Delivering Medication Therapy Management Services in the Community

Delivering Medication Therapy Management Services in the Community is an innovative and interactive certificate training program that explores the pharmacist's role in providing MTM services to patients. Pharmacists have a tremendous opportunity to receive reimbursement for monitoring and improving medication use in patients with complex medication regimens. This practice-based activity teaches pharmacists the essential skills necessary to become a successful MTM practitioner. The certificate training program will enhance pharmacists' clinical expertise in evaluating complicated medication regimens, identifying medication-related problems, and making recommendations to patients, caregivers, and health care professionals. Delivering Medication Therapy Management Services in the Community is conducted in three parts:

• Self-study activity and pre-seminar exercise
• Live interactive training seminar
• Post-seminar exercise
• Additional resources (password required; password included in printed course materials)
• MTM e-Community (must be an APhA member to subscribe)

The goals of the certificate training program are to:

• Advance public health and patient care through improved medication use.
• Provide training to enhance pharmacists' ability to effectively provide MTM services.
• Motivate increased numbers of pharmacists to establish MTM services.
• Communicate benchmark practices for providing MTM services.

Self-Study Modules Description and Learning Objectives

The self-study learning activity is meant to ensure that all participants have a solid understanding of the role of pharmacists as medication therapy managers, the business aspects of setting up MTM services, and the core knowledge, skills, and processes needed for the provision of successful MTM services. As participants work through the self-study activity, they will learn more about the clinical and administrative aspects of providing MTM services.

Module 1. MTM: A New Era for Pharmacy Practice   

After completing this module, pharmacists will be able to:

• Describe the economic and clinical outcomes that are affected when pharmacist-provided patient care services increase.
• State the definition of medication therapy management (MTM).
• Describe the Medicare Part D benefit and how it differs from Medicare Part B.
• Explain reimbursement opportunities provided by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
• List additional opportunities for providing MTM services that do not involve Medicare Part D.
• Define the five core elements of the MTM services model.

Module 2.  Becoming an MTM Practitioner: A Plan for Success

After completing this module, pharmacists will be able to:

• Describe the components of a business plan.
• Identify the strengths and weaknesses of current pharmacy operations and list potential services and barriers using a SWOT analysis and needs assessment.
• Write a mission statement and goals for providing MTM services.
• Describe appropriate activities for technicians, student pharmacists, and pharmacy practice residents involved with MTM services.
• Discuss reimbursement strategies to incorporate in the MTM business model.
• Outline the process and key considerations of making MTM services operational and integrated with existing services.
• Identify measures to track the economic, clinical, and humanistic outcomes of an MTM service.
• Project revenues and expenses to establish fees for MTM services.
• Review elements of a marketing plan for attracting patients, providers, employers, and payers to MTM services.
• List opportunities for professional and staff development to address any unmet learning needs.

Module 3.  Getting Ready for MTM Service Delivery: Knowledge and Skills

After completing this module, pharmacists will be able to:

• Identify areas of therapeutic knowledge essential for providing MTM services.
• Describe strategies for, and limitations of, using clinical practice guidelines during MTM services.
• Explain pharmacodynamic and pharmacokinetic changes that are common in elderly adults.
• List other common health problems in elderly adults.
• Explain the risks of medication-related problems in elderly patients, and strategies for reducing their incidence.
• List patient assessment strategies that may be useful during MTM visits.
• Identify patients with low health literacy.
• Describe techniques that support open communication with patients, including the use of open-ended questions and active listening techniques.
• Describe a strategy for improving the cultural competence of pharmacists providing patient care during MTM visits.
• Identify the stages of behavior change in the transtheoretical model of change.
• Describe the communication process used in motivational interviewing.
• Adapt patient communication strategies for patients with functional impairments.
• Describe strategies for communicating effectively with prescribers.

Module 4.  Ready for Action: Conducting an MTM Encounter

After completing this module, pharmacists will be able to:

• Define the responsibilities of the patient as it relates to the MTM process.
• Identify pertinent information needed from patients and other providers.
• Identify components of the personal medication record (PMR) and medication-related action plan (MAP).
• Describe how the patient might use the PMR and/or MAP.
• Describe the steps involved in completing an assessment of a patient's medication-related needs.
• List at least seven types of medication-related problems and possible solutions.
• Describe the primary responsibilities of the pharmacist in terms of identifying, prioritizing, resolving, and preventing medication therapy problems.
• Recognize opportunities for intervention and/or collaboration with (or referral to) other health care professionals to resolve medication-related problems.
• Explain information that should be included in a SOAP note.
• Describe how to document MTM services in a manner appropriate for evaluating patient progress, sufficient for billing purposes, and applicable for tracking clinical and financial outcomes of an MTM service.

