Objective To describe events leading to development of a professionwide consensus definition of medication therapy management (MTM) and attendant programs and services and present the document (definition, services, and program requirements) resulting from the process. Data Sources Author’s own knowledge and records of events. Summary Following the late 2003 passage of the Medicare Prescription Drug Improvement and Modernization Act, the pharmacy profession had a need to act quickly to define MTM so that a consensus definition would be available as regulations implementing the Medicare Part D benefit were being written. The American Pharmacists Association facilitated this process by convening a broad working group of members and other involved parties to draft a preliminary definition. The Pharmacy Practice Activity Classification was used to check elements of the definition for consistency with services being offered in a wide variety of settings. A professionwide stakeholders conference was then convened with representatives from each of 11 national pharmacy organizations. This group, following a daylong meeting in late May 2004 and several weeks of e-mail messages and conference calls, finalized the MTM definition, which was then approved by the chief executive officers of all 11 groups. Conclusion Through the extraordinary efforts of the numerous organizations and participants, the MTM Services Definition is one that is applicable within diverse pharmacy practice segments, whose services are feasible for a majority of practitioners to implement, and whose elements are supported by a profession-wide consortium of 11 national professional pharmacy organizations. This historic achievement is the first step on a journey to find the best ways to effectively deliver MTM services to patients.

https://www.japha.org/article/S1544-3191(15)31641-1/pdf

Definition of Medication Therapy Management: Development of Professionwide Consensus

An increased interest is observed in broadening community pharmacists' role in public health. To date, little information has been gathered in Canada on community pharmacists' perceptions of their role in health promotion and prevention; however, such data are essential to the development of public-health programs in community pharmacy. A cross-sectional study was therefore conducted to explore the perceptions of community pharmacists in urban and semi-urban areas regarding their ideal and actual levels of involvement in providing health-promotion and prevention services and the barriers to such involvement. Using a five-step modified Dillman's tailored design method, a questionnaire with 28 multiple-choice or open-ended questions (11 pages plus a cover letter) was mailed to a random sample of 1,250 pharmacists out of 1,887 community pharmacists practicing in Montreal (Quebec, Canada) and surrounding areas. It included questions on pharmacists' ideal level of involvement in providing health-promotion and preventive services; which services were actually offered in their pharmacy, the employees involved, the frequency, and duration of the services; the barriers to the provision of these services in community pharmacy; their opinion regarding the most appropriate health professionals to provide them; and the characteristics of pharmacists, pharmacies and their clientele. In all, 571 out of 1,234 (46.3%) eligible community pharmacists completed and returned the questionnaire. Most believed they should be very involved in health promotion and prevention, particularly in smoking cessation (84.3%); screening for hypertension (81.8%), diabetes (76.0%) and dyslipidemia (56.9%); and sexual health (61.7% to 89.1%); however, fewer respondents reported actually being very involved in providing such services (5.7% [lifestyle, including smoking cessation], 44.5%, 34.8%, 6.5% and 19.3%, respectively). The main barriers to the provision of these services in current practice were lack of: time (86.1%), coordination with other health care professionals (61.1%), staff or resources (57.2%), financial compensation (50.8%), and clinical tools (45.5%). Although community pharmacists think they should play a significant role in health promotion and prevention, they recognize a wide gap between their ideal and actual levels of involvement. The efficient integration of primary-care pharmacists and pharmacies into public health cannot be envisioned without addressing important organizational barriers.

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Ideal and actual involvement of community pharmacists in health promotion and prevention: a cross-sectional study in Quebec, Canada.

Background Medicare Part D is a voluntary prescription drug benefit for Medicare beneficiaries. As part of the coverage, medication therapy management services (MTMS) are mandated for beneficiaries with chronic diseases who take multiple medications covered under part D and who are likely to incur annual costs that exceed a specified level. Objective To predict the behavioral intention of pharmacists to provide Medicare medication therapy management services (MTMS) using the theory of planned behavior (TPB) and to determine the relationship between pharmacists' characteristics and intention to provide MTMS. Methods The population for this cross-sectional descriptive study consisted of all community pharmacists in Iowa. Data collection occurred through a self-administered anonymous mail survey. Two surveys each were mailed to 500 pharmacies selected through a stratified random sample, 1 survey for the pharmacy manager and 1 survey for a staff pharmacist if applicable. Descriptive statistics and scale reliability were calculated for each of the 4 TPB scales (attitude, subjective norm, perceived behavioral control, and intention). Linear regression was used to predict intent as a function of the other 3 TPB factors, demographic factors, experience, and type of pharmacy. Results Out of 212 surveys received, 203 had usable data. The usable response rate ranged from 21% to 41%. Pharmacists' intent to provide MTMS was generally positive but varied in strength with a mean score of 22.47 (±4.00) and a range of 7-30. Pharmacists mostly agreed that they had appropriate training to provide MTMS but lacked time and support. The linear regression analysis found the constructs of attitude, subjective norm, and perceived behavioral control to be significant predictors of intent ( P Conclusion Pharmacists showed generally positive intent to provide MTMS. Perceived behavioral control, subjective norm, and attitude were significant predictors of intent ( P

