Medication therapy problems identified by pharmacists conducting telephonic comprehensive medication management within a team‐based at‐home care program

Introduction Comprehensive Medication Management (CMM) is a collaborative patient‐centered approach to medication optimization. We recently implemented telephonic CMM as part of a multidisciplinary team within a team‐based at‐home care program. The objective of this study was to describe the type and frequency of medication therapy problems (MTPs) identified by pharmacists delivering CMM as part of this program, as well as the acceptance rates of the recommendations made to rectify them. Methods We conducted a retrospective chart review of all patients receiving CMM within the program between December 12, 2018 and December 31, 2019. We identified and classified MTPs based on the framework developed by the Pharmacy Quality Alliance. Descriptive statistics were used to determine the quantity of MTPs, as well as the acceptance rates of the recommendations. Results We identified 307 patients who received CMM. Of these patients, 58% were female (178/307) and 96% identified as White (296/307). Average age was 72 years old (SD 13). On average, pharmacists identified 4 MTPs/patient with a 35% acceptance rate (431/1228) for their recommendations. Of those accepted, pharmacists were able to resolve 185 (43%) of these MTPs on their own while providers resolved the remaining 246 (57%) MTPs. Acceptance of MTPs was more likely if patients were spoken to (38.4% vs 29.5%, relative risk [RR] = 1.30, 95% CI 1.10‐1.54, P = .002). Conclusions Pharmacists were able to identify several MTPs when conducting telephonic CMM within a team‐based at‐home care program. These MTPs and their associated recommendations however, often failed to be resolved. Recommendations were more likely to be resolved if patients were spoken to, highlighting the importance of engaging the patient as part of CMM. Future studies should examine ways to improve intervention acceptance as well as the clinical and economic impact of changes made as a result of telephonic CMM and MTP identification.