Outcomes Personal Pharmacist ™ Training Module/Encounter™ MTM Case Examples

Case Example #1  A 45 year old female, presented to a pharmacy with a prescription for a sulfa antibiotic (Drug A).  The pharmacist reviewed her drug history and found a notation that she is allergic to sulfas. The previous reaction was anaphylaxis. The pharmacist contacted the physician recommending a switch to an alternative medication (Drug B). The physician was not aware of the patient’s history and agreed with the pharmacist’s recommendation.  The pharmacist filled the new prescription for the alternative medication and properly educated the patient. Upon follow-up the pharmacist learned that the patient’s infection had resolved after a full course of therapy.

Case Example #1: Question 1  How many Encounter claims should be filed as a result of Case Example #1?  One  Two  Three  Four

Case Example #1: Question 2  What is the Reason for the first claim?  Needs Therapy  Suboptimal Drug Selection  Adverse Drug Reaction  Other

Case Example #1: Question 3  What is the Action for the first claim?  Comprehensive Medication Review (CMR)  Prescriber Consultation  Patient Education/Monitoring  Patient Compliance Consultation

Case Example #1: Question 4  What is the Result for the first claim?  Therapeutic Success  Initiated New Therapy  Changed Drug  Altered Regimen/Changed Drug

Case Example #1: Question 5  What is the initial prescription information for the first claim?  The sulfa the patient took previously which caused an anaphylactic reaction  The alternate antibiotic (Drug B) recommended by the pharmacist  The antibiotic (Drug A) originally prescribed by the doctor  There is no initial prescription information

Case Example #1: Question 6  What is the final prescription information for the first claim?  The sulfa the patient took previously which caused an anaphylactic reaction  The antibiotic (Drug B) recommended by the pharmacist  The antibiotic (Drug A) originally prescribed by the doctor  There is no final prescription information

Case Example #1: Question 7  What is the frequency of therapy for the first claim?  Acute  Intermittent  Chronic  You do not need to select a frequency of therapy

Case Example #1: Question 8  What is the ECA for the first claim?  Level 1: Improved Quality of Care  Level 3: Additional Prescription Order  See Previous Claim  Level 7: Life Threatening

Case Example #1: Question 9  What should be included in the note of the first claim?  Description of the education and monitoring  Description of the intervention  Justification for the ECA selected  B & C

Case Example #1: Question 10  What is the Reason for the second claim?  New/Changed Prescription Therapy  Suboptimal Drug Selection  Adverse Drug Reaction  Other

Case Example #1: Question 11  What is the Action for the second claim?  Comprehensive Medication Review (CMR)  Prescriber Consultation  Patient Education/Monitoring  Patient Compliance Consultation

Case Example #1: Question 12  What is the Result for the second claim?  Therapeutic Success  Initiated New Therapy  Changed Drug  Altered Regimen/Changed Drug

Case Example #1: Question 13  What is the initial prescription information for the second claim?  The sulfa the patient took previously which caused an anaphylactic reaction  The alternate antibiotic (Drug B) recommended by the pharmacist  The antibiotic (Drug A) originally prescribed by the doctor  There is no initial prescription information

Case Example #1: Question 14  What is the final prescription information for the second claim?  The sulfa the patient took previously which caused an anaphylactic reaction  The antibiotic (Drug B) recommended by the pharmacist  The antibiotic (Drug A) originally prescribed by the doctor  There is no final prescription information

Case Example #1: Question 15  What is the frequency of therapy for the second claim?  Acute  Intermittent  Chronic  You do not need to select a frequency of therapy

Case Example #1: Question 16  What is the ECA for the second claim?  Level 1: Improved Quality of Care  Level 3: Additional Prescription Order  Level 5: Emergency Room Visit  Level 7: Life Threatening

Case Example #1: Question 17  What should be included in the note of the second claim?  Description of the education and monitoring  Description of the intervention  Justification for the ECA selected  B & C

Case Example #2  A 54 year old male presented to a pharmacy requesting a refill of his medication (Drug A) to prevent gout attacks. He stated that he was having an acute gout flare and he did not feel the medication was helping.  The pharmacist educated the patient that this medication is used for maintenance therapy to prevent gout attacks and explained that the physician must be contacted to recommend a treatment (Drug B) for the current attack. The pharmacist contacted the doctor and recommended a treatment. The physician approved the new order.  The pharmacist educated the patient about the new medication and how to start the refill when the gout flare resolves. A monitoring call was scheduled for two days later. During the monitoring call the patient stated that his attack has resolved and he was doing much better with no questions, and was now taking the medication daily for maintenance.

