The pharmaceutical care model and medication therapy management (MTM) model are two clinical pharmacy practice models that focus on optimizing patient outcomes.
The key elements of the pharmaceutical care model are to identify and resolve actual drug therapy problems, prevent potential problems, and achieve therapy goals through assessment, care planning, and evaluation. The MTM model emphasizes establishing a relationship between the pharmacist and patient to provide individualized services through medication therapy reviews, prioritizing issues, and creating plans to address problems and optimize outcomes.
Both models take a patient-centered approach to medication management with the goals of improving safety, effectiveness and adherence.
The pharmaceutical care model and medication therapy management (MTM) model are two clinical pharmacy practice models that focus on optimizing patient outcomes.
The key elements of the pharmaceutical care model are to identify and resolve actual drug therapy problems, prevent potential problems, and achieve therapy goals through assessment, care planning, and evaluation. The MTM model emphasizes establishing a relationship between the pharmacist and patient to provide individualized services through medication therapy reviews, prioritizing issues, and creating plans to address problems and optimize outcomes.
Both models take a patient-centered approach to medication management with the goals of improving safety, effectiveness and adherence.
The pharmaceutical care model and medication therapy management (MTM) model are two clinical pharmacy practice models that focus on optimizing patient outcomes.
The key elements of the pharmaceutical care model are to identify and resolve actual drug therapy problems, prevent potential problems, and achieve therapy goals through assessment, care planning, and evaluation. The MTM model emphasizes establishing a relationship between the pharmacist and patient to provide individualized services through medication therapy reviews, prioritizing issues, and creating plans to address problems and optimize outcomes.
Both models take a patient-centered approach to medication management with the goals of improving safety, effectiveness and adherence.
The pharmaceutical care model and medication therapy management (MTM) model are two clinical pharmacy practice models that focus on optimizing patient outcomes.
The key elements of the pharmaceutical care model are to identify and resolve actual drug therapy problems, prevent potential problems, and achieve therapy goals through assessment, care planning, and evaluation. The MTM model emphasizes establishing a relationship between the pharmacist and patient to provide individualized services through medication therapy reviews, prioritizing issues, and creating plans to address problems and optimize outcomes.
Both models take a patient-centered approach to medication management with the goals of improving safety, effectiveness and adherence.
Practice Model Description of Model Key Elements Steps
Pharmaceutical The pharmaceutical care model is The pharmaceutical care model has three key com- 1) ASSESSMENT of patient’s drug-related needs care1 now defined as a patient-centered ponents: Includes a pharmacotherapy workup and a full review of systems to identify DTPs. way to deliver medication manage- 1) Identify a patient’s actual and potential drug All DTPs are categorized and must fall under one of four categories, composed of ment services. The model stresses therapy problems (DTPs). seven types of DTPs: a pharmacist’s responsibility for a patient’s drug-related needs and 2) Resolve actual DTPs. a. Indication being held accountable for the com- 3) Prevent potential DTPs from becoming actual i. Unnecessary drug therapy mitment. The purpose is to achieve DTPs. ii. Needs additional drug therapy positive patient outcomes. The phar- macist ensures that all of a patient’s b. Effectiveness drug therapy is indicated, effective, The pharmaceutical care process has three key i. Ineffective drug and safe and that the patient is able steps: ii. Dosage too low and willing to adhere to instructions. 1) ASSESS It is a generalist practice, consistent c. Safety 2) CARE PLAN with the concepts of primary care i. Adverse drug reaction and the medical home. 3) EVALUATION ii. Dosage too high d. Adherence In the standards of care for pharmaceutical care, the practitioner: i. Patient not able or willing to take medication 1) Collects patient-specific information to use in 2) CARE PLAN development to meet patient’s needs decision-making regarding all drug therapies Four categories of interventions are selected to establish goals of therapy: 2) Analyzes assessment data to determine that a. Resolve DTPs. drug-related needs are being met; that all medica- b. Achieve goals of therapy. tions are indicated, effective, and safe; and that the patient is able and willing to take the medica- c. Prevent future DTPs. tion as intended. d. Schedule follow-up. 3) Analyzes assessment data to determine whether Types of interventions that can occur: any DTPs are present a. Initiate new drug therapy. 4) Identifies goals of therapy that are patient-cen- b. Change dosage regimen. tered c. Change the drug product. 