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PCC Lectures > Drug Therapy Problems and Medication Therapy Management > Flashcards

Drug Therapy Problems and Medication Therapy Management Flashcards

1
Q

What is a drug therapy problem?

A

A drug therapy problem is any undesirable event experienced by a patient that involves, or is suspected to involve, drug therapy, and that interferes with achieving and desired goals of therapy and requires professional judgement to resolve.

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2
Q

What are the components of drug therapy problems?

A
  1. An undesirable event or risk of an event experienced by the patient. The problem can take the form of a medical complaint, sign, symptom, diagnosis, disease, illness, impairment, disability, abnormal laboratory value, or syndrome. The event can be a result of physiological, sociocultural, or economic conditions.
  2. The drug therapy (products and/or dosage regimen) associated with the problem
  3. The relationship that exists 9or is suspected to exist between the undesirable pt event and drug therapy. (consequence of drug therapy and need to add/modify drug therapy)
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3
Q

What are examples of the problem category for indication?

A
  • Unnecessary drug therapy
  • Needs additional drug therapy
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4
Q

What are examples of the problem category for effectiveness?

A
  • Ineffective drug
  • Dose to low
  • Needs additional monitoring
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5
Q

What are examples of the problem category for safety?

A
  • Dose too high
  • Adverse drug reaction
  • Needs additional monitoring
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6
Q

What are examples of the problem category of adherence?

A
  • Non-adherence
  • Cost
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7
Q

What questions do you need to ask yourself for each medication?

A

Is the medication indicated? Are all medical conditions being treated?
Is the medication effective?
Is the medication safe?
Can the patient adhere?

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8
Q

What are unnecessary drug therapy?

A
  • duplicate therapy
  • no medical indications
  • non-drug therapy more appropriate
  • addiction/recreational drug use
  • Treating avoidable adverse reaction
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9
Q

What are examples of additional drug therapy?

A
  • preventative therapy
  • untreated condition
  • synergistic therapy
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10
Q

What are examples of ineffective drugs?

A
  • More effective drug available
  • Condition refractory to drug
  • Dosage form inappropriate
  • Contradiction present
  • Drug not indicated for condition
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11
Q

What are phrases that signify dosage too low?

A
  • Ineffective dose
  • Needs additional monitoring
  • Frequency inappropriate
  • Incorrect administration
  • Drug interaction
  • Incorrect storage
  • Duration inappropriate
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12
Q

What is a phrase to show that the effectives of medication is not up to par?

A

Medication requires monitoring pertaining to its effectiveness.

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13
Q

Terms to use when sharing adverse drug reaction.

A
  • Undesirable effect
  • Unsafe drug for patient
  • Drug interaction
  • Incorrect administration
  • Allergic reaction
  • Dose increase/decrease too fast
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14
Q

What are terms you should use to signify that the dose is too high?

A
  • Dose too high
  • Needs additional monitoring
  • Frequency too short
  • Duration too long
  • Drug interaction
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15
Q

What are some terms that you can use to indicate safety concern for needs additional monitoring?

A

Medication requires monitoring pertaining to its safety.

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16
Q

What are some phrases used to signify non-adherence?

A
  • Does not understand instructions
  • Pts prefers not to take
  • Pt forgets to take
  • Drug product not available
  • Cannot swallow/administer drug.
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17
Q

What are some phrases used to signify DTP rooted in cost?

A
  • Drug product too expensive
  • More cost-effective medication available
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18
Q

When stating a DTP, what are the three components of the problem?

A
  1. A description of the patient’s medical condition or clinical state.
  2. The drug therapy involved (causing or solving the problem).
  3. The specific association between the drug therapy and patient’s condition.
19
Q

How to prioritize DTP?

A

Based on….
- Urgency/severity of problem
- Patient wishes

Need to ensure all DTPs ultimately resolved and patient is monitored for new DTPs.

20
Q

How do physical assessments vary by pharmacists?

