Medication Therapy Management

1. Medication Therapy Management The Patient and Provider Variables

2. 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

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

4. 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?

5. The Patient Interview • Gathering social history • Marital status, living situation, cooking • Occupation • Tobacco, alcohol, caffeine • Past medical history • Family medical history

6. 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

7. 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

8. The Patient InterviewMedications • Safety • Ask about common side effects • Ask about adverse reactions • Evaluate drug interactions • Evaluate disease interactions • Mention monitoring guidelines

9. 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

10. 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

11. 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

12. 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

13. Efficient Patient Communication • Communicating evaluation comments • Prepare a generic cover letter to patients, then personalize it • Don’t duplicate documenting efforts! • Prepare evidence-based, patient-friendly evaluation comments • Include an indication/medication list

14. ProviderCommunication The Next Step

15. How Will You Communicate With Providers? • Phone? • E-mail? • Fax? • Letter? • Sent to office • Sent with patient visit

16. Efficient Provider Communication • Prepare a generic cover letter to providers that explains MTM and your service • Don’t duplicate documenting efforts! • Prepare evidence-based, patient-friendly evaluation comments • Let the patient be your advocate • Hand delivered by patient at next visit

17. 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

18. 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’

19. Benefits of Collaborative Practice Practice Efficiency and Deliverables

20. 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

21. Collaborative Practice Agreements • Community based agreement ideas • Lantus adjusting • Diabetes meter (SMBG) training • Seasonal allergies • Asthma management • And many more…

22. Medication Therapy Management Recruiting Patients

23. 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

24. 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

25. 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!

26. Questions?