Apr 9, 2021
In this podcast, Ashley Leland and Alex Ross, clinic pharmacists with Ridgeview, provide a discussion on medication therapy management, through a case study perspective.
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Medication Therapy Management can also be called CMM or Comprehensive Medical Management. For the sake of this episode, it will be referred to as MTM throughout.
MTM is a pharmacy service for targeted disease states like - asthma, COPD, diabetes, and/or congestive heart failure, and also for patients with polypharmacy. Really, any patient with concerns about their medications, can utilize this service.
The goal is to identify drug therapy problems: side effects, medication compliance, drug interactions, and overall management of symptoms, to improve outcomes, for example, reducing hospital readmissions.
In chapter 2, a patient was seen with a complex medical history, including heart failure, diabetes, new a-fib, and a recent hypokalemic event. MTM services identified several drug therapy problems, including drug interactions between the patient's diltiazem and atorvastatin, and between turmeric and Eliquis. Also identified was the need for diabetic management, and that the patient's over-the-counter potassium supplements were not sufficient in maintaining normal levels. In follow-up, the patient was doing well, had started taking farxiga, stopped the turmeric, and switched from diltiazem to metoprolol.
In this chapter, Ashley and Alex briefly discuss natural medications and the use of the Natural Medicines Database to evaluate over-the-counter supplements and herbals. It's noted that some patients want to take a more wholesome approach to their medications, they recommend doing the research for good manufacturing practices or USP verified supplements and herbals. A great resource is your local MTM pharmacist.
Another important service MTM pharmacists is helping patients navigate the financial decisions regarding medication cost. Whether suggesting alternatives or navigating the patient to assistance programs for specific mediations.
In chapter 3, a patient who recently changed countries, had several drug therapy problems like adjusting medications to what is available here in the US, adjusting dosages of his current medications, gaining access to a glucose monitor, and updating vaccines. It's a good example of the range of things a MTM pharmacy visit can manage.
Common drug interactions were touched on briefly. Highlighting the importance of knowing not just what over-the-counter medications a patient is taking, but the quantity as well. Also important, knowing the supplements and herbals being taken and how they might interact with any prescribed medications.
It's noted that the structure of an MTM visit, that hour long conversation just about medication management, helps break down barriers, and hone in on the issues that patients can have with their medications. It also brings up areas for opportunity elsewhere, where that medication discussion is happening in much shorter time periods.
The last patient case touches on an important demographic for MTM pharmacists, mental health regimens. This patient presented with a new tremor and agitation. Her drug therapy problems included duplicate therapy, suspected serotonergic complications, stimulating compounds, and an emotional attachment to her medications.
The results of her MTM visit included stopping her amitriptyline and her focus supplement. Tapering off her duplicate therapy escitalopram, and then returning for follow-up.
The follow-up time frame for patients depends on the complexity of drug therapy problems identified. Ashley found that setting the follow-up appointment during the current appointment, increases the follow through for patients.
MTM Pharmacy is located at 7-9 Ridgeview primary and specialty clinics. They can be directly consulted by the patient's primary care provider or patient's can reach out to any of the clinics they are located in. Patients that would specifically benefit from these services include those with polypharmacy, those who are not doing well with their current medication regimen, and those with chronic disease states.
Other areas where MTM pharmacy is involved, but not mentioned in depth here include - immunizations, opioid prescribing and stewardship, anticoagulation, and non-surgical weight loss programs.
Thank-you for listening.