Continuous Medication Monitoring

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The profession has been quite adept at proffering new names for the activities of pharmacists in daily practice, ranging from ‘drug use control’, to ‘pharmaceutical care’, then “medication therapy management” (MTM). Are these names important? Well, we certainly cannot get caught up in nomenclature wars, and some might argue that all of these concepts regardless of name are part and parcel with the pharmacist’s responsibility. However, there are at least subtle if not relatively noticeable differences in these terms that are important. Remember, the Code of Ethics for pharmacists up until the 1960s suggested that pharmacists not even speak with the patient about the medicine they’ve been prescribed. Pharmaceutical care placed responsibility onto pharmacists for drug therapy outcomes and disease statement management takes a a population, rather than individual patient bent.

Goedken et al offered a practice paradigm call Continuous Medication Monitoring (CoMM) in community pharmacy and describe it as systematically reviewing the patient’s record and monitoring every medication dispenses so as to prevent, identify, and resolve drug-related problems1 In comparison with other models, Comprehensive Medication Management (CMM) has the pharmacist as part of a team in an interdisciplinary approach evaluating high-risk patients; MTM is usually considered for patients with multiple comorbidities or concentrated on very expensive medications; whereas CoMM addresses all medications for all patients in the community setting. It encourages leveraging the opportunity where dispensing occurs for the pharmacist to engage the patient and their therapeutic regimen. In a pilot at one pharmacy, nearly 2500 patients received almost 17,000 CoMM interventions, with an average of 6.8 interventions per patient in a year. The researchers described the types of patients that received the greatest number interventions, which drug resulted in the most number of interventions (warfarin), and the increase in counseling activities coupled with drug therapy problems successfully addressed with the prescriber. The authors insist that conducting MTM only for patients with a promise of health plan reimbursement is short-sighted, as this will not demonstrate pharmacists’ full value, and many patients not deemed “high-risk” would still otherwise benefit from CoMM. They indicated that for CoMM to become successful, there would have to be improvements in availability and accessibility of software that can better document interventions along with changes in workflow and specific job responsibilities assigned to support personnel.

CoMM has promise even if not all the bugs have been worked out. Pharmacy managers must understand the nuance behind different models of practice discussed in the literature and at conferences. They must on the one hand let staff know that they already are doing much in fulfilling the organization’s and pharmacy’s mission, but that perhaps some tweaking and continuous quality improvement are in order so that the pharmacy’s productivity and service to patients can be maximized.

Additional information about Value-Added Services as a Components of Enhancing Pharmacists’ Roles in Public Health and Ensuring Quality in Pharmacy Operations  can be found inPharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1Goedken AM, Butler CM, McDonough RP, et al. Continuous Medication Monitoring (CoMM): A foundation model to support the clinical work of community pharmacists. Res Social Adm Pharm. 2018;14:106-111.

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California

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Shane Desselle 6 months ago

What do you see as the primary difference between CoMM and other models of care?