Pre-Seminar Exercise

After completion of the self-study portion of the certificate training program, participants must complete two pre-seminar patient cases.  The pre-seminar exercises are intended to provide participants with initial experience in conducting a medication therapy review.  Completing these exercises will give participants a baseline understanding of the process and allow them to identify questions and specific areas of difficulty to address during the live seminar.  This activity is integral to a comprehensive learning experience and is useful for indentifying personal areas for additional practice and improvement.  Participants should be prepared to use these patient cases during interactive portions of the live seminar.

Live Seminar Description and Learning Objectives

The second part of the certificate training program is an active learning seminar focusing on pharmacy practice implementation; it is based on the experience of practitioners involved with the development and delivery of MTM services.  The live seminar reinforces and expands on the self-study activity.  Participants will practice a variety of communication techniques to elicit a patient's medication experience and identify medication-related problems.  Participants also will gain experience in prioritizing medication-related problems, developing interventions, and documenting activities.  Strategies for implementing an MTM service will be explored.  

After completing the live seminar, participants will be able to:

• Explain how to overcome communication barriers and employ active listening when interviewing a patient.
• Conduct a thorough medication therapy review.
• Complete a personal medication record (PMR).
• Develop a medication-related action plan (MAP).
• Perform the following tasks, given a patient case including one or more medications:
  • Assess patient-specific data and issues, and interpret these findings to identify the patient's medication-related problems.
  • Account for pharmacokinetic and pharmacodynamic changes when reviewing an elderly person's medication regimen.
  • Develop a list of the patient's drug therapy problems.
  • Establish goals of therapy for each medical condition and medication-related problem identified.
  • Make recommendations for resolving situations in which a patient's medications are potentially inappropriate.
• Document services in a manner appropriate for evaluating patient progress, sufficient for billing purposes, and that facilitates tracking clinical and financial outcomes.
• Discuss the elements of an effective recommendation to another health care practitioner.
• Describe the medication use concerns and adverse drug events that affect senior patients.
• Explain how to bill for MTM services using the appropriate CPT code(s).

Post-Seminar Exercise

Following the same format as the pre-seminar exercises and using cases from the pharmacist's practice, participants must perform and document a medication therapy review for three additional patient cases.   For each case, participants will identify and prioritize the patient's medication-related problems, develop appropriate interventions, complete the appropriate documentation, and devise a plan for follow-up. 

After completing the post-seminar, pharmacists will be able to:

• Conduct a thorough patient medication history for three patients.
• Complete a personal medication record (PMR) for three patients.
• Develop a medication-related action plan (MAP) for three patients.
• Given three patient cases:
  • Identify patient-specific data and issues and interpret these findings to assess the patient's medication-related needs.
  • Apply the principles of pharmacokinetic and pharmacodynamic changes when reviewing an elderly persons medication regimen.
  • Generate a list of medication-related problems for the patient.
  • Establish goals of therapy for each identified medical condition and medication-related problem.
  • Provide recommendations for modifying potentially inappropriate medication regimens.
• Document services provided to three patients in a manner appropriate for evaluating patient progress, sufficient for billing purposes, and applicable to tracking of clinical and financial outcomes.

The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as providers of continuing pharmacy education. The self-study learning portion of the Delivering Medication Therapy Management Services in the Community certificate training program is approved for 10 hours (1.0 CEU) of continuing pharmacy education credit (UAN 202-999-09-006-H04-P). The live training seminar is approved for 8 hours (0.8 CEU) of continuing pharmacy education credit (UAN 202-999-09-005-L04-P).
The post-seminar exercise is approved for 3 hours (0.3 CEU) of continuing pharmacy education credit (UAN 202-999-09-007-H04-P). CPN: 202-0012.

Initial Release Date: March 1, 2009; Expiration Date: March 1, 2012

Activity Type:  Practice-based; Target Audience:  Pharmacists in all practice settings

Completion Information: A Certificate of Achievement is awarded to participants who successfully complete all activity requirements, which include the self-study activity and pre-seminar exercises, the self-study examination, the live training seminar, and the post-seminar patient interviews.  Successful completion is defined as a submission of the pre-work and post-work, a self-study examination score of 70% or better, and attendance at the live seminar.   

For more information on the certificate training program curriculum or agenda, contact the APhA Certificate Training Department by e-mailing ctp@aphanet.org.

If your company or organization is interested in offering this certificate training program to its pharmacists, please contact the APhA Certificate Training Department (ctp@aphanet.org).

Delivering Medication Therapy Management Services in the Community, developed by the American Pharmacists Association and the American Society of Consultant Pharmacists, was originally supported in part by independent educational grants from Boehringer Ingelheim Pharmaceuticals, Eisai Pharmaceuticals, Eli Lilly and Company, JanssenPharmaceuticals, Ortho-McNeil Janssen Pharmaceuticals, sanofi-aventis Pharmaceuticals, and Wyeth Pharmaceuticals.