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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

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Medication Therapy Management

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  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?

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