Practices and Processes of Care

Question 1

1. A 77-year-old man is referred to the pharmacy for medication therapy management (MTM) under Medicare
   Part D. Which best describes why the patient is eligible for MTM under Medicare Part D?
   A. He pays at least $4376 per year for his Part D covered medications, has at least one chronic disease
   state, and takes one medication.
   B. He pays at least $4935 per year for his Part D covered medications, has at least four chronic disease
   states, and takes two medications.
   C. He pays at least $4696 per year for his Part D covered medications, has at least two chronic disease
   states, and takes three medications.
   D. He pays at least $4044 per year for his Part D
   covered medications, has at least three chronic
   disease states, and takes four medications

Answer 1

1. Answer: C
   According to CMS’s definition for 2022, the criteria for
   eligibility of MTM services encompass multiple chronic
   disease states, multiple Part D–covered medications, and
   Part D drug costs of at least $4935 per year and/or are
   at-risk beneficiaries under the plan’s drug management
   program, making Answer C correct and Answers A, B,
   and D incorrect

Question 2

2. A 64-year-old man is referred to the pharmacist by
   his provider for management of uncontrolled diabetes as dictated by the established collaborative drug
   therapy management (CDTM) agreement. Which best
   describes the pharmacist’s general scope of practice
   under a CDTM agreement?
   A. Diagnose the patient with peripheral neuropathy,
   and initiate gabapentin.
   B. Discontinue the patient’s glyburide, and initiate
   glargine.
   C. Order and obtain the patient’s chemistries and A1C.
   D. Order continuous positive airway pressure
   (CPAP) machine for the patient’s obstructive
   sleep apnea

Answer 2

2. Answer: B
   The pharmacist’s responsibilities under the CDTM agreement can include initiating, modifying, and discontinuing
   medications; ordering and interpreting laboratory values;
   and assessing and providing patient education, depending
   on the individual practice act covering the state of practice.
   Furthermore, a pharmacist can place a referral as necessary to improve patient care. The physician is responsible
   for determining the illness diagnosis; therefore, Answer A
   is incorrect. Answer C is incorrect; whereas the CDTM
   agreement allows for ordering labs, it does not have a provision for drawing the actual lab. Answer D is incorrect
   because sleep apnea is outside the scope of the CDTM
   agreement. Discontinuing and initiating a medication for
   diabetes management is in the scope of the CDTM, making Answer B correct.

Question 3

3. A 57-year-old woman has an anticipated hospital
   discharge for tomorrow. She was admitted because
   of a mild asthma exacerbation requiring steroids and
   nebulizer treatments. Which best describes how a pharmacist could improve the patient’s transition of care?
   A. Scheduling the patient for a comprehensive
   medication review (CMR) in 3 months with the
   pharmacist.
   B. Completing medication reconciliation for the
   patient on hospital admission and discharge.
   C. Providing recommendations to the inpatient team
   on outpatient pharmacies that will deliver the
   patient’s medications to her home.
   D. Conducting an Asthma Control Test with the
   patient at a follow-up visit in the clinic

Answer 3

3. Answer: B
   To ensure a safe and effective transition for the patient,
   it is important to facilitate a detailed, timely, and thorough handoff from the inpatient to the outpatient setting.
   Therefore, scheduling the CMR 3 months later may not be
   as beneficial as scheduling it within 14 days of discharge,
   making Answer A incorrect. To ensure a smooth transition
   for the patient, a thorough medication reconciliation must
   be completed at each transition, whether from the outpatient to inpatient setting or vice versa, and a discharge plan
   should be communicated to the outpatient provider verbally
   or in writing, making Answer B correct. Providing recommendations to the inpatient team on pharmacies located
   in the area may not be beneficial to patients, depending
   on where they live, and the pharmacy should be tailored
   to the patient’s preference, making Answer C incorrect.
   Conducting an Asthma Control Test at a follow-up visit
   will not assist in transitioning the patient to the outpatient
   setting, making Answer D incorrect

Question 4

4. Which method of medication safety analysis is best for
   prospectively identifying the risk of error in a process and
   for estimating the likelihood of a process failure?
   A. Root cause analysis.
   B. Failure modes and effects analysis.
   C. Safety culture assessment.
   D. Analysis of medication error trends

Answer 4

4. Answer: B
   Failure modes and effects analysis is useful for identifying potential failures to a new system or process before
   it is implemented, allowing safety measures to be put in
   place to prevent those failures or minimize their risks,
   making Answer B correct. Root-cause analysis is a structured retrospective method used to analyze serious adverse
   events, and system and process improvements are typically
   identified, making Answer A incorrect. Safety culture
   assessment facilitates the identification of problems within
   the culture of an organization that may not foster a safety
   culture, but it is not used to analyze processes, making
   Answer C incorrect. Analysis of medication error trends
   is not a prospective method, making Answer D incorrect.

Question 5

5. A pharmacist who is a member of the organization’s
   pharmacy and therapeutics (P&T) committee needs
   to determine whether a new drug that came to market
   should be placed on the drug formulary. Which best
   depicts what the pharmacist should consider before
   recommending that the drug be placed on formulary?
   A. Ease of preparation, cost-effectiveness, time on
   the market.
   B. Adherence, manufacturer, variety of dosage forms.
   C. Storage requirements, somnolence potential,
   convenience.
   D. Safety, physician demand, efficacy

Answer 5

5. Answer: D
   There are several aspects that a P&T committee may evaluate, typically both the clinical and financial impacts that
   could provide value. These could include dosage forms
   of the medication, volume of use, convenience, dosing
   schedule, adherence, abuse potential, provider demand,
   and storage requirements. Making Answer D correct and
   Answers A, B and C incorrect