A

Will vary by pharmacist’s experience, setting, and scope of practice.
- Minimal (BP measurement) to quite extensive (listening to lung sounds)

21
Q

Give examples of equipment pharmacists use.

A
  • POC Devices: blood glucose, A1C, lipids
  • Assessment tools: adherence questionnaires; depression screeners
22
Q

How does inpatient vs outpatient care vary?

A
  • specific type of DTPs encountered
  • information sources used when assessing DTPs/information that is readily available
  • extent of physical assessment conducted and equipment used
  • documentation of DTPs
  • Payment for services designed to support identification and resolution of DTPs.
23
Q

What is one example of how pharmacists, specifically in community settings, are being paid to complete the PPCP to identify and resolve DTPs?

A

Medication Therapy Management

24
Q

Define Medication Therapy

A
  • lead by joint commission of pharmacy practitioners
  • Representatives of 13 national pharmacy organizations

Medication Management Services (MMS)
- “a spectrum of patient-centered, pharmacist-provided, collaborative services that focus on medication appropriateness, effectiveness, safety, and adherence with the goal of improving health outcomes.
- MTM is one service example under the MMS umbrella
- All MMS are delivered following the PPCP

25
Q

What are core elements of MTM?

A
  • Medication Therapy Review (MTR)
  • Personal Medication Record (PMR)
  • Medication-related Action Plan (MAP)
  • Intervention and/or Referral
  • Documentation and Follow-up

CORE ELEMENTS FOLLOW THE STEPS OF THE PHARMACISTS’ PATIENT CARE PROCESS

26
Q

Describe the MTR

A

Medication Therapy Review; systemic process of collecting patient specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them.

27
Q

Compare comprehensive MTR vs targeted MTR

A

Comprehensive MTR:
- Conversation between pharmacist and patient
- Pharmacist reviews all the patient’s medications (Rx, OTC, herbals, etc) and identifies any medication-related problems and strategies for resolution, and provides patient education.

Targeted MTR:
- Often completed after the comprehensive is completed
- Conversation and or assessment focused on one or more medication-related problems

28
Q

What is the PMR?

A

Personal Medication Record

  • Implement step of patient care process (providing education and self-management support)
  • Comprehensive record of patient’s medications (prescription and nonprescription medications, herbal products, and other dietary supplements)
  • Patient centered document that should be used by the patient and/or caregiver
  • PMR should be carried by the patient and presented to each health care provider seen.
  • Should be updated as needed and pharmacist may provide updates during the appointment.
29
Q

What is the information sometimes included on the PMR?

A
  • Patient and caregiver name/contact info
    -Doctor and pharmacist name/contact info
  • Date updated and reviewed with provider
  • Medication information (Name/dose, indication, directions, start/stop dates, etc)
  • Other notes for patient (additional medication instructions, reminders of questions they want to ask doctor)
  • Allergy information
30
Q

Describe the MAP implementation step

A

Medication-Related Action Plan
- Implement step of patient care process (providing education and self-management support)
- A patient centric document containing a list of actions for the patient to use in tracking progress for self-management
- Provides the patient with a to do list for managing medication adherence
- May include date of patient’s next MTM appointment

31
Q

Describe the intervention/referral plan of the implementation step

A
  • Implement step of patient care process (addressing problems)
  • Pharmacist intervenes with patient to resolve medication-related problems within the scope of pharmacy practice
  • Refers patient back to their physician or requests physician approval to resolve medication-related problems that require actions outside of their scope of practice
  • Referrals may include those to their health professionals as appropriate.
32
Q

Describe the documentation and follow-up needed in the implementation step

A
  • Implement and follow-up steps of patient care process
  • Specific format depends on health care setting where MTM performed
  • May include patient demographics, findings from objective assessments, prioritized list of medication-related problems, interventions/recommendations, plan for monitoring, etc.
  • Includes documentation required for billing.
33
Q

What is the difference of MTM vs Patient Counseling?

