Medication Therapy Management

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Medication Therapy Management

• The Patient and Provider Variables

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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

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Interviewing Tips

• Use open-ended questions
• Let the patient talk
• Address patient concerns first
• Steering talkative patients

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The Patient Interview

• Introduction of MTM
• Indicated, effective, safe, convenient
• Explain how this is different than dispensing
• Patients chief complaint
• What are your main concerns about your
  medications or health care?

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The Patient Interview

• Gathering social history
• Marital status, living situation, cooking
• Occupation
• Tobacco, alcohol, caffeine
• Past medical history
• Family medical history

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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

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The Patient InterviewMedications

• 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

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The Patient InterviewMedications

• Safety
• Ask about common side effects
• Ask about adverse reactions
• Evaluate drug interactions
• Evaluate disease interactions
• Mention monitoring guidelines

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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

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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

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The Patient InterviewEvaluation Comments

• Utilizing the SOAP format
• Subjective
• How referred
• Chief complaint
• Social history
• Past medical history, comments on diagnosis
• Broken into disease state
• Objective

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The Patient InterviewEvaluation 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

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Efficient Patient Communication

• Communicating evaluation comments
• Prepare a generic cover letter to patients, then
  personalize it
• Dont duplicate documenting efforts!
• Prepare evidence-based, patient-friendly
  evaluation comments
• Include an indication/medication list

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ProviderCommunication

• The Next Step

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How Will You Communicate With Providers?

• Phone?
• E-mail?
• Fax?
• Letter?
• Sent to office
• Sent with patient visit

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Efficient Provider Communication

• Prepare a generic cover letter to providers that
  explains MTM and your service
• Dont duplicate documenting efforts!
• Prepare evidence-based, patient-friendly
  evaluation comments
• Let the patient be your advocate
• Hand delivered by patient at next visit

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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

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Provider CommunicationChoosing 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

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Benefits of Collaborative Practice

• Practice Efficiency and Deliverables

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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

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Collaborative Practice Agreements

• Community based agreement ideas
• Lantus adjusting
• Diabetes meter (SMBG) training
• Seasonal allergies
• Asthma management
• And many more

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Medication Therapy Management

• Recruiting Patients

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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

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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

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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! Youll like it!
• 9/10 times we find something we can improve
  upon! I promise!

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Questions?