American College of Clinical Pharmacy
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ACCP Report - March 2019

President’s Column. Implementing CMM to Achieve Medication Optimization

Written by Suzanne Amato Nesbit, Pharm.D., FCCP, BCPS, CPE


While ACCP awaits the results of its $2.4 million comprehensive medication management (CMM) in primary care grant later this year, the College must begin planning for the dissemination and implementation of the study team’s findings. Indeed, ACCP is already engaged in this effort, as evidenced by the College’s strategic plan, its publications in JACCP, and its planned workshops during the Patient-Centered Team-Based Practice Forum at the April 26–28 Updates in Therapeutics® meeting in St. Louis.

To ensure desired patient outcomes, it is imperative that clinical pharmacists be viewed as the health care professional responsible for medication optimization within team-based settings. As such, clinical pharmacists must prepare to implement CMM in their own practice settings. Clinical pharmacists should avail themselves of the educational offerings and tools emerging from the CMM study team and ACCP while familiarizing themselves with key concepts of successful implementation strategies.

Moreover, clinical pharmacists should ensure that their health care colleagues have a common understanding of medication optimization. The Center for Medication Optimization at the University of North Carolina Eshelman School of Pharmacy defines medication optimization as “a patient-centered, collaborative approach to managing medication therapy that is applied consistently and holistically across care settings to improve patient care and reduce overall health care costs” (see https://pharmacy.unc.edu/research/centers/cmo/).

To achieve medication optimization, clinical teams must exercise coordination and collaboration. This needs to be combined with an understanding of the new, value-based payment models that reward quality and cost containment while focusing on health-related outcomes. Value-based payment models create incentives to manage population health with a goal of identifying and proactively treating patients with complex conditions across all care settings. The goal of these efforts is to lower overall health care costs while meeting clinical quality measures.1

A potential setback to implementing medication optimization is the inability of teams to adopt new ways of viewing a patient’s care and recognizing that patient outcomes are a shared responsibility. Medication optimization should be a team-based effort, with the clinical pharmacist assuming primary responsibility. Health care professionals should work as a team instead of in the all-too-common siloed structures of individual disciplines. Moreover, clinical pharmacists must employ a consistent patient care process to achieve medication optimization. The Joint Commission of Pharmacy Practitioners Pharmacists’ Patient Care Process combined with the ACCP CMM Process of Care allows for the delivery of CMM consistently and holistically. In addition, this process ensures that patients are receiving appropriate, safe, and effective medications and are taking them as intended.2

Introduction of a new approach does not guarantee consistency or effective implementation. However, the tenets of implementation science (IS) provide a framework for success. Done correctly, IS can accelerate the adoption of CMM. Consistent delivery of core components of the intervention/care process ensures a quality outcome. Of importance, implementation consists of three phases: pre-implementation, implementation, and stabilization, each of which is then supported by individual steps, activities, and supportive resources to ensure success.3

The goal of medication optimization within team-based care delivered by a clinical pharmacist can only be achieved through implementation that affords consistency of the process. This allows interventions such as CMM to provide effectiveness and sustainability. Teams embracing the goal of medication optimization in turn realize the added benefit of satisfying the quadruple aim:

  • Improve population health through CMM for patients with complex, chronic conditions.
  • Improve patient experience through patient-centered, targeted goals with patient engagement.
  • Reduce costs through providing greater value (from improved outcomes and reaching target goals), decreasing the total cost of care, and improving efficiency.
  • Improve the work life of health care providers through team-based, efficient patient care.

Therefore, CMM dissemination and implementation will remain an important ACCP strategic initiative in achieving medication optimization for patients.

References:

  1. Easter JC, DeWalt DA. The medication optimization value proposition: aligning teams and education to improve care. N C Med J 2017;78:168-72.
  2. CMM in Primary Care Research Team. The Patient Care Process for Delivering Comprehensive Medication Management (CMM): Optimizing Medication Use in Patient-Centered, Team-Based Care Settings. July 2018. Available at accp.com/cmm_care_process. Accessed March 12, 2019.
  3. Livet M, Blanchard C, Sorensen TD, et al. An implementation system for medication optimization: operationalizing comprehensive medication management delivery in primary care. J Am Coll Clin Pharm 2018;1:14-20. Available at https://doi.org/10.1002/jac5.1037. Accessed March 12, 2019.