A
  • Patient-centered versus product-centered
  • Includes a comprehensive MTR versus a focus on only one drug product
  • Conversation between pharmacist and patient is 2 way in MTM; In counseling the conversation can by 1-way with the pharmacist providing the patient with specific education points about the medication being dispensed
  • MTM services independent of, but can occur in conjunction with, the provision of medication product”
  • MTM requires documentation of the visit information.
  • Compensation for MTM not related to drug product provision
  • Intervention/Follow-up a part of the MTM core elements but not necessarily a part of patient counseling
  • Patient interactions while dispensing/counseling may lead to MTM visits.
34
Q

How is an MTM different than Disease State Management?

A

The primary focus in an MTM visit is on the patient’s entire medication regimen rather than on ensuring that a patient meets therapy goals for one specific disease state. Patients may need both MTM and DSM.

35
Q

Who pays for MTM?

A

Healthcare payers
- Commercial plans: most adults receive health insurance from their employer
- Medicare: Federal program that provides insurance to those 65 years and with certain disabilities
- Medicaid: Federal/State partnership (administered at State level) that provides insurance to very low-income families with a focus on children

Social Security Act
- Lists health professions considered “Providers”; only these providers can bill Medicare for their services. Most other payers will follow what Medicare does. - Pharmacists NOT included; many advocacy efforts attempting to get pharmacists added

36
Q

Describe Medicare Part D MTM

A
  • Part D established through the Medicare Prescription Drug Improvement, and Modernization Act of 2003 (MMA) and launched in 2006.
  • Part D includes prescription drug benefit and MTM services for targeted beneficiaries
37
Q

What is the purpose of MTM services?

A

to optimize therapeutic outcomes for targeted beneficiaries by improving medication use and reducing adverse drug events (ADEs)
- enhance enrollee understanding of medications
- increase adherence
- detect ADEs and medication under/over-use

38
Q

What are the CMS Guidelines for Part D MTM in 2024?

A

Eligibility criteria: either 1 or 2 must be met-
1. All of these
- Drug spend in Part D medications >$5,330
- Multiple Part D medications greater or equal to 2 to 8
2. At-risk beneficiary

Plan must target at least 5 of nine:
- Alzheimer’s
- ESRD (End-Stage Renal Disease)
- Hypertension
- CHF (congestive heart failure)
- DM (diabetes mellitus)
- HLD (hyperlipidemia)
- Respiratory Disease (COPD, asthma, other chronic lung disorders)
- Bone disease/arthritis (osteoporosis, osteoarthritis, rheumatoid arthritis)
- Mental health disorders (depression, bipolar disorder, schizophrenia, other “chronic and disabling disorders)

39
Q

What are the CMS Guidelines for Part D MTM?

A
  • May be provided by pharmacist or other qualified provider
  • Must provide CMR annually and targeted medication reviews at least quarterly
  • Must use systematic process to summarize interaction
40
Q

How may Medicare Part D MTM change in 2025?

A
  1. The addition of HIV/AIDS as a core chronic disease for targeting.
  2. Cost threshold now based on average cost of eight generic drugs ($1,623 in 2025)
41
Q

Describe the Purdue MTM Program

A
  • Launched in May 2024
  • Contracted with Clarest Health
  • Expands access to MTM for Purdue insurance members
  • Can now access MTM at Center for Healthy Living AND now through network of community pharmacies contracted with Clarest Health
  • Clarest Health call center also completing virtual MTM appointments when needed
42
Q

Compare Purdue’s MTM Program to Part D

A
  • Everyone with Purdue Insurance is eligible
  • Every Medication fill every time is eligible for a TMR (pays $12 each)
  • Patients can receive up to 5 CMRs in a year (pay $75 each)
  • Pharmacists can self-enroll patients if they feel they need a CMR
  • PUP is one of the pharmacies in the network
43
Q

What are some challenges to MTM implementation?

A
  • patient engagement
  • physician/provider support
  • lack of health information exchange in some settings
  • time required for documentation/billing
  • limited billing opportunites

PCC Lectures (21 decks)

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