Transcript The Patient Interview

Medication Therapy
Management
The Patient and Provider Variables
Efficiencies in MTM
Practice
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Managing the patient interview
– Gathering pertinent information
– Keeping patients on track
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Documenting the encounter
Communicating with providers
Utilizing collaborative practice
agreements
Recruiting your patients
Interviewing Tips
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Use open-ended questions
Let the patient talk
Address patient concerns first
Steering talkative patients
The Patient Interview
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Introduction of MTM
– Indicated, effective, safe,
convenient
– Explain how this is different than
dispensing
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Patient’s chief complaint
– What are your main concerns about
your medications or health care?
The Patient Interview
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Gathering social history
– Marital status, living situation,
cooking
– Occupation
– Tobacco, alcohol, caffeine
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Past medical history
Family medical history
The Patient Interview
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Allergies and adverse reactions
Objective information
– Lab results if they have them
– Self monitoring of blood sugars
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Download their meter
– Blood pressure
– Weight
– Peak flows
The Patient Interview:
Medications
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Finally, the medications!
– Indication
Separate medications by indication
 Address chief complaint first
 Vitamins, herbal supplements
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– Effectiveness
Explain goals of therapy
 Ask about symptoms
 Ask about frequency of PRN meds
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The Patient Interview
Medications
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Safety
–Ask about common side effects
–Ask about adverse reactions
–Evaluate drug interactions
–Evaluate disease interactions
–Mention monitoring guidelines
The Patient Interview,
Medications
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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
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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
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– Objective
The Patient Interview
Evaluation Comments
Utilizing the SOAP format
– Assessment/plan
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Patient self-management education
provided on:
– Disease & patient non-drug action steps
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‘Medication comments/concerns
include:’
– These are your drug therapy problems!
– Broken into disease state and numbered out
– Potential solutions suggested
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Time spent with patient
Efficient Patient
Communication
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Communicating evaluation
comments
– Prepare a generic cover letter to
patients, then personalize it
– Don’t duplicate documenting efforts!
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Prepare evidence-based, patientfriendly evaluation comments
– Include an indication/medication list
Provider
Communication
The Next Step
How Will You Communicate
With Providers?
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Phone?
E-mail?
Fax?
Letter?
–Sent to office
–Sent with patient visit
Efficient Provider
Communication
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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
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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
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May wish to evaluate continued need
for…
– Vs. ‘No medical indication’
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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
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Allow us to make immediate
changes in drug therapy
– Immediate deliverable to patients
– Easier to justify to cash patients
– Makes follow-ups more valuable
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Not difficult to implement
– Ask your providers what bothers
them and act on it
Collaborative Practice
Agreements
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Community based agreement
ideas
–Lantus adjusting
–Diabetes meter (SMBG) training
–Seasonal allergies
–Asthma management
–And many more…
Medication Therapy
Management
Recruiting Patients
Recruiting Patients
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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
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Pharmacy already providing great
service!
– Been coming here for years
– Answering their questions
– Checking for drug interactions
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Clinic always checks my drug list
– ‘Dr has followed me for 20 years’
– Worried what the doctor will think
Recruiting Patients
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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?