Medication Therapy Management CER

This is a demonstration project to study the usefulness and scalability of using computer informatics tools to collect and retrieve electronic clinical data across organizations.  The goal is to design data retrieval tools with privacy and confidentiality safeguards for clinicians and researchers to assess medication therapy management (MTM) parameters.  In this demonstration project, informatics tools are applied to two ongoing MTM programs (for hypertension and diabetes) in participating clinics.  The informatics tools, if shown to be clinically effective, can be used by clinicians for management of other disease conditions.  There are 2 study aims:

 

Aim 1: to engage sites with a diverse set of data systems to ensure that SCANNER is interoperable across a wide variety of software platforms and IT architectures.

 

Aim 2: to use the established software platforms and IT architectures in the clinic settings for comparative effectiveness research related to MTM.  This demonstration project includes the following cohorts of patients with diabetes and hypertension MTM.

 

  1. Diabetic patients:
    1. Cohort 1 - care is managed only by a physician
    2. Cohort 2 - care is co-managed by a physician-pharmacist pair
  2. Hypertensive patients:
    1. Cohort 3 - care is managed only by a physician
    2. Cohort 4 - care is co-managed by a physician-pharmacist pair

 

 

Significance

 

There is currently no distributed research network that can implement diverse policies or scale to multiple health care settings and to multiple diseases or health conditions.

 

The SCANNER network is designed to support comparative effectiveness in the form of clinical trials or observational studies and to close the loop with the health care providers at their clinical practice sites.

 

SCANNER is also designed to enable effective recruitment, intervention monitoring in acute and chronic disease, comparative analyses, and feedback to health care providers.

 

 

Background

 

Hypertension and diabetes MTM programs were selected as the demonstration projects because these two disease conditions affect a large group of patients and are commonly encountered in the primary care setting.

 

The Center for Disease Control and Prevention reports that hypertension affects 74.5 million Americans.  However, blood pressure is controlled in only 34% of patients with hypertension in the United States, leading to unnecessary strokes, myocardial infarctions, and other cardiovascular events.  Diabetes also affects a significant number of Americans—more than 25.8 million.  Uncontrolled diabetes can lead to both macrovascular and microvascular complications.

 

The physician-pharmacist care delivery model has been shown to be an effective method of improving outcomes for patients with chronic diseases, including those with hypertension and diabetes (Carter BL et al. 2008; Jameson JP et al. 2010).  Therefore, we are collaborating with investigators who are a part of the San Diego Pharmacist Resource and Research Network (SDPharmNet™), a practice-based research network with clinics that have pharmacists and physicians who manage patients with hypertension and/or diabetes.