How are we doing on MTM?

July 15, 2011

A pharmacy student who works in a retail pharmacy and has completed several clinical and community rotations has not seen wide implementation of MTM at any level.

However, speaking as a pharmacy student who works in a retail pharmacy and has completed several clinical and community rotations, I have not seen wide implementation of MTM at any level. Moreover, in my current rotation with a group of public health pharmacists, I have encountered 2 very interesting problems that I would like to discuss.

MTM and hospital discharge

I asked whether a clinical pharmacist had gone over the medications with the patient during the discharge process and the answer was "No," with no discussion of the possibility of bringing clinical pharmacists into the discharge process in the future.

I was surprised that no one at that meeting even thought about involving pharmacists in medication consultation with patients at discharge. It seemed that many of those present had little knowledge about the services pharmacists can provide.

MTM and patient care

The second issue that captured my attention also pertains to post-discharge patient care. This time I had a chance to observe exactly how confused a patient can become.

A group of us (2 pharmacy students with our pharmacist preceptor, 2 nursing students, and a social worker from a local county public health office) visited the home of a 59-year-old African American female patient. As we walked in, the patient was coughing and seemed short of breath. She reached for her inhalers, picked one, and inhaled several puffs to help with coughing and breathing. The inhalers had no labels, and she could not distinguish which one was for immediate relief and which one was for maintenance therapy.

With the patient's permission, we began sorting her medications and asking her about her medical history, medication therapy, etc. We opened a drawer filled with medication vials and bottles, and various asthma/COPD inhalers. Many of her medications had never been used and most were expired. Various medication labels included the names of several doctors she didn't even recognize.

The patient had diabetes, hypertension, asthma, chronic pain, hyperlipidemia, and heart problems. She was very confused about her diseases, diagnosis, treatments, and medications, and was unaware that pharmacists could discuss her health conditions and assist her with proper medication treatment.

We separated the medications that were current (22 bottles, inhalers, and insulin pens), confiscated the old/expired/never-used medications (24 bottles and inhalers), instructed her on how to take her medications, and left, planning to review her medications again and call her various pharmacies and doctors to find an easy way of managing her care.

Clearly, this patient has not been receiving proper treatment and has not been adherent with her medications. No matter how many medications we prescribe, dispense, and deliver, she will not get better until someone educates her about the importance and proper use of these medications.

Less talk, more action

The issues discussed above come down to one thing: MTM. It is mentioned constantly, but we don't see it often in real life.

Some pharmacists are waiting for MTM models they can follow. I agree that we do need more productive established models. But in the meanwhile, if each pharmacist influenced one patient's life each day, we could make a huge difference in public health.

Healthcare professionals should unite. And other healthcare professions should accept that pharmacists are well trained in MTM and can be highly helpful in the achievement of better treatment outcomes, decreased hospital readmission rates, and overall healthcare cost savings.

A longer version of this article can be seen on the DT Blog at http://www.drugtopics.com/leann.

Leann Hakobyan is a 2012 PharmD/MPH candidate at Touro University. She can be reached at leann.hakobyan@tu.edu
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