Prediction of pharmacist intention to provide Medicare medication therapy management services using the theory of planned behavior.

Objective To assess a model to screen minority, elderly, and at-risk individuals for diabetes, hypertension, and dyslipidemia in pharmacy and non–health care settings Design Multicenter, prospective, observational trial Setting 26 pharmacies and 4 non–health care settings Participants 888 individuals with one or more of the following risk factors: first-degree relative with diabetes, age 55 years or older, obesity, previous diagnosis of hypertension, or a previous diagnosis of dyslipidemia Intervention Measurement of plasma glucose, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and blood pressure; risk assessment using a risk factor tool; referral of participants with abnormalities to physicians Main Outcome Measures Adherence with follow-up, physician recommendations, and new diagnoses of diabetes, hypertension, and dyslipidemia Results Pharmacists screened 888 participants in pharmacies and non–health care settings; 794 scored at least 10 on the risk factor tool and received further screenings Of these, 81% were referred for follow-up for at least one abnormality: 15% glucose, 68% blood pressure, 66% total cholesterol, and 26% HDL-C For those referred, the mean (± SD) fasting plasma glucose concentration was 179 ± 87 mg/dL, and the random glucose concentration was 234 ± 90 mg/dL Of participants completing follow-up, 16% received one or more new diagnoses as follows: diabetes, 8; hypertension, 9; and dyslipidemia, 29 Therapy changed for 42% of participants Participants who were elderly, of African American and Hispanic race/ethnicity, or those with elevated cholesterol values were at significantly greater risk for elevated glucose levels Screenings in community pharmacy settings had improved follow-up rates with physicians compared with screenings conducted in non–health care settings Conclusion Pharmacists identified individuals with elevated glucose, cholesterol, and blood pressure values through community-based screenings Pharmacists also identified individuals who could benefit from further control of previously diagnosed hypertension and hyperlipidemia

https://www.japha.org/article/S1544-3191(15)31535-1/pdf

Pharmacy- and Community-Based Screenings for Diabetes and Cardiovascular Conditions in High-Risk Individuals

Summary
This study evaluated the effect of a multifaceted intervention (screening and patient education) by community pharmacists on testing or treatment of osteoporosis. One hundred and twenty-nine patients randomized to receive the intervention were compared to 133 patients who did not receive the intervention. Twice as many patients who got the intervention received further testing or treatment for osteoporosis.

Community pharmacist-initiated screening program for osteoporosis: randomized controlled trial.

A series of pentenyl barbituric acid derivatives has been studied. In general, the amount required to produce anesthesia is independent of the duration of action. Furthermore, there is no obvious relationship between the pharmacological action and chemical structure of these compounds. Many of these derivatives are isomeric, but show considerable variation in action, dosage, duration of action and therapeutic index. One of these compounds is shorter acting than two well-known barbiturates and with a better therapeutic index.

The pharmacological relationship of a series of pentenyl substituted barbituric acid derivatives.

SummaryA new compound, l-methyl-5-allyl-(1 -methyl-2-pentynyl) barbituric acid, sodium salt, (#22451) has been studied and compared with Pentothal and Thioseconal in rats, rabbits, dogs and monkeys. It is a more potent anesthetic than either Pentothal or Thioseconal. With an observed AD60 this compound has a shorter duration of anesthetic action than the two thio-compounds. When one-half of the AD50 is injected by vein at hourly intervals #22451 shows less cumulative action than Pentothal or Thioseconal. After prolonged anesthesia, recovery time is much more rapid with this agent than with Pentothal or Thioseconal and, as other experiments show, this transient action is related to detoxification by the liver.

E. E. Swanson

Papers

The pharmacological relationship of a series of pentenyl substituted barbituric acid derivatives.

Pharmacology of a short-acting non-sulphur barbituric acid derivative.