Outcomes Personal Pharmacist

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• Outcomes Personal Pharmacist Training

Module/Encounter MTM Case Examples
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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 patients history
  and agreed with the pharmacists recommendation.
• The pharmacist filled the new prescription for
  the alternative medication and properly educated
  the patient. Upon follow-up the pharmacist
  learned that the patients infection had resolved
  after a full course of therapy.

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Case Example 1 Question 1

• How many Encounter claims should be filed as a
  result of Case Example 1?
• One
• Two
• Three
• Four

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Case Example 1 Question 2

• What is the Reason for the first claim?
• Needs Therapy
• Suboptimal Drug Selection
• Adverse Drug Reaction
• Other

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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

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Case Example 1 Question 4

• What is the Result for the first claim?
• Therapeutic Success
• Initiated New Therapy
• Changed Drug
• Altered Regimen/Changed Drug

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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

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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

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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

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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

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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

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Case Example 1 Question 10

• What is the Reason for the second claim?
• New/Changed Prescription Therapy
• Suboptimal Drug Selection
• Adverse Drug Reaction
• Other

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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

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Case Example 1 Question 12

• What is the Result for the second claim?
• Therapeutic Success
• Initiated New Therapy
• Changed Drug
• Altered Regimen/Changed Drug

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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

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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

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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

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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

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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

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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.

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Case Example 2 Question 1

• How many Encounter claims should be filed as a
  result of Case Example 2?
• One
• Two
• Three
• Four

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Case Example 2 Question 2

• What is the Reason for the first claim?
• Other
• Overuse
• Underuse
• Administration/Technique

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Case Example 2 Question 3

• What is the Action for the first claim?
• Patient Education/Monitoring
• Prescriber Consultation
• Patient Consultation
• Patient Compliance Consultation

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Case Example 2 Question 4

• What is the Result for the first claim?
• Therapeutic Success
• Altered Compliance
• Initiated New Therapy
• Altered Regimen/Changed Drug

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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

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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

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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

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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

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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

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Case Example 2 Question 10

• What is the Reason for the second claim?
• New/Changed Prescription Therapy
• OTC Therapy
• Needs Therapy
• Unnecessary Therapy

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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

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Case Example 2 Question 12

• What is the Result for the second claim?
• Therapeutic Success
• Initiated New Therapy
• Changed Drug
• Altered Regimen/Changed Drug

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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

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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

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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

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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

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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

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Case Example 2 Question 18

• What is the Reason for the third claim?
• New/Changed Prescription Therapy
• Suboptimal Drug Selection
• Adverse Drug Reaction
• Other

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Case Example 2 Question 19

• What is the Action for the third claim?
• Comprehensive Medication Review (CMR)
• Prescriber Consultation
• Patient Education Monitoring
• Patient Compliance Consultation

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Case Example 2 Question 20

• What is the Result for the third claim?
• Therapeutic Success
• Initiated New Therapy
• Changed Drug
• Altered Regimen/Changed Drug

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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

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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

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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

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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

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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

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Congratulations!

• This concludes Module/Encounter MTM Case
  Examples.