Maximizing the MTPC Framework for Current and Future Pharmacists
As a PQA MPH Practicum Program student this summer, I collaborated with the Performance Measurement and Research Team to learn about PQA’s various frameworks and initiatives. As a dual-degree student pursuing my Doctor of Pharmacy (PharmD) and Master of Public Health (MPH), I found my background and interests to be greatly aligned with PQA. The practicum experience enriched my understanding of measure development through its iterative lifecycle and illuminated how PQA’s efforts positively impact pharmacy services like medication therapy management (MTM).
Throughout my practicum, I engaged in conversations related to MTM services and how the patient care process across pharmacy practice lacks uniformity, which makes it challenging to develop patient-centered outcome measures. Coming from a PharmD candidate’s perspective, one way I envision strengthening the standardization of processes within MTM services is through the standardized use of the PQA Medication Therapy Problem (MTP) Categories Framework, available by request from the PQA Quality Measures page.1
The Medication Therapy Problem Resolution (MTPR) monitoring measure is based on the PQA Medication Therapy Problem Categories Framework and evaluates the percentage of interventions that resolve medication therapy problems among individuals participating in an MTM program. To request the framework, contact PQA at [email protected].
As a part of the patient care process there is a method to systematically address MTPs given their potential impact on achieving therapeutic goals. During my practicum, I learned there is a logical approach to categorizing an MTP. In the MTP Categories Framework, pharmacists assess each medication for appropriate indication, effectiveness, safety, and patient adherence and should do so in that order. For example, if a medication is not indicated and the patient should not be taking it, it does not matter if it is effective, safe or adherent. In documentation of the care provided, the MTP Categories Framework promotes consistent identification of MTPs found and the interventions taken to resolve MTPs within MTM services. To learn more about the logical approach, see the third edition of Pharmaceutical Care Practice: The Patient Centered Approach to Medication Management.2
One opportunity to integrate the framework into pharmacy practice is through pharmacy school curriculum. To optimize learning, student pharmacists should receive routine reinforcement in other courses on the systematic and logical approach to ensure they practice MTP categorization logic while enhancing clinical decision-making skills.
Another opportunity to integrate this framework more broadly into practice is to develop a national continuing education program specific to MTPs. The educational modules could focus on the importance of identifying and resolving MTPs within MTM services. The program could facilitate the evaluation of patient-specific cases and encourage pharmacy professionals to practice the use of the MTP Categories Framework to optimize patients’ medication use. PQA can play a role in providing this education for use of a logical and standardized approach to the framework.
As a current student and future pharmacist, I recognize the need to bring awareness to the MTP Categories Framework and to categorize MTPs in a systematic and logical way. The logical process has enlightened my perspective to efficiently care for patients. I appreciate Cipolle’s statement, that “drugs don’t have doses – people have doses.”3 Cipolle and colleagues further explain in their book, Pharmaceutical Care Practice, that this statement is a reminder for pharmacists to fulfill their responsibilities and to focus on patient-centeredness during MTP evaluation. It is clear to me that this rational approach is vital for practice standardization and documentation.
The MTP Categories Framework enables pharmacists to speak the same language when addressing MTPs. A structured reporting process would also benefit the creation of outcome measures related to MTM services. Overall, standardization of a process using the framework allows for succinct communication between pharmacy teams and limits variation between clinical settings. Learning about how to use the MTP Categories Framework in the patient care process enhanced my confidence to evaluate MTPs and feel more prepared for my clinical career.
Citations:
- Pharmacy Quality Alliance. PQA Medication Therapy Problem Categories Framework. Updated August 2017. Available upon request at: https://www.pqaalliance.org/pqa-measures
- Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: the patient-centered approach to medication management services. Third ed. McGraw-Hill; 2012.
- Cipolle RJ. Drugs don’t have doses – people have doses!: A clinical educator’s philosophy. Drug Intelligence & Clinical Pharmacy. 1986;20(11):881-882. doi:10.1177/106002808602001112
Katie Quigley was a PQA MPH Practicum Program student in 2024. Applications for 2025 are due December 13, 2024. Visit PQA’s website to learn more about the program.