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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

Medication Therapy Management

The Patient and Provider Variables

efficiencies in mtm practice
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
interviewing tips
Interviewing Tips
  • Use open-ended questions
  • Let the patient talk
  • Address patient concerns first
  • Steering talkative patients
the patient interview
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?
the patient interview5
The Patient Interview
  • Gathering social history
    • Marital status, living situation, cooking
    • Occupation
    • Tobacco, alcohol, caffeine
  • Past medical history
  • Family medical history
the patient interview6
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
the patient interview medications
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
the patient interview medications8
The Patient InterviewMedications
  • Safety
    • Ask about common side effects
    • Ask about adverse reactions
    • Evaluate drug interactions
    • Evaluate disease interactions
    • Mention monitoring guidelines
the patient interview medications9
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
the patient interview wrap up
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
the patient interview evaluation comments
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
the patient interview evaluation comments12
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
efficient patient communication
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
how will you communicate with providers
How Will You Communicate With Providers?
  • Phone?
  • E-mail?
  • Fax?
  • Letter?
    • Sent to office
    • Sent with patient visit
efficient provider communication
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
effective provider communication
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
provider communication choosing your words
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’
benefits of collaborative practice

Benefits of Collaborative Practice

Practice Efficiency and Deliverables

collaborative practice agreements
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
collaborative practice agreements21
Collaborative Practice Agreements
  • Community based agreement ideas
    • Lantus adjusting
    • Diabetes meter (SMBG) training
    • Seasonal allergies
    • Asthma management
    • And many more…
recruiting patients
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
recruiting patients counterpoints
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
recruiting patients25
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!