 Medication Therapy
Reviews
The medication therapy review is a systematic process of collecting
patient-specific information, assessing medication therapies to identify
medication-related problems, developing a prioritized list of
medication-related problems, and creating a plan to resolve them.
Medication therapy reviews are one of the five Medication
Therapy Management Core Elements Service Model Version 2.0
1 these reviews can be comprehensive or
targeted to an actual or potential medication problem. Whether
comprehensive or targeted, the individual patient’s medications
are evaluated in the context of the patient as a whole, taking into
consideration all of the patient’s conditions and medication
therapies.
1. American
Pharmacists Association, National Association of Chain Drug Stores
Foundation. J Am Pharm Assoc. 2008; 48(3):341-53
Pharmacotherapy
Consults
Pharmacotherapy consults refer to services provided by pharmacists on
referral from other health care providers or other pharmacists. These
consult services are typically reserved for more complicated patient
cases, specifically for patients who have complex medical conditions and
who have either already experienced medication related problems or who
are at high potential to develop them.1, 2 A pharmacotherapy
consult incorporates the pharmacist’s expertise into achieving
desired therapeutic goals for patients by promoting safe, appropriate,
and cost-effective use of medications. Patients requiring
pharmacotherapy consults may have a single or multiple complex medical
conditions that require medication therapy to effectively manage.
Pharmacists providing these services typically have advanced expertise
and training in the subject area and may be Board Certified in their
specialty by the Board of
Pharmaceutical Specialties.
1. ACCP
White Paper. Pharmacotherapy 2008;28(2):7e–34e
2. Bluml BM. Definition of medication therapy management:
development of profession wide consensus. J Am Pharm Assoc.
2005;45:566-72.
Disease management
coach/support
Disease management principles involve coordinated healthcare
interventions for diseases in which patients must assume some
responsibility for their care. Pharmacists providing these medication
therapy management services address drug and non-drug therapy, as well
as lifestyle modifications associated with these diseases integrate the
patient into programs that empower them to manage their disease and
medications, and thereby reduce healthcare costs and improve quality of
life of patients. Diverse disease management programs that
incorporate effective medication management have been developed for a
variety of chronic disease state such as Diabetes, Asthma, COPD,
Heart Failure, Parkinson’s Disease, Alzheimer’s Disease,
Depression and many others. Examples of the clinical, humanistic, and
economic outcomes of these programs provided by pharmacists have been
documented in demonstration projects that include the as The
Asheville Project, The Diabetes
Ten City Challenge, and many others.
Pharmacogenomics
Applications
Pharmacogenomics is a new and emerging medication therapy management
service provided by pharmacists in which pharmacists play a role in the
interpretation and application of a patient’s genetic information
to optimize a patient’s response to medication therapy. In various
patient care settings from hospitals to community pharmacies pharmacists
are comparing patient-specific treatments based on genetic markers,
predicting patients’ response to therapy, dosing medications based
on genetic test results, predicting which patients will experience
adverse reaction to selected therapies, and making informed
recommendations to prescribers on the best treatments for that
individual patient that maximize effectiveness while minimizing
risk. Pharmacogenomics has also been referred to as
“personalized medicine.” More
information on pharamacogenomics.
Anticoagulation
Management
Pharmacists providing anticoagulation management provide diverse
services to patients who are taking oral blood thinning agents.
Warfarin, the most prescribed oral medication agent for this
purpose, must be continuously monitored and managed to ensure patient
safety and minimize risk. Pharmacists work with educating many different
types of patients on these therapies such as those with
atrial fibrillation and at high risk for stroke on the importance of
oral anticoagulation adherence and attaining routine blood tests.
Pharmacists provide services in anticoagulation management.
Examples of services provided by pharmacists include in-pharmacy fingers
sticks and INR testing , education on patient self
monitoring/management, and adjustment of doses based established
collaborative practice agreements between physicians and the
pharmacist. More
information.
Other Clinical
Services
As pharmacist provided medication therapy management services
continue to evolve, pharmacists roles continues to expand into new and
emerging areas. These diverse clinical services all focus on optimizing
medication outcomes for the individual patient. Examples of other
clinical services in medication therapy management include employee
health services & screening, travel medicine, nuclear pharmacy,
veterinary pharmacy, nutrition and many others.
Medication Safety
Surveillance
Pharmacists provide medication therapy management through medication
safety surveillance programs, where they serve an important role in
prevention of medication errors and adverse events. Improving the safety
of the medication use system as a whole is critical to achieve optimum
therapeutic outcomes for individual patients. From medication error and
adverse event reporting to the collection of data and identification of
medication safety on an expanded scale, pharmacists are breaking new
ground in ensuring medication related safety. Emerging areas include the
development, utilization and standardization of Risk Evaluation and
Mitigation Strategies (REMS), a program for drugs or biologics that pose
specific safety risks for patients, will optimize the balance of patient
access and medication safety. REMS programs are being required
more and more by the Food and Drug Administration to address potential
patient safety issues. More information on the pharmacist’s
role in patient safety. More
information on REMS.
Health, wellness,
public health
Pharmacists provide a wide range of health, wellness and public
health services to improve care for individual patients in the
communities they serve. Examples of services include screening programs
for common disease states (e.ge. asthma, diabetes cardiovascular
disease) nutritional planning, weight loss, smoking cessation
counseling, These services help to address the critical need to improve
the overall health and wellness of the U.S. Population. More information
available in the Health,
Wellness, and Public Health section.
Immunization
Pharmacists in all 50 states are authorized to provide medication
therapy management by administering immunizations under collaborative
practice agreements with physicians. Pharmacists provide valuable
immunization services and information for patients to improve
vaccination rates for vaccine preventable illnesses. Pharmacists
provide immunization medication management services through
identification of patients based on disease states and medication
therapies that could potentially benefit from receiving various vaccines
and by directly immunizing those patients or providing education on the
benefits and importance of vaccinations for preventable illness.
Pharmacist administration authority varies from state to state based on
individual scope of practice regulation. As examples, pharmacists
administer seasonal flu vaccine, H1N1 vaccine, herpes zoster vaccine,
travel vaccines and many others. For more information on pharmacist
immunization medication therapy management services visit the Pharmacist
Immunization Center.
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