SCIENCE UPDATES
Medication therapy management: Primum non nocere Patrick G. Clay
A tenet of medicine is the overarching guiding principle of first not harming patients when providing care. A recently published systematic review of medication therapy management (MTM) literature concluded that the strength of evidence on the benefit of MTM was insufficient and imprecise in many regards.1 In examining the methodology these authors applied to the existing body of literature, their conclusion accurately reflects the approach taken in this assessment. However, it is important to peel back the layers of statistical analyses and scrutinize the report for insights and tips on how to address the shortcomings in the body of evidence that our research into MTM has generated. In keeping with the principle of primum non nocere, we must begin with a central question: Does MTM cause harm to either patients or the care system? As with other aspects of this recent review, the authors concluded that the evidence is insufficient to judge MTM with respect to harm. Only one study reported on harms, the authors wrote, and the harm noted was on the inconvenience resulting from monthly appointments. ”We found no evidence on other prescribed harms including care fragmentation, patient decisional conflict, patient anxiety, increased adverse drug events, prescriber confusion, and prescriber dissatisfaction,” the article states. This statement can be interpreted to mean that the authors found that MTM causes no harm to patients, and it presents no adverse disruption of care to the system of care. Did this published review of the MTM literature produce any other findings that infer potential harm to patients from MTM? It appears not. 112 JAPhA | 5 5:1 | JAN/F E B 2 0 1 5
Based on 32 studies in which one or more intermediate patient outcomes were quantified, MTM significantly improved medication appropriateness (P
Medication therapy management: Primum non nocere Patrick G. Clay
A tenet of medicine is the overarching guiding principle of first not harming patients when providing care. A recently published systematic review of medication therapy management (MTM) literature concluded that the strength of evidence on the benefit of MTM was insufficient and imprecise in many regards.1 In examining the methodology these authors applied to the existing body of literature, their conclusion accurately reflects the approach taken in this assessment. However, it is important to peel back the layers of statistical analyses and scrutinize the report for insights and tips on how to address the shortcomings in the body of evidence that our research into MTM has generated. In keeping with the principle of primum non nocere, we must begin with a central question: Does MTM cause harm to either patients or the care system? As with other aspects of this recent review, the authors concluded that the evidence is insufficient to judge MTM with respect to harm. Only one study reported on harms, the authors wrote, and the harm noted was on the inconvenience resulting from monthly appointments. ”We found no evidence on other prescribed harms including care fragmentation, patient decisional conflict, patient anxiety, increased adverse drug events, prescriber confusion, and prescriber dissatisfaction,” the article states. This statement can be interpreted to mean that the authors found that MTM causes no harm to patients, and it presents no adverse disruption of care to the system of care. Did this published review of the MTM literature produce any other findings that infer potential harm to patients from MTM? It appears not. 112 JAPhA | 5 5:1 | JAN/F E B 2 0 1 5
Based on 32 studies in which one or more intermediate patient outcomes were quantified, MTM significantly improved medication appropriateness (P
