By Katherine Capps, Co-Founder and Executive Director, GTMRx Institute
September 18, 2019
It’s about time: Getting the medications right calls for expanding the care team
Comprehensive medication management offers physicians, pharmacists and other members of the patient care team a way to ensure patients are taking the right medications in the right dosages—and that they understand their medication therapy.
The GTMRx Institute just published an issue brief looking at the value of pharmacogenomics testing in helping pinpoint instances where patients were prescribed medicines that would not be effective—and in some cases, harmful—for them based on their genetic makeup. This scientific advancement is only one example of the new molecular tools that are changing how we define precision medicine—and redefining how we practice medicine.
The implications for how the care team handles medication management are important.
Today, at least 80% of the means by which we help individuals prevent illness and control disease is medications. Yet, the anatomy of a typical office visit isn’t currently structured to ensure medication optimization. One study found approximately 5% of a 16-minute office visit—less than a minute—involved introducing and explaining newly prescribed medications. Roughly 26 seconds was devoted to guideline-recommended components and 23 seconds to all the other aspects of the drug.1
Physicians recognize that 49 seconds is not nearly the time they’d like to spend on medication therapy, but time restraints and reimbursement sometimes leave them hamstrung. In their recent article, Christine Sinsky and Thomas Bodenheimer discuss the dilemma facing the primary care team in particular, sharing that “most primary care is delivered in an outmoded model, which has been described as a frantic physician running from visit to visit with a skeletal support staff who is kept out of the visit and therefore unable to optimally contribute.” They advocate for advanced team care with an in-room support model as a way to “power up” primary care and make it more satisfying to clinicians and patients alike.2
The potential economic gains from a team-based model for medication management also are significant. Avoidable illness and death resulting from non-optimized medication therapy cost $528.4 billion in 2016. That’s more than 16% of the $3.2 trillion U.S. annual health care spend.3
And, when you consider the more than 10,000 medications currently available on the market, along with over-the-counter medications used by patients, you find circumstances that create even more of a complex, time and knowledge demand in treatment rooms today.
Increased complexity requires a team
The scientific knowledge around medication therapy is growing exponentially, largely due to advances in complimentary and advanced diagnostics allowing us to gain insight into an individual’s response and/or risks. But these discoveries are not making it from the bench to the bedside quickly enough.
We lack an operational framework to translate these new discoveries into clinical practice and an expanded team to support such practice. In this expanded model, we envision access to a medication expert, working collaboratively with the team, available to discuss a patient’s medication regimen in detail. Not for 49 seconds, but for 49 minutes—if the time is needed. The team must be comprised of those with the skills and training to work in a patient-centered way, recommending medication changes needed to achieve clinical goals of therapy thereby ensuring optimal outcomes.
The solution, as with so many other issues, is to embrace a team-based approach in collaborative practice with physicians – in this case, something called comprehensive medication management (CMM).
Expand the team
CMM is a systematic approach to medications in which physicians and pharmacists ensure all medications—prescription, nonprescription, alternative, supplements, etc.—are individually assessed to determine that each is appropriate for the patient, effective for the condition, safe, and able to be taken by the patient as intended.4
This team-based, patient-centered approach improves patient care by optimizing the skills of everyone on the care team.
We know it works. Adding a clinical pharmacist to a care team makes the physician more efficient, improves outcomes and lowers costs. It even reduces physician burnout.5
Physicians welcome the opportunities
In talking about CMM and expanding the care team, there are those that ask about physician receptivity.
We hear clearly from physicians and other providers that have worked in this model an enthusiastic welcome and appreciation of pharmacists in collaborative team-based care.
A medication management program led by Jane Cheshire Gilbert, CPA, director of retiree health care, Teachers’ Retirement System of the State of Kentucky (TRS) illustrates this.
Key components of the program included covering pharmacogenomics testing and engaging pharmacists to develop medication action plans. Both the physician and the patient received a copy of the plans, which explained the results of the testing and the pharmacist’s recommendation. Of the medication action plans delivered to the initial 4,788 program enrollees, 64% resulted in medication changes by a pharmacist with over 40% of these suggested changes associated with drugs with DNA implications.6
Beyond the obvious benefits to member health, the program sponsor found the physicians’ acceptance of the initiative gratifying and “astounding,” reporting that prescribing physicians almost universally accepted the pharmacists’ recommendations.
“We were worried that physicians would not accept the results, but they did—94% of the time,” Gilbert says. Like the retirees, physicians were generally appreciative. “We’re hearing a lot of positive feedback, such as ‘you’re helping me become a better doctor, to take better care of my patients and to be able to prescribe the right drug at the right time for them.”
It’s time for a team-based approach to medication management
For all physicians, having a way to minimize the time, dollars and stress that comes with a trial-and-error type of prescribing should be welcomed. Adding a medication expert to the team addresses the frustrations shared by many about not having enough time to spend with patients and not having the time needed with them to focus on getting the medications right. And, as we welcome exciting therapeutic advances that are more complex to manage, that’s time physicians and patients desperately need.
It’s time for us to expand the care team to help patients take advantage of the innovation at our fingertips. We agree with Sinsky and Bodenheimer that we must challenge the existing mindset that doctors should do almost everything and replace it with one that extends the core care team with clinicians and professionals “who can together care for specific clinical conditions.”
CMM offers a path for physicians to do just that. If this sounds right to you, visit the GTMRx Institute to learn more about what we’re doing to advance CMM and how you can leverage it in your work to get the medications right for your patients.
 Tarn DM, Paterniti DA, Kravitz RL, et al. “How much time does it take to prescribe a new medication?” Patient Educ Couns. 2008;72(2):311–319.
 Sinsky, CA, Bodenheimer, T. “Powering-Up Primary Care Teams: Advanced Team Care with In-Room Support.” Annals of Family Medicine, 2019; 17(4): 367-371.
 Watanabe, JH, McInnis, T, Hirsch, JD. “Cost of Prescription Drug-Related Morbidity and Mortality.” Annals of Pharmacotherapy, 2018; 52(9): 829-837.
 McInnis, Terry, et al., eds. The Patient Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes. 2nd ed., Patient Centered Primary Care Collaborative. PCPCC Medication Management Task Force.
Funk, KA, et al. “Primary Care Providers Believe that Comprehensive Medication Management Improves Their Work Life.” J Am Board Fam Med. 2019 Jul-Aug, 32(4): 462-473.
 GTMRx Institute. “Pharmacogenomics: Improving outcomes, lowering costs by making precision medicine personal.” Issue Brief. September 2019.