MTM powerpoint part 2 Flashcards
Comprehensive medication review and targeted intervention program are all under the umbrella of Medication therapy reviews…CMR is all inclusive and we are not only reviewing medications and conditions but we are also going to take some of the other pieces that we talked about from that first wheel including looking at the patients _____________based on their disease state and medications we can see that they can benefit from certain _________ we are going to look at their health and wellness as a whole we are going to look at medication safety and disease state management and goes into non-medication related topics (health and wellness) if its say someone that has hypertension…its non medication related if we talk to them about how often they measure their __________, what their blood pressure goals are with their healthcare provider, whats their level of __________ throughout the week, we can tell their goals and we can go over those things with them in that comprehensive review because we know that they are not all going to be medication related topics
immunizations
vaccines
blood pressure
exercise
Targeted Intervention Program (TIP) these are pt specific and they are usually potential drug therapy problems, can deal with things like drug therapy ___________, potential drug _____________, suboptimal drugs, suboptimal doses, perhaps ____________companies have found cost effective alternatives that we would first want to see if the patient is open to and then and then we can reach out to the providers and see if they are willing to make that switch
we can also talk to pts about the appropriateness of drug therapy they are currently on and is there perhaps something that is better or do they need what they are on right now…all questions we would research first and then talk with our patient about
drug interactions
duplication
insurance companies
CMR and TIP require some looking into before you speak to the patient so the one that takes the most, review and workup and getting ready is the comprehensive because its all inclusive and your looking at the entire patient as a whole all their medications and all their herbals, all their supplements, you want to ask about their allergies, about their medical conditions, about side effects they had, you want to talk about non medication related topics, you want to talk about health and wellness in general, immunization, want to make sure you are well prepared before you speak to your patient
TIP (Targeted Intervention Program) can be a little quicker so you can look at their drug profile and you can see their on drug X perhaps the insurance company is saying this might be more cost effective through their plan and then making the call to the patient and wording it just like that to them and seeing if there open to reaching out to you there provider etc so that one is a little bit less of the backend work but still take time to do backend work before reaching out to pt
Core elements of MTM
First is medication therapy review.
If its comprehensive medication review its going to also include a _____________ record that we go over with the patient and that we can give to them, whatever we find out if there is something that we can suggest maybe the patient has an issue and then we put it on that medication action ________ and they have record of it, we have record of it and they can take that to their provider and they can advocate or we can advocate and they can also go and talk with them but its all written down so they have that action plan that they feel empowered to go and make change then there’s ____________and or referral so perhaps that’s going on and we need somebody else to take part in it…maybe it’s a pharmacotherapy consult…maybe its somebody we need to get more help or for that complicated medication case so somebody that’s more complex maybe we need somebody that is board certified that they have that advanced expertise and training in that subject area so we want them to intervene or we want to refer to them
Document and make a plan to followup with your patient
personal medication record
plan
intervention
MTR can be conducted face to face, done through a tele conversation or done over the phone and they are always conducted btwn us as pharmacists and the __________themselves or their caregiver…so if it is through caregiver there would have to be permission from the pt to be able to talk to that person abut their health, looking at disease states,allergies, immunizations and overall health and wellness, any gaps in care, are there labs that are overdue that we can suggest that they reach out to their prescriber to obtain are there immunizations that they would be due for…are there further consults that we can recommend, is there an opportunity to identify any medication related problems either that the pt is bringing forward or that we identified in our workup or any healthcare related problems all of which you want to discuss, review, and make a plan in your medication therapy review…
patient
as your working up your patient cases you can have a focus with your patient questions especially when it comes to their medication list so you can go through and ask your patient why they are taking a certain medication and how is it working for them, what concerns do they have, how many times are they missing a dose, keep questions open ended so that your able an open conversation and your engaging with your pts, with open ended question can you find out where a pts knowledge lies and where are there gaps, where you can help to fill in versus just dumping information on them
Personal medication record: what the medication is, whose prescribing it, how pt is taking it, whats happened when they have taken it, how effective has it been and it encourages the patient to have a running list so something that is fluid and flexible something that they can update and something they can share with all of their healthcare providers, reminding our patients how important it is to have a list with them at all times in case something happens or in case they are at the dentist or at another nonprimary care office and they need to have a comprehensive list of all of their medications and it gives that freedom and autonomy and that strength to run their own health and puts that in the patient’s hands
Together with pt we are coming up with a medication action plan so this should always be patient centered and this whole process should be patient centered as we talked about keeping those questions open ended in an effort to empower our patients instead of just dumping information on them and allowing them to say what their concerns are and what they want to see change and making sure that the word choice in this document is directed toward the patient completely using language such as “we” or “I” and it acts as the patients personal plan to move forward but it also helps them to recap what when on during your interaction with them and it allows for their own accountability but our accountability to followup as well and remember as the pharmacist you don’t have to know everything if they have a question for you or if they say I have been dealing with x,y,and z you don’t have to know the answer to everything you are completely within your right to say in the followup piece this is something that we will write in your medication action plan together for you to followup with PCP to have that conversation here are some options or I can followup with you and let you know options
You don’t have to solve every problem instantly and you don’t have to know everything right off the bat…things may require digging…but both the medication records and this action plan will be mailed out to the pt so you have to time to add,substract or do some digging and research and get it out to the pt
Sometimes might need to reach out to home health aids or visiting nurses, maybe pt needs help with transportation, maybe a mental health concern. If you don’t document some could say it never happened
Systematic approach to medication therapy management
When your getting ready to complete medication therapy review so either the comprehensive or the targeted your going to be collecting information, collecting objective from pt’s medication list in your computer system first and then your going to call your pt and your going to collect their subjective information your going to find out how many times a day they test their blood sugar if they have diabetes your going to find out how they take their lisinopril whether or not their medication list says they take it once a day
Followup section of patient care process:What are lab and monitoring parameters look like after 6 months, Are pts feeling better or worse?,If there medication had to be changed
