| Intermediate Outcome | Study Design: No. Studies (N Patients Analyzed) | Strength of Evidence | Supporting Judgment | Findings and Direction of Effect |
|---|---|---|---|---|
| Anticoagulation | RCT: 1 (10) | Insufficient | Medium study limitations, consistency unknown (single study), direct, imprecise | Therapeutic INR achieved, 100% vs. 16.7%; p = 0.048. |
| HbA1c | RCT: 2 (102) | Insufficient | Medium study limitations, inconsistent, direct, imprecise | One trial with significantly greater percentage of patients with HbA1c <7.5% at 12 months. |
| Cohort: 2 (2,688) | Insufficient | High study limitations, inconsistent, direct, imprecise | One study: adjusted findings significant at 12 months for percentage with HbA1c <7%, but findings not maintained at 24 months. Other study: no change in mean HbA1c or percentage <7% at 6 months. | |
| Low-density lipoprotein cholesterol | RCT: 1 (38) | Insufficient | Medium study limitations, consistency unknown, direct, imprecise | Calculated OR, 56.00; 95% CI, 5.583 to 561.753. |
| Cohort: 2 (3,062) | Insufficient | High study limitations, inconsistent, direct, imprecise | One study: adjusted difference in difference coefficient,1.95; 95% CI, 0.81 to 4.84; p = 0.13. Other study: calculated OR for achieving LDL goal,1.392; 95% CI, 1.160 to 1.670; p <0.001. | |
| BP | RCT: 1 (53) | Insufficient | Medium study limitations, consistency unknown, direct, imprecise | MTM group 28 times more likely to achieve BP goals than controls. |
| Cohort: 2 (2,507) | Insufficient | High study limitations, consistent within design but inconsistent with RCT, direct, imprecise | MTM group less likely to achieve BP goals than controls. | |
| Drug therapy problems identified | Cohort: 1 (582) | Insufficient | High study limitations, consistency unknown, indirect, imprecise | Risk difference, 6.1%; calculated p = 0.062. |
| Number of drug therapy problems resolved | Cohort: 1 (120) | Insufficient | High study limitations, consistency unknown, indirect, imprecise | Calculated mean difference, -1.00; 95% CI, -1.967 to -0.033; p = 0.04. |
| Medication adherence measured as proportion adherent to a threshold | RCT: 1 (69) | Insufficient | Medium study limitations, consistency unknown, direct, precise | 100% of intervention patients and 88.9% of controls were adherent; p = 0.115. |
| Cohort: 2 (224 to 200,722) | Low for benefit | High study limitations, inconsistent, direct, precise | Two studies with findings in opposite direction; larger study showing range of ORs for medication-specific adherence depending on medication. For comparison of PDP vs. controls, ORs ranged from 0.99 to 1.43; 95% CIs ranged from (0.90, 1.08) to (1.26, 1.62). For comparison of MA-PD vs. controls ORs ranged from 1.10 to 1.40; 95% CIs ranged from (0.83, 1.24) to (1.29, 1.52). For clinic-based MTM vs. usual care for adherence to aspirin, odds of adherence ranged from 5.981 (95% CI, 0.284 to 126.030; p = 0.250) during the intervention to 1.17 1 year after the intervention (95% CI, 0.072 to 18.903; p = 0.912). | |
| Medication adherence measured as percentage of prescribed doses taken | Cohort: 2 (120 to 4,500) | Low for benefit for adherence to treatment for hypertension and dyslipidemia Insufficient for treatment of patients with diabetes, depression, and asthma | High study limitations, inconsistent, direct, imprecise | Calculated mean difference from small study, -0.040; 95% CI, -0.101 to 0.021; p = 0.201. Larger study found a small (difference in adherence ∼4.6%) but statistically significant effect of MTM on adherence to medications for some (2 of 5) conditions but no significant effect for the other conditions. |
| Medication adherence using self-report measures | RCT: 1 (292) | Insufficient | Medium study limitations, consistency unknown, direct, imprecise | Calculated mean difference, 0.090; 95% CI, -0.076 to 0.256; p = 0.289. |
| Medication adherence, miscellaneous measures | RCT: 2 (365) | Insufficient | Medium study limitations, inconsistent, direct, imprecise | Two studies with opposite direction of effect, both with nonsignificant differences between groups. |
| Medication Appropriateness General Index Scores | RCT: 1 (208) | Low for benefit | Low study limitations, consistency unknown, direct, precise | Improvement in MTM group from score of 17.7 to 13.4 at 3 months and 12.8 at 12 months. |
| Medication-specific appropriateness | RCT: 2 (261) | Insufficient | Medium study limitations, inconsistent, direct, imprecise | Significant improvement in appropriateness in the MTM group for some medications but not others. |
| Medication dosing | RCT: 1 (56) | Low for benefit | Medium study limitations, consistency unknown, indirect, precise | Mean difference, -2.2 doses; calculated 95% CI, -3.738 to-0.662. |
| Goals of therapy | 0 | NA | NA | NA |
| Patient engagement | 0 | NA | NA | NA |
BP = blood pressure; CI = confidence interval; HbA1c = hemoglobin A1c; INR = International Normalized Ratio; LDL = low-density lipoprotein; MA-PD = Medicare Advantage Part D Plan; MTM = medication therapy management; NA = not applicable; OR = odds ratio; PDP = Medicare Part D Plan; RCT = randomized controlled trial.
From: Executive Summary
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