Medication Therapy Management The Patient and Provider Variables

Efficiencies in MTM Practice Managing the patient interview Managing the patient interview –Gathering pertinent information –Keeping patients on track Documenting the encounter Documenting the encounter Communicating with providers Communicating with providers Utilizing collaborative practice agreements Utilizing collaborative practice agreements Recruiting your patients Recruiting your patients

Interviewing Tips Use open-ended questions Use open-ended questions Let the patient talk Let the patient talk Address patient concerns first Address patient concerns first Steering talkative patients Steering talkative patients

The Patient Interview Introduction of MTM Introduction of MTM –Indicated, effective, safe, convenient –Explain how this is different than dispensing Patient’s chief complaint Patient’s chief complaint –What are your main concerns about your medications or health care?

The Patient Interview Gathering social history Gathering social history –Marital status, living situation, cooking –Occupation –Tobacco, alcohol, caffeine Past medical history Past medical history Family medical history Family medical history

The Patient Interview Allergies and adverse reactions Allergies and adverse reactions Objective information Objective information –Lab results if they have them –Self monitoring of blood sugars Download their meter Download their meter –Blood pressure –Weight –Peak flows

The Patient Interview: Medications Finally, the medications! Finally, the medications! –Indication Separate medications by indication Separate medications by indication Address chief complaint first Address chief complaint first Vitamins, herbal supplements Vitamins, herbal supplements –Effectiveness Explain goals of therapy Explain goals of therapy Ask about symptoms Ask about symptoms Ask about frequency of PRN meds Ask about frequency of PRN meds

The Patient Interview Medications Safety Safety –Ask about common side effects –Ask about adverse reactions –Evaluate drug interactions –Evaluate disease interactions –Mention monitoring guidelines

The Patient Interview, Medications Convenience Convenience –Remember to take medications? Evaluate frequency of dosing Evaluate frequency of dosing Evaluate timing of various medications Evaluate timing of various medications –Auxiliary labels at dispensing –Affordability Utilize insurance formulary Utilize insurance formulary Utilize therapeutic alternatives Utilize therapeutic alternatives

The Patient Interview, Wrap-up Summarize the visit Summarize the visit –We found and decided to… Identify drug therapy problems & action items Identify drug therapy problems & action items –I will… Send a medication list & summary of visit Send a medication list & summary of visit Communicate with health care provider(s) Communicate with health care provider(s) –You will… Changes not dependent on health care provider Changes not dependent on health care provider Set a follow-up time and say why Set a follow-up time and say why

The Patient Interview Evaluation Comments Utilizing the SOAP format –Subjective How referred How referred Chief complaint Chief complaint Social history Social history Past medical history, comments on diagnosis Past medical history, comments on diagnosis Broken into disease state Broken into disease state –Objective

The Patient Interview Evaluation Comments Utilizing the SOAP format –Assessment/plan Patient self-management education provided on: Patient self-management education provided on: –Disease & patient non-drug action steps ‘Medication comments/concerns include:’ ‘Medication comments/concerns include:’ –These are your drug therapy problems! –Broken into disease state and numbered out –Potential solutions suggested Time spent with patient Time spent with patient

Efficient Patient Communication Communicating evaluation comments 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 Prepare evidence-based, patient- friendly evaluation comments –Include an indication/medication list

Provider Communication The Next Step

How Will You Communicate With Providers? Phone? Phone? ? ? Fax? Fax? Letter? Letter? –Sent to office –Sent with patient visit

Efficient Provider Communication Prepare a generic cover letter to providers that explains MTM and your service Prepare a generic cover letter to providers that explains MTM and your service Don’t duplicate documenting efforts! Don’t duplicate documenting efforts! –Prepare evidence-based, patient- friendly evaluation comments Let the patient be your advocate Let the patient be your advocate –Hand delivered by patient at next visit

Effective Provider Communication Emphasize teamwork and collaboration Emphasize teamwork and collaboration Recognize the patient/provider relationship Recognize the patient/provider relationship Recognize that you may be missing information Recognize that you may be missing information Opportunities to optimize drug therapy Opportunities to optimize drug therapy –Vs. Drug therapy problems

Provider Communication: Choosing Your Words May wish to evaluate continued need for… May wish to evaluate continued need for… –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 to/aggravating… Drug X may be contributing to/aggravating… –Vs. ‘Contraindication’

Benefits of Collaborative Practice Practice Efficiency and Deliverables

Collaborative Practice Agreements Allow us to make immediate changes in drug therapy 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 Not difficult to implement –Ask your providers what bothers them and act on it

Collaborative Practice Agreements Community based agreement ideas Community based agreement ideas –Lantus adjusting –Diabetes meter (SMBG) training –Seasonal allergies –Asthma management –And many more…

Medication Therapy Management Recruiting Patients

Patients to target 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 Pharmacy already providing great service! Pharmacy already providing great service! –Been coming here for years –Answering their questions –Checking for drug interactions Clinic always checks my drug list Clinic always checks my drug list –‘Dr has followed me for 20 years’ –Worried what the doctor will think

Recruiting Patients Does your medical provider ask about… 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! Try it! You’ll like it! 9/10 times we find something we can improve upon! I promise! 9/10 times we find something we can improve upon! I promise!

Questions?