Case Example #2: Question 1  How many Encounter claims should be filed as a result of Case Example #2?  One  Two  Three  Four

Case Example #2: Question 2  What is the Reason for the first claim?  Other  Overuse  Underuse  Administration/Technique

Case Example #2: Question 3  What is the Action for the first claim?  Patient Education/Monitoring  Prescriber Consultation  Patient Consultation  Patient Compliance Consultation

Case Example #2: Question 4  What is the Result for the first claim?  Therapeutic Success  Altered Compliance  Initiated New Therapy  Altered Regimen/Changed Drug

Case Example #2: Question 5  What is the initial prescription information for the first claim?  The medication to prevent gout attacks (Drug A)  The medication to treat gout attacks (Drug B)  A pain medication  There is no initial prescription information

Case Example #2: Question 6  What is the final prescription information for the first claim?  The medication to prevent gout attacks (Drug A)  The medication to treat gout attacks (Drug B)  A pain medication  There is no final prescription information

Case Example #2: Question 7  What is the frequency of therapy for the first claim?  Acute  Intermittent  Chronic  You do not need to select a frequency of therapy

Case Example #2: Question 8  What is the ECA for the first claim?  Level 1: Improved Quality of Care  Level 2: Drug Product Costs  Level 3: Additional Physician Visit  Level 5: Emergency Room Visit

Case Example #2: Question 9  What should be included in the note of the first claim?  Description of the education and monitoring  Description of the intervention  Justification for the ECA selected  B & C

Case Example #2: Question 10  What is the Reason for the second claim?  New/Changed Prescription Therapy  OTC Therapy  Needs Therapy  Unnecessary Therapy

Case Example #2: Question 11  What is the Action for the second claim?  Comprehensive Medication Review (CMR)  Prescriber Consultation  Patient Education/Monitoring  Patient Compliance Consultation

Case Example #2: Question 12  What is the Result for the second claim?  Therapeutic Success  Initiated New Therapy  Changed Drug  Altered Regimen/Changed Drug

Case Example #2: Question 13  What is the initial prescription information for the second claim?  The medication to prevent gout attacks (Drug A)  The medication to treat gout attacks (Drug B)  A pain medication  There is no initial prescription information

Case Example #2: Question 14  What is the final prescription information for the second claim?  The medication to prevent gout attacks (Drug A)  The medication to treat gout attacks (Drug B)  A pain medication  There is no final prescription information

Case Example #2: Question 15  What is the frequency of therapy for the second claim?  Acute  Intermittent  Chronic  You do not need to select a frequency of therapy

Case Example #2: Question 16  What is the ECA for the second claim?  Level 1: Improved Quality of Care  Level 3: Additional Physician Visit  Level 5: Emergency Room Visit  See Previous Claim

Case Example #2: Question 17  What should be included in the note of the second claim?  Description of the education and monitoring  Description of the intervention  Justification for the ECA selected  B & C

Case Example #2: Question 18  What is the Reason for the third claim?  New/Changed Prescription Therapy  Suboptimal Drug Selection  Adverse Drug Reaction  Other

Case Example #2: Question 19  What is the Action for the third claim? A.Comprehensive Medication Review (CMR)  Prescriber Consultation  Patient Education & Monitoring  Patient Compliance Consultation

Case Example #2: Question 20  What is the Result for the third claim?  Therapeutic Success  Initiated New Therapy  Changed Drug  Altered Regimen/Changed Drug

Case Example #2: Question 21  What is the initial prescription information for the third claim?  The medication to prevent gout attacks (Drug A)  The medication to treat gout attacks (Drug B)  A pain medication  There is no initial prescription information

Case Example #2: Question 22  What is the final prescription information for the third claim?  The medication to prevent gout attacks (Drug A)  The medication to treat gout attacks (Drug B)  A pain medication  There is no final prescription information

Case Example #2: Question 23  What is the frequency of therapy for the third claim?  Acute  Intermittent  Chronic  You do not need to select a frequency of therapy

Case Example #2: Question 24  What is the ECA for the third claim?  Level 1: Improved Quality of Care  Level 3: Additional Prescription Order  Level 5: Emergency Room Visit  Level 7: Life Threatening

Case Example #2: Question 25  What should be included in the note of the third claim?  Description of the education and monitoring  Description of the intervention  Justification for the ECA selected  B & C

46 Congratulations! This concludes Module/Encounter MTM Case Examples.