11 - Pharmaceutical care, medication therapy management and patient-centered care Flashcards Preview

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1

What came AFTER
"Pharmaceutical Care"

ACPE - 2007

Patient-Centered Care
&
Medication Therapy Management

2

What came AFTER
"Patient Centered Care"

Standards 2016

Pharmacists Patient Care Process
still focuses on patient-centered care
but 
incorporates Team-based / Collaberative care model

3

Define:
a partnership of the
pharmacist, the patient or their caregiver, and other health professionals
that promotes the safe and effective use of medications
and helps
patients achieve the targeted outcomes from medication therapy.

MTM

Medication Therapy Management

4

PURPOSE of
MTM SERVICES

To optimize THERAPEUTIC OUTCOMES

To enhance Patient understanding / adherence

to decrease the likelyhood of adverse events

to reduce overall healthcare spending

 

5

Define:

•Services provided by a pharmacist that improve treatment outcomes for individual patients

•A professional service to promote the safe and effective use of medications

•A way to provide better care for patients

–Promotes collaboration among the patient, the pharmacist, and the patient’s other health care providers

MTM SERVICES

6

Spectrum of
Pharmacist-Provided MTM-Services

Comprehensive Medication Therapy Review
CMR

Adherence Services

Targetted Medication Intervention Programs

Disease State Management

Health / Wellness Services

7

5 Core Elements for MTM

in Community Pharmacies

CMR = Medication Therapy Review

Personal Med Record

Medication-Related action Plan

Intervention +/- Referral

Documentation / Follow Up

8

2017 Medicare MTM
Eligibility Criteria

CMS establishes minimum thresholds for individuals eligible for MTM services

Multiple Chronic Conditions
2-3 conditions = chronic - Diabiabetes / HT / heart failure

Taking Multiple Part-D Drugs
2-8 medications - MOST @ 8

likely to incur annual costs for covd part D drugs 
exceeding $3919

9

Required MTM Services

sponsors MUST OFFER a minimum level of MTM serves

Interventions for beneficiaries & prescribers

CMR 
Annual comprehensive Medicare Review

TMR
Quarterly Targeted medication Review

10

MTM Providers

ALL HAVE PHARMACISTS

second most is pharmacy interns

but can also be other professions

11

MTM Evidence

AHRQ DEcIDE 
Randomized trial that showed that
 MTM was associated with REDUCED DRP's
but it had no effect on ADEs or Health Care use

PQA Study
showed that it did NOT matter if Telephone / in person
does not matter how it was delivered

12

Define:

Established in 2014

encompasses a contemporary and comprehensive approach to patient-centered care that is delivered in collaboration with other members of the health care team

 

PATIENT CARE PROCESS

developed by examining 
Pharm care + MTM practice/guadance/evidence

13

Pharmacist's Patient Care Process

Collect / Assess / Plan / Implement / Follow-Up
VVV
Collaborate / Communicate / Document
VVV
Patient-Centered Care

14

Inpatient Medication Use
 PROCESS

BCMA = Bar Code Admin
--> can lead to a REDUCTION in errors up to
Administering 
(nurses have to scan barcode b4 admin)

Prescribing -> transcribing

-> dispensing -> administering

-> monitoring -> QA ACTIVITIES

15

Ambulatory Medication Use

PROCESS

Prescribe -> dispense

-> self-admin -> monitor

---> reporting
VOLUNTARY safety reporting to Company or FDA

16

OTC Medication Use Process

Self Prescribe or Prescibed

-> purchase -> self admin

-> self monitor

17

Potential berriers to
Pharmaceutical Care // MTM

•Drug product focus

•Services focus

•Organizations

•Other health-care professionals

•Compensation methods

•Lack of incentives

Logistical barriers

18

Lack of Incentives / Compensation Methods

Potential barriers to
Pharmaceutical Care // MTM

FFS pays ONLY when medications are DISPENSED
pt monitoring / ensuring compliance are NOT compensated

Financial + PROFESSIONAL incentives 

like recognition

19

Logistical Barriers

Potential barriers to
Pharmaceutical Care // MTM

Lack of access to:
Patient medical Info
other HCP's
Patients

how to overcome?
Take initiative in gathering info + communicationg

effective utilization of TECH / Supportive personnel

20

Need for Pharmaceutical care/MTM: 
Trends impacting pharmacy practice

Demographic Trends
growing elderly population --> more self care
cultural / economical diversity

Epidemiologic Trends
more chronic > acute --> MTM
CV Disease / Metabiolic Illness / Cancer / Mental / Infective

Economics
need rational / cost-effective drug therapy

Technologies
advances in affecting organization / delivery / cost
biotechnlogy / automated / electric

21

Other trends enabling patient-centered care by pharmacists

GROWING use of PHARMACEUTICALS as PRIMARY therapy
vs surgery or procedures

Changes in Pharmacy Practiece Acts

MED D // MTM services