Medication Therapy Management
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Transcript of Medication Therapy Management
Medication Medication Therapy Therapy
ManagementManagement
The Patient and Provider VariablesThe Patient and Provider Variables
Efficiencies in MTM Efficiencies in MTM PracticePractice
Managing the patient interviewManaging the patient interview– Gathering pertinent informationGathering pertinent information– Keeping patients on trackKeeping patients on track
Documenting the encounterDocumenting the encounter Communicating with providersCommunicating with providers Utilizing collaborative practice Utilizing collaborative practice
agreementsagreements Recruiting your patientsRecruiting your patients
Interviewing TipsInterviewing Tips
Use open-ended questionsUse open-ended questions Let the patient talkLet the patient talk Address patient concerns firstAddress patient concerns first Steering talkative patientsSteering talkative patients
The Patient InterviewThe Patient Interview
Introduction of MTMIntroduction of MTM– Indicated, effective, safe, convenientIndicated, effective, safe, convenient– Explain how this is different than Explain how this is different than
dispensingdispensing Patient’s chief complaintPatient’s chief complaint
– What are your main concerns about What are your main concerns about your medications or health care?your medications or health care?
The Patient InterviewThe Patient Interview
Gathering social historyGathering social history– Marital status, living situation, Marital status, living situation,
cookingcooking– OccupationOccupation– Tobacco, alcohol, caffeineTobacco, alcohol, caffeine
Past medical historyPast medical history Family medical historyFamily medical history
The Patient InterviewThe Patient Interview
Allergies and adverse reactionsAllergies and adverse reactions Objective informationObjective information
– Lab results if they have themLab results if they have them– Self monitoring of blood sugarsSelf monitoring of blood sugars
Download their meterDownload their meter
– Blood pressureBlood pressure– WeightWeight– Peak flowsPeak flows
The Patient Interview:The Patient Interview:MedicationsMedications
Finally, the medications!Finally, the medications!– IndicationIndication
Separate medications by indicationSeparate medications by indication Address chief complaint firstAddress chief complaint first Vitamins, herbal supplementsVitamins, herbal supplements
– EffectivenessEffectiveness Explain goals of therapyExplain goals of therapy Ask about symptomsAsk about symptoms Ask about frequency of PRN medsAsk about frequency of PRN meds
The Patient InterviewThe Patient InterviewMedicationsMedications
SafetySafety– Ask about common side effects Ask about common side effects – Ask about adverse reactionsAsk about adverse reactions– Evaluate drug interactionsEvaluate drug interactions– Evaluate disease interactionsEvaluate disease interactions– Mention monitoring guidelinesMention monitoring guidelines
The Patient Interview, The Patient Interview,
MedicationsMedications ConvenienceConvenience
– Remember to take medications?Remember to take medications? Evaluate frequency of dosingEvaluate frequency of dosing Evaluate timing of various Evaluate timing of various
medicationsmedications– Auxiliary labels at dispensingAuxiliary labels at dispensing
– AffordabilityAffordability Utilize insurance formularyUtilize insurance formulary Utilize therapeutic alternativesUtilize therapeutic alternatives
The Patient Interview, The Patient Interview, Wrap-upWrap-up
Summarize the visitSummarize the visit– We found and decided to…We found and decided to…
Identify drug therapy problems & action Identify drug therapy problems & action itemsitems
– I will…I will… Send a medication list & summary of visitSend a medication list & summary of visit Communicate with health care provider(s)Communicate with health care provider(s)
– You will…You will… Changes not dependent on health care Changes not dependent on health care
providerprovider Set a follow-up time and say whySet a follow-up time and say why
The Patient InterviewThe Patient InterviewEvaluation CommentsEvaluation Comments
Utilizing the SOAP formatUtilizing the SOAP format– SubjectiveSubjective
How referredHow referred Chief complaintChief complaint Social historySocial history Past medical history, comments on Past medical history, comments on
diagnosisdiagnosis Broken into disease stateBroken into disease state
– ObjectiveObjective
The Patient InterviewThe Patient InterviewEvaluation CommentsEvaluation Comments
Utilizing the SOAP formatUtilizing the SOAP format– Assessment/plan Assessment/plan
Patient self-management education Patient self-management education provided on:provided on:
– Disease & patient non-drug action steps Disease & patient non-drug action steps ‘‘Medication comments/concerns include:’Medication comments/concerns include:’
– These are your drug therapy problems!These are your drug therapy problems!– Broken into disease state and numbered outBroken into disease state and numbered out– Potential solutions suggestedPotential solutions suggested
Time spent with patientTime spent with patient
Efficient Patient Efficient Patient CommunicationCommunication
Communicating evaluation Communicating evaluation commentscomments– Prepare a generic cover letter to Prepare a generic cover letter to
patients, patients, thenthen personalize it personalize it– Don’t duplicate documenting efforts!Don’t duplicate documenting efforts!
