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?