Communicating with Other Healthcare Providers Regarding MTM Session 2

1
Wednesday, December 13, 2006 UPN
063-999-06-021-L04
2
Communicating with Healthcare Providers Regarding
MTM

• Heather Kruse, Pharm.D.
• Assistant Professor of Pharmacy Practice
• South Dakota State University
• Clinical Pharmacist Lewis Drug Stores

3
Market Your MTM Services

• Let other healthcare providers know about your
  service in advance
• In person (ideal)
• Brochures/mailers
• Fax
• Phone
• Provider is not caught off guard if informed
  ahead of time

4
Contacting Providers with Recommendations

• Do NOT imply that the prescriber did something
  wrong
• Do NOT provide recommendations without offering
  potential solutions
• DO mention the potential benefits to the patient
  if changes are made
• DO reference evidence-based guidelines

5
Contacting Providers with Recommendations

• Example
• I recently met with your patient, Mrs. Jane
  Smith, for a medication review. During the
  visit, Mrs. Smith presented a list of her recent
  BP readings which were 140/91, 143/89, 138/90.
  According to the ADA guidelines and the JNC-7,
  Mrs. Smith is not meeting her BP goal of less
  than 130/80 as a type 2 diabetic. Please
  consider an increase in her current dose of
  lisinopril from 10 to 20mg per day, to offer
  better protection against complications of
  hypertension and diabetes. Thanks for your
  consideration.

6
Contacting Providers with Recommendations

• Use words or phrases like
• Please consider......
• Be concise, yet complete
• Only provide information that is necessary to
  make an informed decision
• Provide an easy way to respond
• Allow provider to check a box or initial next to
  a recommendation, etc

See Example Physician Authorization Request Form
in Attachment Section
7
Contacting Providers with Recommendations

• Find out how the provider would like to
  communicate in the future
• Fax
• Phone
• Email
• Combination
• Be open to provider suggestions or ideas

8
Case Presentation
9
Case Presentation

• Robert Smith is a 69-year old male patient who
  has been assigned to your pharmacy for an MTM
  visit. Robert agrees to meet with you next week
  for the review. What should you ask him to bring
  to the appointment?

10
Case Presentation

• After placing a phone call to Robert, he agrees
  to set up an MTM visit with you at the pharmacy.
  Before meeting with Robert, what should you do to
  prepare?

11
Case Presentation

• The online chart lists the following medications
  for Robert -Crestor 10mg 1 qd -Prevacid 30mg 1
  qam -Temazepam 15mg 1 qhs prn
• -Hydrochlorothiazide 25mg 1 qam -Avodart 0.5mg
  1 qhs
• -Metoprolol 25mg 1 bid

12
Case Presentation

• Roberts fills out the health history form which
  reveals the following
• Drug Allergies Sulfa
• Past Medical History Hypertension,
• MI-3 years ago, GERD, insomnia, BPH, high
  cholesterol
• Robert is married, does not use tobacco,
  exercises 3 times weekly x 20 minutes

13
Case Presentation

• You are ready to begin the MTM session with
  Robert. What GENERAL questions will you want to
  ask him regarding his medications?

14
(No Transcript)
15
(No Transcript)
16
Case Presentation

• Medication Concern I met with your patient,
  Robert Smith, today for a medication review.
  Robert reports that his systolic BP is
  consistently running in the 140s (Goallt140/90,
  JNC-7). His BP reading today was 143/81 at the
  pharmacy. Robert also has a past history of MI,
  and therefore, would likely benefit from the
  addition of an ACE-inhibitor to his regimen.
  (ACC/AHA Clinical Guidelines) Secondly, Robert
  reports taking his temazepam 15mg every night
  before bed, vs. just on an as needed basis. He
  also reports waking up pretty groggy on most
  mornings.

17
Case Presentation

• Proposed Changes Based on his elevated BP
  readings and his past history of MI, would you
  consider adding lisinopril 10mg to RSs
  medication regimen?
• In regards to his temazepam, a decrease in dose
  to 7.5mg nightly would decrease his risk for side
  effects or future adverse reactions. Please
  advise.
• Thanks for your consideration.

