College of Pharmacy Student to Medication Therapy Management Practitioner

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College of Pharmacy Student to Medication
Therapy Management Practitioner
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Agenda

• Medication Therapy Management Services (MTM) at
  the University of Minnesota Fairview
• How I got there?
• What is it?
• Who is it for?
• What are the benefits?

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Pharmacy School and Residency

• Professional Organizations
• Work Experiences
• 4th Year Advanced Practice Experiences
• Pharmaceutical Care Residency

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Medication Therapy Management Training/Experience

• Certification in Pharmaceutical Care
• Practitioner at the University of Minnesota
  Fairview since April 2006

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University of Minnesota FairviewPractice Setting

• Primary Care Clinic, Phillips-Wangensteen
  Building
• Work stations for myself and 4th year pharmacy
  student
• Consultation rooms in the clinic for patient
  appointments

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Typical Day

• One hour for administrative time
• Emailing
• Practice Promotion
• Phone Calls
• One hour for student time
• Six hours for patient appointments (up to 12
  follow-up appointments per day)
• Face-to-face time with patient
• Documentation
• Consultation with other healthcare providers

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Medication Therapy ManagementAs practiced by
Fairview Pharmacy Services

• A consultative relationship between a specially
  trained pharmacist and patient, focused on
  optimizing medication therapy outcomes. The
  pharmacist becomes part of the patients care
  team.
• Initial Consultation
• 30 to 60 minute appointment
• Follow-up
• Schedule is determined by individual patient
  needs
• Typically, initial follow-up in 30 days, with
  subsequent follow-ups every 180 days

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Who Is It For?

• Multiple Chronic Conditions (two or more)
• Multiple Medications (four or more)
• Drug Therapy Problems
• Needs Additional Drug Therapy 32
• Dosage Too Low 21
• Noncompliance 18
• Adverse Drug Reaction 9
• Ineffective Drug 8
• Dosage Too High 6
• Unnecessary Drug Therapy 6

19,268 Drug Therapy Problems identified and
resolved in 6,362 Fairview Pharmacy Services MTM
patients, Sept 1998 Dec 2005.
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Multiple Chronic Conditions6,362 MTM Patients
Sept 1998 Dec 2005
Average 7 medical conditions/patient

of Patients
of Medical Conditions
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Multiple Medications6,362 MTM Patients Sept 1998
Dec 2005
Average 12 medications/patient
of Patients
of Medications
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Medication Therapy ManagementAs practiced by
Fairview Pharmacy Services
ESTABLISH A THERAPEUTIC RELATIONSHIP
ASSESSMENT
CARE PLAN
EVALUATION

• Record actual patient
• outcomes
• Evaluate progress in
• meeting therapeutic goals
• Reassess for new problems

• Ensure all drug therapy is
• indicated, effective, safe
• and convenient
• Identify drug therapy
• problems

• Resolve drug therapy
• problems
• Establish therapeutic goals
• Prevent drug therapy
• problems

Continuous Follow-up
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ASSESSMENT
CARE PLAN
EVALUATION
Drug Therapy Problems
Drug-Related Needs
Indication Effectiveness Safety Convenience
Unnecessary drug therapy Needs additional drug
therapy
More effective drug available Dosage too low
Adverse drug reaction Dosage too high
Compliance
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ASSESSMENT
CARE PLAN
EVALUATION

• Appropriate indications/medical conditions
• Medications
• Dosage regimens
• Allergies
• Pharmacist recommendations
• Follow-up visit schedule
• How to obtain additional information

• Prevent and resolve drug therapy problems
• Establish therapeutic goals

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ASSESSMENT
CARE PLAN
EVALUATION

• Assess and document actual patient outcomes for
  each medical condition
• Defined outcome parameters
• Reassess for new drug therapy problems
• Adjust personalized care plan

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Collaborative Practice Agreements

• Written agreement with physicians to prescribe,
  monitor and titrate medications for specific
  conditions
• Hypertension
• Hyperlipidemia
• Diabetes
• Smoking Cessation
• Anemia

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Drug Therapy Problems(6,362 MTM Patients, Sept
1998 Dec 2005)
19,268 Drug Therapy Problems Resolved

• 83 of patients had gt 1 drug therapy problem
• 41 of patients had gt 3 drug therapy problems
• 27 of patients had gt 5 drug therapy problems

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Drug Therapy Problems (DTP) (N 19,268 Drug
Therapy Problems Identified and Resolved in 6,362
Patients)
of DTP
Unnecessary Drug Therapy 6 Needs
Additional Drug Therapy 32 Ineffective Drug
8 Dosage Too Low 21 Adverse Drug
Reaction 9 Dosage Too High 6
Noncompliance 18 Total 100
Indication
38
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Effectiveness
15
Safety
18
Compliance
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Improved Clinical Outcomes(12,928 conditions
(3,633 patients) evaluated on at least two
occasions 12,928 conditions not at goal when
enrolled in program)
Condition the Same (22 )
Condition Improved (56 )
Condition Declined (22 )
56 of these patients conditions, that were not
at goal when the patient was enrolled in the
program, improved following the identification
and resolution of their drug therapy problem(s)
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Health Care Events Avoided
Health care savings represented by U.S. national
averages for 2001 Pharmaceutical Care Practice
The Clinicians Guide, McGraw-Hill, New York, NY,
2004
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Patient and Physician Satisfaction

• Patient Satisfaction Surveys
• 95 of patients agreed or strongly agreed that
  their overall health and well-being has improved
• I want you to know (the pharmacist) has done an
  excellent job with me to understand my health
  care and because of her, my health has improved.
• (The pharmacist) is excellent!! He has
  encouraged me through ups and downs and as a
  result I have lost weight and my number on my
  HBA1C test has been reduced significantly. Our
  goal is to get me off the diabetes meds. This
  will decrease my health care expenditures
• (The pharmacist) really cares about my health,
  but also cares about my finances. How to look
  for items (i.e., alternatives, competitive
  prices, and/or generic). (The pharmacist) is a
  great person to discuss these issues with.
• I was happy for all the information I received.
  It was a great help for me to understand what I
  had to do Thank you so much for all your help.
• Physician Satisfaction Surveys
• 94 agreed that their patients overall health
  and well-being improved

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Billing for MTM

• Began receiving payment for services in April
  2006!
• MTM covered by the following payors
• Medical Assistance
• Fairview Employees
• Metropolitan Health Plan
• Health Partners Medicare Part D
• Humana
• State of Minnesota Employees with Diabetes
• Cash Paying Patients
• Initial Visit (60 min) 150
• Follow-up Visit (30 min) 75

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Contact Information

• Kelly Schweim, PharmD
• Primary Care Clinic Medication Therapy
  Monitoring Pharmacy
• Monday Friday (700-330PM)
• 612-626-5412
• kschwei1_at_fairview.org

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