IMM 13: MTM in CP I – Medication Review Service Flashcards
What is a medication review?
patient-care service provided by a pharmacist that seeks to enhance a patient’s understanding of their medication regimen, identify and resolve drug therapy problems, and improve health outcomes
What do pharmacists provide the patient with a copy of at the end of a medication review?
best possible medication history (BMPH)
What are the eligibility criteria for a medication review service funded by Pharmacare? (7)
- BC resident
- BC PHN
- not covered under Pharmacare Plan B
- minimum of 5 different qualifying medications entered on PharmaNet within last 6 months, and before medication review service provided
- clinical need for service
- not exceeded the allowable number of medication review services
- sign acknowledgement on BPMH form
What are the qualifying medications for a medication review service?
- prescription medication (schedule 1 drug)
- compounded prescription medication (with discrete PIN)
- insulin – but multiple types only count as one qualifying
individual DINs and PINs may be counted only once
What are the non-qualifying medications for a medication review service?
- non-prescription products (except insulin) regardless of whether they are benefit on Pharmacare – OTC, vitamins and nutritional supplements, natural/homeopathic products, non-prescription compounds, vaccines (privately or publicly funded)
- prescriptions with ‘discontinued’ status in Pharmanet
- prescriptions that have been reverse in Pharmanet
- prescriptions with ‘not filled’ status in Pharmanet
- non-drug supplies (ie. blood glucose testing supplies, insulin pump supplies, medical equipment and supplies)
What indicates a clinical need for a medication review service?
- prescriber has requested a medication review
- patient has multiple diseases
- patient has one or more chronic diseases
- patient’s medication regimen includes one or more non-prescription medications
- patient’s medication regimen includes one or more natural health products (NHPs)
- patient has a drug therapy problem
- patient was recently discharged from hospital
- patient has multiple prescribers
- patient is receiving medication(s) that require lab monitoring
What is the allowable number of MR-S or MR-PCs?
eligible for either one MR-S or MR-PC (but not both) every 6 months
- not eligible for MR-S or MR-PC if they have received MR-PCN within last 6 months – but are still eligible for up to 4 MR-F in community within 12 months
What is the allowable number of MR-Fs?
eligible for up to 4 MR-F every 12 months
- must have already received MR-S or MR-PC or MR-PCN in the last year
What are the 3 types of medication review services at community pharmacies?
- Medication Review – Standard (MR-S)
- Medication Review – Pharmacist Consultation (MR-PC)
- Medication Review – Follow-up (MR-F)
What are the required activities for medication review service in community pharmacy? (4)
- provided by an authorized pharmacist, or pharmacy student under supervision of authorized pharmacist
- provided as one-on-one in-person appointment
- provided in a suitable area that the patient accepts as respectful of their right to privacy
- provided and documented in accordance with the specific requirements of BC Pharmacare policies
Medication Review – Standard (MR-S)
- medical issues – ie. allergies and reactions
- current and recently discontinued medications – prescription, non-prescription, NHPs
- information collected from: Pharmanet, local pharmacy medication profile, interview with patient (or legal representative), hospital discharge summaries, other available records
- determine whether patient is currently taking each medication and how they are taking it
- document any clinically relevant medication the patient is no longer taking
- discuss, review, and document details of each medication currently being taken with the patient (or their legal representative): what medication the patient is taking (name, strength, dosage form), why the patient is taking the medication (what disease, condition, or symptoms are being alleviated or controlled by the medication), how to best take the medication (when to take it, how to take it, warnings), any special instructions
- document all information relevant to continuity of care – ie. details about decisions, evaluations, plans of action, and other directions or observations
- ensure all forms are fully completed
- obtain signature from patient (or legal representative) in Patient Acknowledgement section of BMPH
- provide copy of completed and signed Patient section BMPH to patient (or legal representative)
- retain signed original at pharmacy for record – store all documents together for future reference
Medication Review – Pharmacist Consultation (MR-PC)
takes place if a minimum of one drug therapy problem (DTP) is identified, resolved and documented during the course of a medication review service
- if a DTP is identified during a MR-S, the pharmacist is professionally responsible for taking action by working to resolve the issue or referring the patient to an appropriate health care professional
- if the pharmacist takes action to resolve the issue and completes the DTP documentation, a MR-PC claim may be submitted
- document the identification and actions taken/to be taken to resolve the DTP(s)
- pharmacist works with patient to: identify DTPs, prepare care plan to resolve each DTP, implement care plan, create monitoring plan and follow-up
- document all DTP-related decisions, plans, and actions decided upon during appointment
- notify (and if necessary, collaborate with) most responsible physician(s) about DTP, care plan, and results achieved
What are some actions of pharmacists to resolve DTPs?
- adapt prescription
- give immunization (public)
- give immunization (private)
- contact prescriber to change/start/stop Rx
- change/start/stop non-Rx
- eliminate patient barrier
- provide education
- initiate monitoring
- refer to medical physician
- refer to other health professional
- other recommendation (specify)
Medication Review – Follow-up (MR-F)
provided if there is a clinical need that requires either (a) follow-up due to subsequent medication change that is entered on Pharmanet, or (b) follow-up to implement and/or evaluate patient’s response to action taken to resolve DTP
complete required activity for follow-ups:
- follow-up due to subsequent medication change (that is entered on Pharmanet) – speak with patient to review, correct, or update information and improve patient’s understanding about medication changes
- follow-up to implement and/or evaluate patient’s response to action taken to resolve DTP – review and evaluate patient’s progress with their DTP, and if necessary, modify the plan to help patient reach their goal
How much can pharmacies claim for an MR-S?
$60
