Medication therapy management lifestyle and wellness program for patients in rural Arizona.

Abstract

Background: Pharmacist-provided medication therapy management (MTM) services have demonstrated improved clinical outcomes for patients. MTM services could incorporate additional lifestyle and wellness counseling to potentially enhance health care for underserved patients.

Objective: To report the outcomes of a new pharmacist-provided MTM lifestyle and wellness counseling program for underserved rural Arizonans with diabetes and/or hypertension.

Methods: A community health center referred rural Arizonans with type 2 diabetes and/or hypertension to the MTM pharmacist for telephonic MTM lifestyle and wellness counseling between July 2020 and June 2023. Data were collected on clinical characteristics, adherence issues, and pharmacist recommendations. A nurse reviewed the patients' electronic health record to determine which recommendations had been accepted by the primary care provider after 90 days. Summary statistics were computed.

Results: For 93 patients in the program, pharmacists identified many drug-drug interactions, adverse drug reactions, utilization/cost concerns, and recommended preventative vaccines. Pharmacists provided counseling for exercise, nutrition, laboratory values, and disease state education. Twenty-nine patients reported missing any doses of their medications in the past 2 weeks. Patients used a variety of methods to remind them to take their medications. A total of 309 recommendations were made by the pharmacist averaging 3.3 ± 1.4 per patient. Of these, 113 (36.6%) were accepted within 90 days. The most common recommendations made were screening needed (n = 77) and vaccination due (n = 70). The most frequently accepted recommendations by the patients' provider were reinforcing lifestyle/disease self-management strategies (61.7%) and decreasing medication dose (60.0%).

Conclusion: This novel MTM lifestyle and wellness counseling program demonstrated some success for underserved Arizonans with diabetes and/or hypertension. Over one-third of recommendations made by the pharmacist to the patients' primary care provider were accepted, which is encouraging in showing the value of this program but suggests further work is needed to act upon them or understand why they are not implemented.