Although Medicare Part D prescription drug programs are mandated to provide medication therapy management (MTM) services to beneficiaries meeting certain criteria, the effectiveness of these programs has varied. In designing these services there is a need for a special focus on the needs of the chronically ill as MTM eligibility criteria emphasize common chronic diseases. Therefore, further research is required to inform the design of MTM programs that have the greatest impact on patient-centered outcomes, particularly among patients with chronic conditions. Additionally, there is a need for a pool of highly trained health services researchers to conduct this work. This career development award proposal has been designed to position the candidate to meet her career goal of achieving full independence as a health services researcher focused on the study of medication therapy management for chronically ill Medicare Part D beneficiaries. The proposed research will provide a greater understanding of the barriers, facilitators, and effective strategies for incorporating Chronic Care Model principles into MTM delivery. Specific training activities proposed include didactic coursework, seminars/methods workshops, and visits to off-site mentors. These activities will enhance her skills specifically in the use of mixed methods and community-based research involving collaborations with practice-based research networks. The research specific aims include-- Aim 1: In a cohort of community pharmacies participating in a practice-based research network, characterize practice workflow in order to identify challenges, facilitators, and effective strategies for providing MTM to chronically ill Medicare Part D beneficiaries and examine these findings in a statewide sample of MTM practices, and Aim 2: Provide recommendations to providers and policymakers for MTM delivery redesign that would optimize service provision and patient-centered outcomes, particularly to the chronically ill. A mixed-methods approach will be utilized to achieve each of these aims.
For Aim 1, data collection will initially occur in collaboration with a practice-based research network of community pharmacies in Indiana and will include conduct rapid ethnography, contextual inquiry, process mapping, and semi-structured interviews. This work will then inform the design of a survey to be administered to MTM practices statewide in Indiana.
For Aim 2, the findings of Aim 1 will be used to develop a list of MTM delivery recommendations to be prioritized through the use of an expert panel. In addition to the proposed research, key training activities will enhance the candidate's expertise and increase the nation's capacity for subsequent MTM research efforts. The proposed work is significant because achievement of the stated training and research aims will provide evidence to support the enhancement of community pharmacist-provided MTM and grow the capacity for research in this field.
The proposed career development award is relevant to public health because understanding of barriers, facilitators and effective strategies for incorporating Chronic Care Model principles into community pharmacist-provided medication therapy management (MTM) is expected to result in novel enhancements to MTM for chronically ill Part D beneficiaries that will be tested through subsequent MTM comparative-effectiveness research. Furthermore, the training activities proposed will position the candidate to be a future leader in these research efforts. This work is relevant to AHRQ's mission and focuses on AHRQ's priority populations of the elderly and chronically ill.
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