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 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 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 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.”
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.
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.
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.
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.
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. For example, pharmacists administer seasonal flu vaccine, H1N1 vaccine, herpes zoster vaccine, travel vaccines, and many others. Learn more in the Immunization Center.