A Grounded Theory Approach To Determining A Patient’S Decision To Use Medication Therapy Management Services

Abstract

Introduction: For every $1 spent on prescription drugs, another $1.30 is spent to correct drug-related problems. Pharmacist-delivered medication therapy management (MTM) services have been documented to decrease the number of drug-related problems; however, patient underutilization of MTM services hinders these programs from realizing their goals. Purpose: Using a grounded theory approach, explain the process by which a patient decides whether to initially attend an employer-sponsored, pharmacist-delivered MTM service by assessing the influence of social, cultural, and/or psychological variables on the patient’s decision. Methods: Focus group participants were recruited from two large self-insured employer groups in Minnesota that offered MTM services as a voluntary health insurance benefit, but which were experiencing low beneficiary enrollment. Study participants were at least 18 years old and were taking four or more prescription medications daily. Participants were assigned to focus groups based on gender, whether they were MTM-naïve or MTM-experienced, and on number of daily medications. Data regarding patient decisions to utilize healthcare services were collected during 12 focus group sessions. Sessions were audio and video recorded, and data codified by two coders. Results: Two primary determinants emerged: A patient’s Healthcare Utilization Paradigm and their Value Assessment of MTM. The resulting DECISION model describes specific variables that impact a patient’s evaluation of MTM: Healthcare Attitudes, Healthcare Team Relationship, Medication Attitudes, Monetary Impact, MTM Service Expectation, Accessibility and Convenience. Only MTM utilization status discriminated between patients within the model; MTM-naïve participants yielded twelve unique variables. This research contributes several new variables beyond what could be extrapolated from the existing Theory of Planned Behavior, Behavioral Model of Healthcare Utilization and AIDA marketing models: Cost of MTM Visit, Employer-Sponsored Healthcare Program, Dissonance of External Review, Scope of Services, Timing of MTM Recruitment, Trust of Program Sponsor, Pharmacist Relationship and Pharmacy Practice Experience. The latter four appear to most significantly impact a patient’s decision to participate in MTM. Conclusions: A patient’s social network, cultural views, economic paradigm and previous experiences play important roles in their MTM participation decision. The results of this study can enable MTM program sponsors and providers to optimize patient participation by increasing interest in MTM.