An Online Virtual-Patient Program to Teach Pharmacists and Pharmacy Students How to Provide Diabetes-Specific Medication Therapy Management

Article excerpt

INTRODUCTION

Medication therapy management (MTM) is the process of a pharmacist interviewing a patient and making therapy recommendations, with the goals of promoting safe and appropriate medication use, resolving or preventing drug-related problems, providing patient education, and promoting the use of evidence-based and cost-effective medications. (1,2) Patients who have been diagnosed with type 1 or type 2 diabetes mellitus are particularly good candidates for pharmacist-performed MTM. Patients with this condition often take several medications concurrently, and because pharmacists are uniquely positioned to provide care and highly accessible to patients in the community, they can have a positive impact on the healthcare of these patients. (3,4) Additionally, some MTM programs, including the Wisconsin Pharmacy Quality Collaborative (WPQC), pay pharmacists to provide MTM to patients with diabetes. (2)

With the emergence of MTM programs, there is a growing need to educate pharmacy students and practicing pharmacists on how to perform high-quality MTM. There is also a need to address the barriers preventing pharmacists from performing this service, such as knowledge of how to operate a particular MTM billing program, and access to educational materials focused on MTM and the disease states typically encountered. (5) Pharmacists' confidence in their ability to perform these reviews is a factor in whether they include MTM services in their practice. Therefore, advanced training focused on improving pharmacists' comfort with performing MTM and responding to patients' needs may result in increased performance of MTM by community pharmacists. (6) Effective training programs for pharmacists should provide example patient cases, teach how to use treatment guidelines to recommend medication changes to patients' providers, and demonstrate how to plan for an efficient MTM meeting with a patient.

MTM education can occur in several formats. Several colleges and schools of pharmacy have implemented elective and required courses in laboratory, lecture, and advanced experiential settings using active-learning techniques, such as role-playing and online learning, that include patient cases and an existing commercial MTM platform. (7-9) Working these simulated patient cases allows participants to increase their confidence and ability to perform MTM in a safe but realistic active-learning environment. (7-8) Online virtual-patient learning experiences increase the knowledge of health professionals, including pharmacists seeking professional development. (10-14)

The Theory of Planned Behavior states that a person's actions may be predicted based on their beliefs about a subject. Assessment of these beliefs will predict whether an educational intervention will alter the participant's future behavior in terms of intent to apply the new knowledge gained. (15) The theory uses 3 realms for this measurement: the participants' attitudes toward the subject (eg, whether they believe the topic is useful for their work setting), their perception of the subjective norm of the topic (social and professional pressure and expectations about the practice, or expectations regarding standards of care), and their perception of control over the topic (whether they feel they can personally perform the activity). For example, if a practitioner believes that a particular laboratory test is effective, accepted as the general practice in the management of a particular condition, and not prohibitively difficult to perform, that practitioner will probably use that test.

The hypothesis of this study was that pharmacists and pharmacy students who completed an online virtual patient MTM program would increase their intent to perform MTM, as measured by a change in their beliefs about MTM described by the Theory of Planned Behavior. If there is a change in whether pharmacists consider MTM to be an effective patient care tool (attitude), in their belief that they are expected to perform MTM (subjective norm), and their perceived ability to perform MTM (behavioral control), then their future behavior toward this activity would likely change. …