There is a good deal of debate going on regarding the shortage of medical professionals in the U.S. these days. Manpower Group’s annual talent shortage survey pegged nurses as being #10 on their list of all professions suffering from significant shortages of qualified job seekers. Maryville University backs this up with a breakdown of the numbers by state. Doctors aren’t exactly in good supply either, according to the Association of American Medical Colleges.
With the number of people seeking medical care rapidly increasing thanks to the coinciding retirement of baby boomers and institution of the American Care Act, our need for medical personnel is outstripping our ability to produce them. In light of this, one institution is proposing that we help out by easing the responsibilities of our existing doctors and nurses by having other medical professionals take over some of their duties.
The University of Florida has instituted a program where it awards Master’s degrees in Medication Therapy Management. Through it U of F believes that Pharmacists can begin relieving doctors of some of the pressures they currently face, allowing them to focus more time on things only doctors can do. They do this by taking over the long term tracking of patients and their prescriptions.
The concept is fairly simple in its approach. It alters the Doctor-Patient-Pharmacist relationship from the current principle of doctors issuing prescriptions for patients to pick up from a pharmacist, and the doctor then monitoring the patient’s reaction to the medications. Instead, the pharmacist now engages in a direct care model by monitoring the patient’s prescription and reporting back to the doctor as necessary.
Through this the pharmacist is able to bring the unique training and education provided to them to bear. Being specialized in pharmaceuticals, pharmacists are better equipped to be able to recognize the risks of drug interactions and side effects ahead of time, monitor patients for signs of either of these, and take steps to adjust medications accordingly. This approach is applied over the entire course of a drug regimen, rather than the current model of pharmacists warning of possible side effects and interactions at the start and then being done with the entire process.
Medication Therapy Managers thus are able to provide far more specific understanding to the prescription process throughout the entire length of the prescription. Being much more familiar with side effects and drug interactions they can therefor provide far better and tailored care for the patient than the doctor can when it comes to the prescription, and will be far more knowledgeable about viable alternatives.
This also benefits the doctors and nurses involved with patients as well. Through a recursive reporting process the pharmacist updates the medical records of the patient whenever changes are merited or complications from medications are experienced. Doctors and nurses are thus relieved of the burden of having to monitor for these things themselves and update records accordingly. The time that would be spent on maintaining records and dealing with recurring visits incurred by a need to deal with side effects and interactions are therefor transferred to the pharmacist, allowing doctors and nurses to focus more time and attention on additional patients and non-pharmaceutical concerns.
The question, of course, is “does this work?” Currently we don’t have an answer for that yet. Florida’s MTM program only launched in 2011, with the first classes starting in June of that year. With a minimum completion time of two years, the first graduating class will currently only have been practicing for a year and a half at this point, allowing for only a small number of examples of this MS degree being put into practice.
However the concept of MTM has an additional ten years on the degree program. Medication Therapy Management as a concept was slammed into the forefront of pharmacist minds as a result of the Medicare Modernization Act of 2003. As a result of this act, Medicare Part D prescription plans were required to include MTM services delivered by qualified medical professionals. While this requirement included doctors and nurses, pharmacists stepped up to the plate as well.
Recent studies have shown promising results. A 2011 study published on the National Institute of Health website showed that patients with hypertension or diabetes who met one on one with pharmacists once a month to engage in MTM practices showed marked improvements in their vital statistics. MTM pharmacists are thus shown to certainly have the ability to have a positive impact by taking over the long term care involved in drug therapy regimens.
An earlier study, published in 2008 by the American Pharmacists Association stated that MTM pharmacists, working in association with physicians, demonstrated “positive clinical, economic, and humanistic outcomes across diverse patient populations in various patient care settings.” It went on to further state, “Pharmacist-provided MTR and consultation in various settings has resulted in reductions in physician visits, emergency department visits, hospital days, and overall healthcare costs.”
These two studies were both based on pharmacists working with a 170 hour certification. In theory, graduates from U of F’s Master’s program will equip pharmacists to provide even better results for both patients and doctors. As Dr. Schuh, a member of Florida’s MTM faculty put it, “The certificate is a start. The Master’s degree delivers the entire toolbox needed to start an MTM practice in just about any community, ambulatory or outpatient setting.”
So while the MTM Master’s at the University of Florida remains virtually untested, the tea leaves make it look promising. The additional training provided is likely to increase the benefits already being demonstrated by MTM certificate holders, including the reduction of stresses placed on doctors by the need to monitor patient medication use. With signs indicating this degree can provide some relief to doctors in terms of the overall burden created by the excess demand and inadequate supply we currently face. It seems that the University of Florida can indeed say “take two and call me in the morning.”
