree with. The employee RC was 0.81 and the SI was 2.04; whereas, the item RC was 0.97 and the SI was 5.94. None of the variables tested illustrated statistically significant associations with the person motivation measure.
The EMQ illustrated reasonable content validity, good construct validity, and reliability evidence when used to measure motivation factors among MMC employees. Consideration of employee motivation factors may help to better meet MMC program goals and improve patient outcomes.
Factors that influence patient acceptance of clinical pharmacy services: A nationwide survey
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However, the patient’s perception of the pharmacist role often changes once patients participate in MTM. Surveys of Medicare beneficiaries indicate that participants find the service beneficial, value information on how to use their medication, and that MTM improves their medication use.18,19 Despite the growing awareness of clinical pharmacy services and demonstrated benefit of these services, patient participation remains a challenge for service implementation.20-22
Examine the factors that influence a patient’s likelihood of participating in clinical pharmacy services so that pharmacists can use this knowledge to effectively expand clinical services.
An online survey was distributed to U.S. citizens 55 years of age or older through a market research company. The survey assessed pharmacy and medication use, general health, interest in clinical pharmacy services, and general demographics. The specific clinical services examined included medication therapy management (MTM) and a collaborative practice agreement (CPA). Logistic regression and best-worst scaling were used to predict the likelihood of participating and determine the motivating factors to participate in clinical pharmacy services, respectively.
Two hundred eight (58.45%) respondents reported being likely to participate in MTM services, and 108 (50.6%) reported being likely to participate in the services offered by a pharmacist with a CPA, if offered. The motivations to participate in MTM were driven by pharmacist management of medication interactions and adverse effects (best-worst scores 0.62 and 0.51, respectively). The primary motivator to participate in a CPA was improved physician-pharmacist coordination (best-worst score 0.80). Those with a personal pharmacist were more likely to participate in MTM (odds ratio [OR] 2.43 [95% CI 1.41–4.22], P = 0.002) and a pharmacist CPA (2.08 [1.26–3.44], P = 0.004). Previous experience with MTM increased the likelihood of participating again in MTM (5.98 [95% CI 2.50–14.35], P < 0.001). Patient satisfaction with the pharmacy increased the likelihood of participating in a pharmacist CPA (1.47 [95% CI 1.01–2.13], P = 0.04).
Patients are interested in clinical pharmacy services for the purposes of medication interaction management, adverse effect management, and improved physician-pharmacist coordination. The factors that influenced the likelihood of participating included having a personal pharmacist, previous experience with MTM, and pharmacy satisfaction. These results suggest a potential impact of the patient-pharmacist relationship on patient participation in clinical services.
A novel advanced pharmacy practice experience training model focused on medication therapy management delivery within provider offices
2018, Currents in Pharmacy Teaching and Learning
Citation Excerpt :
Telephonic MTM delivery is another strategy used by pharmacists, sometimes driven by Medicare Part D plans. There is evidence that patients derive satisfaction from telephonic MTM delivery, and that the pharmacists effectively answered questions that patients had.10 There also is evidence that this type of MTM delivery produced cost-savings.11,12
Pharmacist-delivered medication therapy management (MTM) services are an important part of practice, and students should be trained in MTM provision. Current MTM utilization falls short of the potential benefits that pharmacists could provide, and there are barriers to successful MTM completion. New MTM models need to be explored to demonstrate the pharmacist's role on the medical team and to provide models for cost saving to insurers.
This manuscript describes a novel grant-funded MTM model supported by fourth year pharmacy students in partnership with several medical clinics. Qualifying patients receive MTM services in the provider office. Students are responsible for maintaining day-to-day operations of the MTM program.
Twe pharmacy students completed their MTM training through this model between April 2016 and September 2017. 123 patients received MTM services, with the average time spent with patients estimated at 41 min. A total of 238 patient encounters were provided. Poor adherence, inappropriate drug dose/dosage form or frequency, and patient side effects were the most common problems addressed. Students reported high satisfaction with this model.
