Implementation of a standardized medication therapy management plus approach within primary care

Purpose: the purpose of this study was to implement a clinical pharmacist-led medication therapy management (mtm) service within a primary-care setting that is enhanced by 1) a clinical decision support system (cdss) that includes a unique combination of medication risk mitigation factors,which aids the pharmacist in interpreting the medication profile,and 2) pharmacogenomics (pgx) testing. methods: this was a service implementation study,whereby medicare beneficiaries were eligible if they were patients of elmwood family physicians,a private family,primary care practice with 2 locations in new jersey,and were on at least 7 medications. patients had a medication reconciliation completed by a pharmacist and performed a pgx buccal swab. patient information was run through a cdss to aid the pharmacist with screening for multidrug interactions and assessing patient's medication-related risks. the output of the cdss was used to create recommendations and provide a consult to the physicians. recommendations were followed up by return of the consult. results: enrolled patients used a mean (± standard deviation) of 12.1 (± 4.6) medications. the turnaround time for the mtm plus consults was 11.7 (± 6.2) days. during the consults,the pharmacist identified 138 medication-related problems (mrps). the most common mrps were drug-drug interactions (29.0%) and drug-gene interactions (dgis; 24.6%). conclusion: implementing a clinical pharmacist-led mtm plus service in the primary care setting is feasible. this study highlights that dgis are common in older adults in family practice and indicates that pgx testing identifies additional mrps that may otherwise go unnoticed in these patients. the experiences we shared can aid other clinicians in establishing successful mtm plus services. future studies should also measure the impact of such personalized medicine services on economic,clinical,and humanistic outcomes. this study has been registered with clinicaltrials.gov (study no. nct02748148).