2025 Southeastern Residency Conference

Title: Implementation of a Pharmacy-Led Medication Therapy Management Clinic in a Rural Community Hospital  

Authors: Stanislava Stancheva, Benjamin Gatlin  

Objective: To discuss the implementation of a Medication Therapy Management clinic in a rural community hospital and identify advantages of clinical pharmacy services provided.   

Background: Medication therapy management (MTM) is a strategy to deliver clinical pharmacy services to patients. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 requires that Medicare Part D provide MTM services to select beneficiaries with chronic conditions to offer education, improve adherence, and optimize clinical outcomes while minimizing adverse drug events. This process involves collaboration with patients and providers. Under a collaborative care agreement (CCA), pharmacists can manage specified chronic conditions within the scope of practice outlined by treatment protocols. Regarding financial resources, the 340B Drug Discount Program is a federal initiative designed to provide reduced-cost prescription drugs to eligible hospitals that serve uninsured and low-income patients. In rural communities 340B MTM clinics can bridge the gap in care which medical deserts struggle with and provide valuable resources to improve cost effectiveness of care provided. 

Methods: This is a retrospective cohort study at Baptist Health Deaconess Madisonville (BHDM) hospital with prospective patient recruitment. Patients with hyperlipidemia, diabetes, and osteoporosis were included and enrolled into the 340B MTM clinic. Comprehensive treatment protocols were created and developed from the ground up, and a collaborative care agreement defined the pharmacist’s scope of practice. Pharmacists and pharmacy patient care coordinators were provided with appropriate education including creating and utilizing referrals.  The protocols and CCAs were approved by the hospital Pharmacy and Therapeutics and Medical Executive committees. As patients were enrolled and seen in the clinic, data was assessed to identify the role of the pharmacist in management of chronic conditions, prescribing and de-prescribing under protocol, as well as administration of specialty drugs approved under 340B or using manufacturer buy and bill services.  

Results: Currently, the 340B MTM clinic at BHDM has successfully expanded to 4 chronic disease states being managed under collaborative care agreements. To date, 242 patients have been included in the study with additional enrollment ongoing. Pharmacists have conducted medication reconciliation, discussed labs, ordered future labs, discussed and altered therapy regimens, and entered prescription renewals. Administration of specialty injectable medications covered through buy and bill and pharmacy benefit services was also implemented. From the start of MTM clinic on August 22 to March 31, pharmacists started new medications 71 times, increased doses 52 times, and decreased doses 5 times. Medication was discontinued on 16 occasions. 55 injections were administered by pharmacists. Immunizations, smoking cessation, and other interventions have also been incorporated into clinic visits. Further results in progress.  

Conclusions: The creation of a 340B MTM clinic at BHDM has greatly expanded the clinical services pharmacists offer. Through collaborative care agreements, pharmacists were able to intervene and prevent potential adverse events and treatment failures from occurring. The challenges of creating MTM clinics including reimbursement, referral processes, and availability of resources can be justified by significant savings which were generated through 340B eligible scripts. Further conclusions in progress.