Medication Therapy Management:
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Transcript Medication Therapy Management:
Medication Therapy
Management
The Patient and Provider Variables
Efficiencies in MTM
Practice
Managing the patient interview
– Gathering pertinent information
– Keeping patients on track
Documenting the encounter
Communicating with providers
Utilizing collaborative practice
agreements
Recruiting your patients
Interviewing Tips
Use open-ended questions
Let the patient talk
Address patient concerns first
Steering talkative patients
The Patient Interview
Introduction of MTM
– Indicated, effective, safe,
convenient
– Explain how this is different than
dispensing
Patient’s chief complaint
– What are your main concerns about
your medications or health care?
The Patient Interview
Gathering social history
– Marital status, living situation,
cooking
– Occupation
– Tobacco, alcohol, caffeine
Past medical history
Family medical history
The Patient Interview
Allergies and adverse reactions
Objective information
– Lab results if they have them
– Self monitoring of blood sugars
Download their meter
– Blood pressure
– Weight
– Peak flows
The Patient Interview:
Medications
Finally, the medications!
– Indication
Separate medications by indication
Address chief complaint first
Vitamins, herbal supplements
– Effectiveness
Explain goals of therapy
Ask about symptoms
Ask about frequency of PRN meds
The Patient Interview
Medications
Safety
–Ask about common side effects
–Ask about adverse reactions
–Evaluate drug interactions
–Evaluate disease interactions
–Mention monitoring guidelines
The Patient Interview,
Medications
Convenience
– Remember to take medications?
Evaluate frequency of dosing
Evaluate timing of various
medications
–Auxiliary labels at dispensing
– Affordability
Utilize insurance formulary
Utilize therapeutic alternatives
The Patient Interview,
Wrap-up
Summarize the visit
– We found and decided to…
Identify drug therapy problems & action
items
– I will…
Send a medication list & summary of visit
Communicate with health care provider(s)
– You will…
Changes not dependent on health care
provider
Set a follow-up time and say why
The Patient Interview
Evaluation Comments
Utilizing the SOAP format
– Subjective
How referred
Chief complaint
Social history
Past medical history, comments on
diagnosis
Broken into disease state
– Objective
The Patient Interview
Evaluation Comments
Utilizing the SOAP format
– Assessment/plan
Patient self-management education
provided on:
– Disease & patient non-drug action steps
‘Medication comments/concerns
include:’
– These are your drug therapy problems!
– Broken into disease state and numbered out
– Potential solutions suggested
Time spent with patient
Efficient Patient
Communication
Communicating evaluation
comments
– Prepare a generic cover letter to
patients, then personalize it
– Don’t duplicate documenting efforts!
Prepare evidence-based, patientfriendly evaluation comments
– Include an indication/medication list
Provider
Communication
The Next Step
How Will You Communicate
With Providers?
Phone?
E-mail?
Fax?
Letter?
–Sent to office
–Sent with patient visit
Efficient Provider
Communication
Prepare a generic cover letter to
providers that explains MTM and your
service
Don’t duplicate documenting efforts!
– Prepare evidence-based, patientfriendly evaluation comments
Let the patient be your advocate
– Hand delivered by patient at next visit
Effective Provider
Communication
Emphasize teamwork and
collaboration
Recognize the patient/provider
relationship
Recognize that you may be missing
information
Opportunities to optimize drug therapy
– Vs. Drug therapy problems
Provider Communication:
Choosing Your Words
May wish to evaluate continued need
for…
– Vs. ‘No medical indication’
Could consider…
Studies suggest…
Drug X may provide better…
National guidelines recommend…
Drug X may be contributing
to/aggravating…
– Vs. ‘Contraindication’
Benefits of
Collaborative Practice
Practice Efficiency and
Deliverables
Collaborative Practice
Agreements
Allow us to make immediate
changes in drug therapy
– Immediate deliverable to patients
– Easier to justify to cash patients
– Makes follow-ups more valuable
Not difficult to implement
– Ask your providers what bothers
them and act on it
Collaborative Practice
Agreements
Community based agreement
ideas
–Lantus adjusting
–Diabetes meter (SMBG) training
–Seasonal allergies
–Asthma management
–And many more…
Medication Therapy
Management
Recruiting Patients
Recruiting Patients
Patients to target
– Multiple chronic conditions
– Multiple medications for one
condition
– Multiple medication choices for
condition
– Using a drug delivery device
– Always asking OTC/vitamin
questions
Recruiting Patients,
Counterpoints
Pharmacy already providing great
service!
– Been coming here for years
– Answering their questions
– Checking for drug interactions
Clinic always checks my drug list
– ‘Dr has followed me for 20 years’
– Worried what the doctor will think
Recruiting Patients
Does your medical provider ask about…
– Timing of medication?
– Your copays or cost-saving
opportunities?
– Using your inhaler or drug delivery
device?
Try it! You’ll like it!
9/10 times we find something we can
improve upon! I promise!
Questions?