18
Case Presentation

• When completed, provide the following to Robert
• The PMR with his complete listing of medications
  (Rx and OTC)
• A patient-centered version of the MAP with
  proposed resolutions to problems
• Keep copies of all documentation on file and
  follow-up with patient as needed

19
Questions?
20
Preliminary Efforts to Establish Quality
Measures of Medication Therapy

• Jane R. Mort, Pharm.D.
• Professor of Pharmacy Practice
• South Dakota State University
• Consultant to
• South Dakota Foundation for Medical Care

21
Design Process

• Current measures
• BearingPoint created
• (BearingPoint. Draft Medication Measures for the
  Quality Improvement Organizations. CMS Contract
  No. HHSM-500-2005-00035C)
• Input on measures by stakeholders, Technical
  Expert Panel, and QIOs led to subsequent revision
• Measures use Prescription Drug Event (PDE) data
• Measures under revision
• Measures are being tested and revised
• Additional measures using integrated data will be
  developed
• Florida Quality Improvement Organization is
  carrying out
• CMS government task leader for the Part D project
  has stated that these measures are far from being
  publicly reported or being used for
  accountability

22
Hurdles in the Development

• Drug proxies are used instead of diagnosis
  because of data limitations
• Currently lab data can not be checked for PDPs
  but CPT codes may be checked for MA-PDs.

23
1. Patient Safety Criteria

• Percent of Part D enrollees with
• 1.1 gt 1 Drug Interaction
• 1.2 gt 1 Potentially Inappropriate Medication
  (PIM)
• 1.3 Warfarin
• low, moderate, or high intensity dosing (lt5mg, gt5
  to lt10mg, gt10mg, respectively)

24
Drug Interactions
25
PIM
26
2. Disease Specific Criteria

• Diabetes Mellitus
• Percent of Part D enrollees with Diabetes
  Mellitus
• 2.1 Lipid lowering medication
• 2.2 ACEI and/or ARB
• 2.3 Medication Possession Ratios (MPR) gt0.8 for
  gt1 persistent medication
• Oral hypoglycemic, statin, ACEI, ARB

27
Diabetes Proxy

• Insulin
• gt 2 oral hypoglycemic medications
• 1 fill of oral hypoglycemic for gt 30 day supply

28
Medication Possession Ratio (MPR)

• MPR sum of the days supply dispensed for each
  refill form the first to the last refill, divided
  by the days between first and last refill plus
  the days supply for the last refill

29
2. Disease Specific Criteria

• Heart Failure
• 2.4 Percentage of Part D enrollees with Heart
  Failure with ACEI and/or ARB

30
Heart Failure Proxy

• Loop diuretic digoxin beta blocker
• Loop diuretic aldosterone antagonist digoxin
• Use for 90 days of last 6 months or 180 days of
  last 12 months.

31
2. Disease Specific Criteria

• Coronary Artery Disease
• Percentage of Part D enrollees with CAD
• 2.5 Statin
• 2.6 MPR gt0.8 for statin

32
CAD Proxy

• Nitrates beta blocker
• Nitrates clopidogrel
• 90 days supply in a 6 month period or 180 days in
  a 12 month period

33
3. Therapeutic Monitoring

• 3.1 Percentage of Part D enrollees with Diabetes
  Mellitus
• A1c ordered (ADA twice a year unless
  therapeutic changes then quarterly)
• Nephrology screening ordered (microalbuminuria
  and serum creatinine)

34
3. Therapeutic Monitoring

• Percentage of Part D enrollees with
• 3.2a ACEI/ARB with K level AND creatinine or BUN
  ordered
• 3.2b Digoxin with K level AND creatinine or BUN
  ordered
• 3.2c Digoxin and digoxin level ordered

35
3. Therapeutic Monitoring

• Percentage of Part D enrollees with
• 3.3 Warfarin and proper monitoring (INR lt every 6
  weeks)

36
(No Transcript)