5) Develops a care plan including interventions to resolve DTPs, achieve goals of therapy, and d. Discontinue drug therapy. prevent DTPs e. Institute a monitoring plan. 6) Develops a schedule to follow up and evalu- f. Patient-specific instructions ate the effectiveness of drug therapies and any g. Removal of barriers to obtain medication adverse events experienced by the patient h. Drug administration device provided 7) Evaluates the patient’s outcomes and determines progress toward achieving goals of therapy, iden- i. Refer patient. tifies safety and adherence issues, and assesses 3) Follow-up EVALUATION whether new DTPs have developed Each condition is categorized into eight predetermined outcomes: a. Resolved b. Stable c. Improved d. Partly improved e. Unimproved f. Worsened g. Failure h. Expired (patient died) Clinical Pharmacy Practice Model Description of Model Key Elements Steps Medication therapy MTM is defined as a All MTM services should include: The MTM service model has five core elements: management distinct service or group (1) Establishing a pharmacist-patient relationship 1) Medication therapy review (MTR) (MTM)2 of services that optimize in which the pharmacist provides individualized therapeutic outcomes A systematic process of collecting patient-specific information services specific to the patient (or caregiver) to for individual patients. In whom services are provided a. Assessing medications to identify medication-related problems (MRPs) by this model, the patient is reviewing indication, effectiveness, safety, and adherence empowered to take an ac- (2) The interaction between the patient (or caregiver) and pharmacist preferably occurs through face-to- b. Developing a prioritized list of MRPs tive role in managing his or her medications. face communication. c. Creating a plan to resolve MRPs (3) Opportunities for pharmacists and other quali- Two main types of MTR: fied health care providers to identify patients who a. Comprehensive: annual and after transitions of care should receive MTM services b. Targeted: addresses specific MRP (4) Payment for MTM services consistent with con- temporary provider payment rates 2) Personal medication record (PMR) (5) Processes to improve continuity of care, out- a. A comprehensive record of all medications (prescription, over-the-counter, comes, and outcome measures herbal, and other dietary supplements), which is intended for patients to use in medication self-management b. Can be created as part of discharge process in the institutional setting or as part of patient care in the ambulatory care setting c. Patients are responsible for documenting any changes to their therapeutic regimens to ensure a current and accurate record. 3) Medication-related action plan (MAP) a. Intended for patient use; contains a list of actions for self-management The pharmacist-created MAP includes items the patient can act on that are within the pharmacist’s scope of practice or agreed on by other mem- bers of the health care team. 4) Intervention and/or referral Recommendations on selection of medications; options to address MRPs, recom- mended monitoring parameters, and follow-up care 5) Documentation and follow-up a. MTM services should be documented in a consistent manner, and follow-up MTM visits are scheduled on the basis of the individual patient’s medication-related needs. b. Documentation for patients may include the PMR, MAP, and educational materials. c. Documentation to physicians may include a cover letter, the patient’s PMR, the SOAP note, and the care plan. Clinical Pharmacy Practice Model Description of Model Key Elements Steps Patient-centered The goal of the PCPCC is to The PCMH model emphasizes a team approach to The medication management model in the PCMH is made up of four steps. primary care col- improve the quality of care and patient care and emphasizes that medication man- 1) Assessment of the patient’s medication-related needs laborative (PCPCC) eventually the health of all patients, agement must be comprehensive and encompass all MTM in the patient- specifically through the PCMH of a patient’s medications and that pharmacists and a. Assessment of all medications centered medical model. It is believed that maximizing other medication management practitioners should b. Uncovering the patient’s medication experience home (PCMH)3 the appropriate use of medications be coordinated with other team members in the c. Electronic linking of medication to indication and goals of therapy through comprehensive medica- PCMH. tion management is critical for the 2) Identification and categorization of the patient’s medication-related PCMH to succeed. problems (MRPs), based on the following four categories: a. Appropriateness Face-to-face contact is not required i. Is the medication appropriate? in this model; telephone or a virtual ii. Is there a condition that is not being treated or prevented in which a clinic structure is acceptable. medication should be indicated? b. Effectiveness i. Is the most effective medication being used? ii. Is the dose appropriate to achieve the goals? c. Safety i. Does the patient have any adverse events? ii. Is the dose so high it could cause toxicity? d. Adherence i. Is the patient able and willing to take the medication as intended? 