Prepare evidence-based, patient-Prepare evidence-based, patient-friendly evaluation commentsfriendly evaluation comments
– Include an indication/medication listInclude an indication/medication list
ProviderProviderCommunicationCommunication
The Next StepThe Next Step
How Will You How Will You Communicate Communicate
With Providers?With Providers? Phone?Phone? E-mail?E-mail? Fax?Fax? Letter?Letter?
– Sent to officeSent to office– Sent with patient visitSent with patient visit
EfficientEfficient Provider Provider CommunicationCommunication
Prepare a generic cover letter to Prepare a generic cover letter to providers that explains MTM and your providers that explains MTM and your serviceservice
Don’t duplicate documenting efforts!Don’t duplicate documenting efforts!– Prepare evidence-based, patient-Prepare evidence-based, patient-
friendly evaluation commentsfriendly evaluation comments Let the patient be your advocateLet the patient be your advocate
– Hand delivered by patient at next visitHand delivered by patient at next visit
EffectiveEffective Provider Provider CommunicationCommunication
Emphasize teamwork and Emphasize teamwork and collaborationcollaboration
Recognize the patient/provider Recognize the patient/provider relationshiprelationship
Recognize that you may be missing Recognize that you may be missing informationinformation
Opportunities to optimize drug therapyOpportunities to optimize drug therapy– Vs. Drug therapy problemsVs. Drug therapy problems
Provider Communication:Provider Communication:Choosing Your WordsChoosing Your Words
May wish to evaluate continued need May wish to evaluate continued need for…for…– Vs. ‘No medical indication’Vs. ‘No medical indication’
Could consider…Could consider… Studies suggest…Studies suggest… Drug X may provide better…Drug X may provide better… National guidelines recommend…National guidelines recommend… Drug X may be contributing Drug X may be contributing
to/aggravating…to/aggravating…– Vs. ‘Contraindication’Vs. ‘Contraindication’
Benefits of Benefits of Collaborative Collaborative PracticePractice
Practice Efficiency and Practice Efficiency and DeliverablesDeliverables
Collaborative Practice Collaborative Practice AgreementsAgreements
Allow us to make immediate Allow us to make immediate changes in drug therapychanges in drug therapy– Immediate deliverable to patientsImmediate deliverable to patients– Easier to justify to cash patientsEasier to justify to cash patients– Makes follow-ups more valuableMakes follow-ups more valuable
Not difficult to implementNot difficult to implement– Ask your providers what bothers Ask your providers what bothers
them and act on itthem and act on it
Collaborative Practice Collaborative Practice AgreementsAgreements
Community based agreement Community based agreement ideasideas– Lantus adjustingLantus adjusting– Diabetes meter (SMBG) trainingDiabetes meter (SMBG) training– Seasonal allergiesSeasonal allergies– Asthma managementAsthma management– And many more…And many more…
Medication Therapy Medication Therapy ManagementManagement
Recruiting PatientsRecruiting Patients
Recruiting PatientsRecruiting Patients
Patients to targetPatients to target– Multiple chronic conditionsMultiple chronic conditions– Multiple medications for one conditionMultiple medications for one condition– Multiple medication choices for Multiple medication choices for
conditioncondition– Using a drug delivery deviceUsing a drug delivery device– Always asking OTC/vitamin questionsAlways asking OTC/vitamin questions
Recruiting Patients, Recruiting Patients, CounterpointsCounterpoints
Pharmacy already providing great Pharmacy already providing great service!service!– Been coming here for yearsBeen coming here for years– Answering their questionsAnswering their questions– Checking for drug interactionsChecking for drug interactions
Clinic always checks my drug listClinic always checks my drug list– ‘‘Dr has followed me for 20 years’Dr has followed me for 20 years’– Worried what the doctor will thinkWorried what the doctor will think
Recruiting PatientsRecruiting Patients
Does your medical provider ask about…Does your medical provider ask about…– Timing of medication?Timing of medication?– Your copays or cost-saving Your copays or cost-saving
opportunities?opportunities?– Using your inhaler or drug delivery Using your inhaler or drug delivery
device?device? Try it! You’ll like it!Try it! You’ll like it! 9/10 times we find something we can 9/10 times we find something we can
improve upon! I promise!improve upon! I promise!
Questions?Questions?