Providing MTM services, directly in the medical clinic, represents an innovative model of care where students have multiple interprofessional interactions. The extended period of time spent with patients is not supported by reimbursement rates, suggesting an expansion may be appropriate. Further cost analyses and health outcomes need to be collected to justify this increased expense.
This MTM model represents an important alternative to current practice and promotes interprofessional collaboration.
Community health worker perspectives of an academic community medication therapy management collaboration
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Patients may feel uncomfortable with pharmacists providing MTM or other services including hypoglycemia education, vaccination recommendations, or other advice that is not perceived as directly related to dispensing medication,13 particularly if the service providers are not from the local community. These perceptions may be even more prevalent where pharmacist services are delivered by telephonic or other nonface-to-face modalities.14 This may be further compounded in rural and Hispanic/Latinx communities, where lack of culturally and linguistically appropriate care,15 sociocultural barriers to self-advocacy,16 and low familiarity with the health care system may reduce the utilization of MTM services.16-18
To qualitatively assess community health workers’ (CHWs’) perceptions of the challenges and benefits associated with participating in a collaborative, interprofessional medication therapy management (MTM) program for rural, underserved, predominantly Latinx, patients with diabetes and hypertension.
Nine CHWs participated in a 1-hour, semistructured focus group that explored their experiences while assisting in the delivery of MTM services through an academic community partnership between an MTM provider and participating rural clinics. Audio recordings of the focus group were transcribed and thematically analyzed by 2 independent reviewers.
All program-involved CHWs participated in the focus group. Qualitative analysis identified 2 overarching themes: (1) opportunities and (2) challenges. Opportunities were further subcategorized as benefits to (1) CHWs, (2) patients, or (3) academic community MTM research. The CHWs perceived that they served as a liaison among the medical provider (prescriber), patient, and MTM pharmacist. Benefits to the patients focused on the integration of CHWs as essential to patient recruitment, especially for those who were reluctant to participate or receive a phone call from a stranger. The major challenges identified were (1) interruptions in workflow and (2) communication between CHWs and the health care practitioners (physicians, nurse practitioners, pharmacists). Specifically, the CHWs universally agreed that they needed more time after receiving patient report, scheduling a visit with the patient, and communicating with the patient’s health care provider to better understand the individual’s circumstances and needs.
This study identified perceived opportunities and challenges faced by CHWs and chronically ill, rural Latinx patients in the acceptance of MTM program. These findings may be useful for all interprofessional health care team members to better understand and appreciate the role of CHWs, while simultaneously enhancing and improving respective medication adherence efforts, and to improve collaborative, academic community programs in the future.
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¹: At the time this study was conducted, Leticia R. Moczygemba is currently Assistant Professor, Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.

²: At the time this study was conducted, Michael Johnsrud is currently Vice President, Avalere Health, Washington, DC, USA.

View full text

Original ResearchPatient satisfaction with a pharmacist-provided telephone medication therapy management program

Abstract

Background

Objective

Methods

Results

Conclusions

Introduction

Section snippets

SWHP's MTM program

Results

Discussion

Limitations

Conclusions

Jt Comm J Qual Improv

J Qual Improv

Eval Program Plann

Patient satisfaction as an indicator of quality care

Inquiry

Patients' ratings of outpatient visits in different practice settings: results from the medical outcomes study

JAMA

Development and validation of an instrument to measure patient satisfaction with pharmacy services

Med Care

Further validation of an instrument to measure patient satisfaction with pharmacy services

J Pharm Mark Manage

A comparison of satisfaction with mail versus traditional pharmacy services

J Manage Care Pharm

The structure of satisfaction with pharmacy services

J Manage Care Pharm

Health status and satisfaction with pharmacy services

Am J Manage Care

Are managed care beneficiaries with chronic conditions satisfied with their care?

J Aging Health

Original Research
Patient satisfaction with a pharmacist-provided telephone medication therapy management program