3) Development of a care plan a. Intervention to solve the MRPs b. Establish goals for each condition. c. Design personalized plans to optimize each patient’s medication experi- ence. d. Establish measurable outcome parameters. e. Determine follow-up time frames. 4) Follow-up evaluation to determine actual patient outcomes a. If goals are not met, a reassessment is done to determine whether any MRPs are interfering. Clinical Pharmacy Practice Model Description of Model Key Elements Steps SHPA The SHPA developed The standards define the procedures for clinical phar- 10 specific clinical activities that contribute to the components of a MAP: (Society of Hospital Standards of Practice for macy services for individual patients in great detail. 1) Accurate medication history Pharmacists of clinical pharmacy with In these standards, the two overlapping components the objective to “optimize are (1) a MAP and (2) the discrete clinical activities 2) Assessment of current medication management Australia)4 patient outcomes by work- that contribute to the plan. 3) Clinical review ing to achieve the quality 4) Decision to prescribe a medicine use of medicines (QUM).” Clinical pharmacy practice The MAP focuses on overall patient outcomes, and 5) Therapeutic drug monitoring is defined as “the practice it states that to carry out the plan, a pharmacist will 6) Participation in multidisciplinary ward rounds and meetings of pharmacy as part of a perform several specific clinical activities. The MAP contains six fundamental components: 7) Provision of medicine information to health professionals multidisciplinary health care team directed at 8) Provision of medicine information to patients achieving QUM.” a. Interpretation of patient-specific data 9) Information for ongoing care b. Identification of clinical problems (focus on prob- 10) Adverse drug reaction management The document includes lems that require their expertise) not only a model of c. Establishment of therapeutic goals For each of the above clinical activities, an appendix is provided. Each activity practice, but also the description then has an introduction section, goals for the activity, procedures for other types of activities d. Evaluation of therapeutic options the activity (extensive), and a role for a pharmacy technician with the activity (if clinical pharmacists may e. Individualization of therapy applicable). be engaged in, including f. Monitoring of patient outcomes rounding, providing drug information to health pro- The standards also provide guidance on documenting clinical activities and the fessionals and patients, MAP. reporting and managing adverse drug reactions, and participating in research. Clinical Pharmacy Practice Model Description of Model Key Elements Steps iMAP program The iMAP program is a patient- The iMAP program is outlined in 10 essential steps. The 10 steps in this MTM model: (individualized centered, comprehensive MTM Care along each step is individualized to meet the 1) Review and synthesize information from medical record. medication assess- program. The program consists of needs of the patient. Several steps of the process are 10 essential steps in the provision further described, including conducting a compre- 2) Conduct comprehensive medication review with patient. ment and planning) (Mary Roth, per- of patient care. Although it is being hensive medication review, identifying MRPs, and 3) Identify MRPs. sonal communica- studied in those 65 years and older, documenting encounters. 4) Formulate assessment/propose plan to optimize medication use. tion, May 2012) it is applicable to other age groups, especially patients with multiple 5) Communicate proposed plan to primary care provider. comorbidities and using multiple For example, when assessing and documenting 6) Implement plan once consensus is reached. medications. MRPs, the clinical pharmacist is guided by the iMAP tool (REF #5). This tool categorizes MRPs into seven 7) Educate patient. general categories. Several subcategories under 8) Document plan in medical record and provide written summary to patient. A full description of this model is not each large category are provided to further classify 9) Reconcile medications at all encounters, when possible, including transitions available at this time. the MRP. The general categories are: of care. 10) Provide ongoing face-to-face and telephone follow-up. 1. Drug therapy needed 2. Suboptimal dosing 3. Medication monitoring needed 4. Suboptimal drug 5. Adverse drug event present 6. Suboptimal duration, administration, or frequency 7. Nonadherence
Once an MRP is identified and documented, a recom-
mendation or intervention is proposed to the primary care provider, consensus is reached, and the plan is implemented to optimize medication use. To track interventions made by the clinical pharmacist, a list of 20 possible recommendations is included as part of the iMAP tool to document the intervention used to resolve the MRP (e.g., add a drug, discontinue a drug, decrease a dose, increase a dose, switch to a more effective agent).
